form 4 exhibit a property debt listing

NDLSHC [1] Stip DWC Form 4 Inst/Rev Aug 2018

DIVORCE WITH A WRITTEN AGREEMENT – WITH CHILDREN INSTRUCTIONS FOR FORM 4: EXHIBIT A: CONFIDENTIAL DIVISION

OF PROPERTY & DEBTS & VALUES

(Form 4: Exhibit A: Confidential Division of Property and Debts and Values is part of the Divorce With a Written Agreement – With Children packet of forms. Review the instructions for the

packet of forms before completing the Settlement Agreement and Exhibit A.)

ND Legal Self Help Center Staff and Court employees cannot help you fill out forms. If you are unsure how to proceed, consult a lawyer.

There is no guarantee that all judges and courts will accept forms available through the ND Legal Self Help Center. Use at your own risk.

Do not include these instruction sheets when you serve or file the completed form.

THE PLAINTIFF AND DEFENDANT WORK TOGETHER TO COMPLETE THIS FORM.

Refer to the completed Form 3: Settlement Agreement to fill out this form.

Fill out Exhibit A: Confidential Division of Property and Debts and Values (Form 4) only if Plaintiff and Defendant have agreed to a property settlement and have agreed upon the value of each item of property and the outstanding amount of each debt. If Plaintiff and Defendant have not agreed on the value of each of item of property and the outstanding

amount of each debt, you may not use this form or the Divorce With a Written Agreement – With Children packet of forms.

Exhibit A: Confidential Division of Property and Debts and Values (Form 4) tells the Court the value of your assets and liabilities, how you have agreed to divide your assets and liabilities, and allows the Court to determine the fairness of the division of the property and the debts.

WARNING FOR DIVIDING PROPERTY AND DEBT:

In deciding to divide property and debt, the Court would consider the following factors (the Ruff-Fischer guidelines):

• The respective ages of the parties; • Their earning ability; • The duration of the marriage and conduct of the parties during the marriage; • Their station in life; • The circumstances and necessities of each; • Their health and physical condition;


• Their financial circumstances as shown by the property owned at the time, its value at the time, its income-producing capacity, if any, whether accumulated before or after the marriage; and

• Such other matters that may be material.

The division of property, once approved by the Court, is final and can only be changed under limited circumstances. PROCEED CAREFULLY AND CONSULT A LAWYER IF YOU HAVE ANY QUESTIONS.

Top of form (Caption): Fill in the caption exactly as you filled in the caption on Form 1: Summons.

Paragraph 1: Put a checkmark () in the same option you chose for Paragraph 17 of the Agreement as to Facts and Paragraph 24 of the Stipulated Terms for Judgment of Form 3: Settlement Agreement.

(1) Fill in the street address, city, county, and state where your jointly owned property is located; (2) Fill in the legal description of the property; (3) State the date the property was purchased and its purchase price; (4) State the amount of any existing loans or mortgages; (5) State the market value of the property (this can be found on the most recent property tax statement).

Note: the legal description of the property is not the same as the street address. The legal description can be found on the warranty deed, mortgage, title insurance, or from the County Recorder in the county where the property is located.

Put a checkmark () in the box next to the spouse who will be the owner of the property if the court grants your divorce. List the amount of the mortgage or loan.

Repeat, if you jointly own another property. If not, checkmark () “Does Not Apply.”


(1) Fill in the street address, city, county, and state where Plaintiff’s solely owned property is located; (2) Fill in the legal description of the property; (3) State the date the property was purchased and its purchase price; (4) State the amount of any existing loans or mortgages; (5) State the market value of the property (this can be found on the most recent property tax statement).




Repeat, if Plaintiff solely owns another property. If not, checkmark () “Does Not Apply.”


(1) Fill in the street address, city, county, and state where Defendant’s solely owned property is located; (2) Fill in the legal description of the property; (3) State the date the property was purchased and its purchase price; (4) State the amount of any existing loans or mortgages; (5) State the market value of the property (this can be found on the most recent property tax statement).



Repeat, if Defendant solely owns another property. If not, checkmark () “Does Not Apply.”


List all vehicles and watercraft (cars, trucks, boats, RVs, snowmobiles, jet skis, motorcycles) owned by you, your spouse, or both of you together. List the vehicle even if it is not working, or not licensed, or uninsured. Include the type of vehicle, year/make/model, whose name is on the title, the balance owed (if any), and the monthly payment (if any). If you own a manufactured or mobile home that HAS NOT been converted to real property, list it here.

