DR-502 Page 1 of 7 Rev 4/18
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1 COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION CLERMONT COUNTY, OHIO Plaintiff Case Number: vs. Defendant Instructions: Check local court rules to determine when this form must be filed. List ALL OF YOUR PROPERTY AND DEBTS, the property and debts of your spouse, and any joint property or debts. Do not leave any category blank. For each item, if none, put NONE. If you do not know exact figures for any item, give your best estimate, and put EST. If more space is needed, add additional pages. I. REAL ESTATE INTERESTS AFFIDAVIT OF PROPERTY Affidavit of (Print r Name) Address Present Fair Market Mortgage Balance Equity (as of date) TOTAL SECTION I: REAL ESTATE INTERESTS DR-502 Page 1 of 7 Rev 4/18
2 II. OTHER ASSETS A. Vehicles and Other Certificate of Title Property (List who has possession) (Include model and year of automobiles, trucks, motorcycles, boats, motors, motor homes, etc.) B. Financial Accounts (Include checking, savings, CDs, POD accounts, money market accounts, etc.) DR-502 Page 2 of 7 Rev 4/18
3 C. Pensions & Retirement plans (List who has possession) (Include profit-sharing, IRAs, 401k plans, etc.; Describe each type of plan) D. Publicly Held Stocks, Bonds, Securities & Mutual Funds E. Closely Held Stocks & Other Business Interests and Name of Company (List who has possession) (Type of ownership and number) DR-502 Page 3 of 7 Rev 4/18
4 F. Life Insurance Type (Term/Whole Life) (Any cash value or loans) (Insured party & value upon death) Who Has Possession G. Furniture & Appliances (Estimate value of those in your possession, and value of those in your spouse s possession) H. Safe Deposit Box (Give location and describe contents) DR-502 Page 4 of 7 Rev 4/18
5 I. Transfer of Assets Explanation: List the name and address of any person (other than creditors listed on your Affidavit) who has received money or property from you exceeding 300 in value in the past 12 months and the reason for each transfer. J. All Other Assets Not Listed Above (Also list who has possession) Explanation: List any item you have not listed above that is considered an asset. TOTAL SECTION II: OTHER ASSETS III. SEPARATE PROPERTY CLAIMS: Pre-marital assets, gifts to one spouse only, inheritances Separate property as defined in R.C is real or personal property that was inherited, acquired by one spouse prior to the date of marriage, acquired after a decree of legal separation under R.C , excluded by a valid antenuptial agreement, compensation for personal injury, except for loss of marital earnings and compensation for expenses paid from marital assets, or any gift of property that was given to only one spouse. Why do you claim this as a separate property? Present Fair Market Date of Marriage Market 5. TOTAL SECTION III: SEPARATE PROPERTY CLAIMS DR-502 Page 5 of 7 Rev 4/18
6 IV. DEBT List ALL OF YOUR DEBTS, the debts of your spouse, and any joint debts. Do not leave any category blank. For each item, if none, put NONE. If you don t know exact figures for any item, give your best estimate, and put EST. If more space is needed to explain, please attach an additional page with the explanation and identify which question you are answering. Type Name of Creditor/Purpose of Debt Account Name Name(s) on Account Total Debt Due Monthly Payment A. Secured Debt (Mortgages, Car, etc.) 5. Joint Joint Joint Joint Joint B. Unsecured Debt, including credit cards 5. Joint Joint Joint Joint Joint TOTAL SECTION IV: DEBT DR-502 Page 6 of 7 Rev 4/18
7 V. BANKRUPTCY Filed by: Date of Filing: Case Number Date of Discharge or Relief from Stay Type of Case (Ch. 7, 11, 12, 13) Current Monthly Payments TOTAL SECTION V: BANKRUPTCY OATH (Do Not Sign Until Notary is Present) I, (print your name) swear or affirm that I have read this document and, to the best of my knowledge and belief, the facts and information stated in this document are true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. r Signature Sworn before me and signed in my presence this day of,. Notary Public My Commission Expires: DR-502 Page 7 of 7 Rev 4/18
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