List the current agreed upon value in the column of the spouse who will own the vehicle or watercraft if the court grants your divorce.

Paragraph 5: Refer to Paragraph 21 of the Agreement as to Facts and Paragraph 28 of the Stipulated Terms for Judgment of Form 3: Settlement Agreement.


Fill in the total agreed upon value of each spouse’s share of the household goods, furniture, and furnishings.

WARNING FOR PARAGRAPHS 6 AND 7:

Dividing pension plans and retirement accounts is extremely complicated. The spouses are responsible for making sure these assets are divided, which will require a separate court order. The separate court order is called a qualified domestic relations order (QDRO) and the parties are responsible for obtaining a proposed QDRO and presenting the proposed QDRO to the court. The court will not draft a QDRO document or an order including a QDRO. The ND Legal Self Help Center does not have QDRO forms.

If Plaintiff’s plan will be divided, the Plaintiff is responsible for obtaining the proposed QDRO.

If Defendant’s plan will be divided, the Defendant is responsible for obtaining the proposed QDRO.

Contact the plan administrator early in the process. Some plan administrators have sample QDRO documents for you to follow when drafting your own QDRO.

DO NOT sign the proposed QDRO. The QDRO is signed by the Judge or Judicial Referee.

If neither spouse has pension nor retirement plans, OR each spouse will keep their own pension or retirement plans, without dividing an individual plan, a QDRO is not required.


If Plaintiff or Defendant, or Plaintiff’s past or present employer or union or other group pays or has paid money into a pension, profit-sharing plan, individual retirement account, or other retirement plan for Plaintiff, describe the plan by listing the employer, union, or other group which provides the plan; the date Plaintiff started working at the job or date Plaintiff joined the union or group plan; the type of pension or retirement plan, and the present value. For an individual retirement account, list the account number, the bank which has the individual retirement account, and the present account balance.

List the current agreed upon value in the column of the spouse who will be awarded the pension plan or retirement account if the court grants your divorce.



If Plaintiff or Defendant, or Defendant's past or present employer or union or other group pays or has paid money into a pension, profit-sharing plan, individual retirement account or other retirement plan for Defendant, describe the plan by listing the employer, union, or other group which provides the plan; the date Defendant started working at the job or date Defendant joined the union or group plan; the type of pension or retirement plan, and the present value. For an individual retirement account, list the account number, the bank which has the individual retirement account, and the present account balance.

List the current agreed upon value in the column of the spouse who will be awarded the pension plan or retirement account if the court grants your divorce.

Paragraph 8: Put a checkmark () in the option that is accurate for you and your spouse.

If you or your spouse own a business or a farm, all assets that are part of the operation should be listed under "Business/Farm." These items would include, but are not limited to: farm machinery, grain on hand, accounts receivable, business equipment, etc.

List the current agreed upon value in the column of the spouse who will be awarded the business or farm interest or asset if the court grants your divorce.


List all of your financial or other assets not already mentioned. Include checking accounts, savings accounts, money market accounts, stocks, bonds, Certificates of Deposit, life insurance policies, notes (money owed in writing), money owed (not in writing), investments in limited partnerships, etc. Include where the asset is located, the account numbers or policy numbers, and the value of each asset.

List the current agreed upon value in the column of the spouse who will be awarded the financial or other asset if the court grants your divorce.

WARNING FOR PARAGRAPH 10:

Creditors are not bound by the agreement of the parties. If one of your debts is awarded to the other party and he or she does not make payment, the creditor can still seek payment from you. PROCEED CAREFULLY AND CONSULT A LAWYER IF YOU HAVE ANY QUESTIONS.



If you and your spouse have debts and liabilities, list your outstanding debts and liabilities. List all of the debts you and your spouse now have, even if only one of you created the debt. Include credit card bills, gas bills, water bills, telephone bills, school loans, car loans, and other bills and loans. List to whom the debt is owed (such as "Visa"), the purpose of the debt (such as "clothing for the children), who created the debt (Plaintiff, Defendant, or both parties).

List the current balance due in the column of the spouse who will pay the debt if the court grants your divorce.

Paragraph 11: The Summary is the place to list the total of your assets by category and the total of your debts.

Date and Signature: THE PLAINTIFF AND DEFENDANT MUST EACH SIGN AND DATE THIS COMPLETED FORM IN THE PRESENCE OF A NOTARY PUBLIC OR CLERK OF COURT.

Sign and date the "Exhibit A: Confidential Division of Property and Debts and Values " form and fill in your address.

Each spouse may sign at separate dates and locations, but both spouses must sign and date before filing this completed packet of forms with the court.

• The form does not have to be signed in North Dakota or signed by a North Dakota Notary Public or a North Dakota Clerk of Court.

• If you sign the form in a state other than North Dakota, sign in the presence of a Notary Public or Clerk of Court of that state.

(The Exhibit A: Confidential Division of Property and Debt and Values form is a confidential court record that is not generally available to be viewed by the public after the document is filed with the clerk of court. However, any person with good cause may make a written request to the court for access to the Exhibit A: Confidential Division of Property and Debt and Values.

If a written request is made, the person making the request must notify the parties in the divorce. The parties will then have the option to tell the court in writing why they agree or disagree with the request. If the court finds that the public interest, or the personal interest of the person making the request, outweighs the privacy interest of the parties, or their dependent children, the court will grant access.)

Do not include these instruction sheets when you serve or file the completed form.

of 13 Stip DWC Form 4 Ex A/Rev Aug 2018

STATE OF NORTH DAKOTA IN DISTRICT COURT COUNTY OF ________________________ ____________________ JUDICIAL DISTRICT

________________________________, ) Plaintiff, ) EXHIBIT A:

) CONFIDENTIAL DIVISION OF vs. ) PROPERTY & DEBTS & VALUES

) ) Civil No. __________________________

________________________________, ) Defendant. )

Plaintiff and Defendant have reached an agreement resolving the values and division of

all property and debt in this divorce proceeding.

Plaintiff and Defendant’s entire agreement resolving the values and division of all

property and debt is set forth in this Exhibit A: Confidential Division of Property and Debts and

Values.

1. Real Estate Jointly Owned by Plaintiff and Defendant:

a. (Choose one)

Plaintiff and Defendant DO NOT jointly own any real estate.

Plaintiff and Defendant agree on how to divide their jointly owned real estate.

b. Property 1:

The street address of this property is

, in the City of ,

County of , State of , and it is legally described as:

This real property was purchased on _______________________ for $______________.

There is a mortgage or loan against the property in the amount of $_______________.

The market value of this property is $_______________.


AGREEMENT OF PLAINTIFF AND DEFENDANT:

Plaintiff / Defendant (choose one) shall be awarded sole title and interest in

Property 1, described above, and subject to a mortgage or loan against the property in

the amount of $__________________.

c. Property 2: Does Not Apply.


, in the City of ,








the amount of $__________________.

2. Real Estate Solely Owned by Plaintiff:

a. (Choose one)

Plaintiff DOES NOT solely own any real estate.

Plaintiff and Defendant agree on how to divide Plaintiff’s solely owned real

estate.


b. Property 1:


, in the City of ,








the amount of $__________________.



, in the City of ,









the amount of $__________________.

3. Real Estate Solely Owned by Defendant:

a. (Choose one)

Defendant DOES NOT solely own any real estate.

Plaintiff and Defendant agree on how to divide Defendant’s solely owned real

estate.

b. Property 1:


, in the City of ,








the amount of $__________________.




, in the City of ,








the amount of $__________________.

4. Vehicles and Watercraft:

a. (Choose one)

Plaintiff and Defendant DO NOT own any vehicles or watercraft.

Plaintiff and Defendant agree on how to divide their vehicles and watercraft.

b. Plaintiff and Defendant shall receive as their own, the vehicles and watercraft

listed in their column.

Description of Vehicles/Watercraft (Include the type of vehicle/watercraft, year/make/model, vehicle identification number, name(s) on title, balance owed, monthly payment (if any). If you own a manufactured or mobile home that HAS NOT been converted to real property, list it here.)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $


Description of Vehicles/Watercraft (Include the type of vehicle/watercraft, year/make/model, vehicle identification number, name(s) on title, balance owed, monthly payment (if any). If you own a manufactured or mobile home that HAS NOT been converted to real property, list it here.)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $

$ $

$ $

$ $

Total Value of Vehicles/Watercraft to Each Person $ $

5. Household Goods, Furniture, and Furnishings: Plaintiff and Defendant have already

divided the household goods, furniture and furnishings in an equitable manner to their

satisfaction.

Plaintiff Defendant Total Agreed Upon Value of Share of Household Goods,

Furniture, and Furnishings to Each Person $ $

6. Plaintiff’s Pensions, Profit-Sharing Plans, IRAs and Other Retirement Plans:

a. (Choose one)

Plaintiff DOES NOT have any pensions, profit-sharing plans, individualretirement accounts (IRAs) or other retirement plans.

Plaintiff and Defendant agree on how to divide Plaintiff’s pensions, profit-sharing plans, individual retirement accounts (IRAs) and other retirement plans.


b. Plaintiff’s pensions, profit-sharing plans, individual retirement accounts (IRAs)

and other retirement plans shall be awarded as listed in Plaintiff’s and Defendant’s

columns.

c. If Plaintiff’s retirement plan is divided between Defendant and Plaintiff, Plaintiff

shall obtain the proposed qualified domestic relations order (QDRO).

Description of Plaintiff’s Pensions, Profit-Sharing Plans, IRAs and Other Retirement Plans: (For each plan, list the employer, union, or other group that provides the plan; the date you started working at the job or date you joined the union or group plan; the type of pension or retirement plan, and the present value. For an individual retirement account, list the account number, the bank that has the individual retirement account, and the present account balance.)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $

$ $

$ $

Total Value of Plaintiff’s Retirement Plans to Each Person $ $

7. Defendant’s Pensions, Profit-Sharing Plans, IRAs and Other Retirement Plans:

a. (Choose one)

Defendant DOES NOT have any pensions, profit-sharing plans, individualretirement accounts (IRAs) or other retirement plans.

Plaintiff and Defendant agree on how to divide Defendant’s pensions, profit-sharing plans, individual retirement accounts (IRAs) and other retirement plans.

b. Defendant’s pensions, profit-sharing plans, individual retirement accounts (IRAs)

and other retirement plans shall be awarded as listed in Plaintiff’s and Defendant’s

columns.


c. If Defendant’s retirement plan is divided between Defendant and Plaintiff,

Defendant shall obtain the proposed qualified domestic relations order (QDRO).

Description of Defendant’s Pensions, Profit-Sharing Plans, IRAs and Other Retirement Plans: (For each plan, list the employer, union, or other group that provides the plan; the date you started working at the job or date you joined the union or group plan; the type of pension or retirement plan, and the present value. For an individual retirement account, list the account number, the bank that has the individual retirement account, and the present account balance.)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $

$ $

$ $

Total Value of Defendant’s Retirement Plans to Each Person $ $

8. Business or Farm Interests or Assets:

a. (Choose one)

Plaintiff and Defendant DO NOT have any business or farm interests or assets.

Plaintiff and Defendant agree on how to divide their business or farm

interests or assets.

b. Plaintiff and Defendant shall receive as their own, the business or farm assets

listed in their column.

Description of Business or Farm Interests or Assets: (For each business or farm asset, describe the interest or asset, who owns the interest or asset, the location, list the account number (if any), balances owed (if any), and monthly payments (if any).)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $


Description of Business or Farm Interests or Assets: (For each business or farm asset, describe the interest or asset, who owns the interest or asset, the location, list the account number (if any), balances owed (if any), and monthly payments (if any).)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $

$ $

$ $

Total Value of Business or Farm Assets to Each Person $ $

9. Other Financial Assets:

a. (Choose one)

Plaintiff and Defendant DO NOT own other financial assets not otherwisementioned on Exhibit A.

Plaintiff and Defendant agree on how to divide their other financial assets nototherwise mentioned on Exhibit A.

b. Plaintiff and Defendant shall be awarded all right, title, interest and equity in and

to the other financial assets listed in their column.

Description of Other Financial Assets: (For example checking accounts, savings accounts, money market accounts, stocks, bonds, Certificates of Deposit, life insurance policies, notes (money owed in writing), and money owed (not in writing). For each asset, describe the asset, who owns the asset, the location, list the policy or account number (if any).)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $

$ $


Description of Other Financial Assets: (For example checking accounts, savings accounts, money market accounts, stocks, bonds, Certificates of Deposit, life insurance policies, notes (money owed in writing), and money owed (not in writing). For each asset, describe the asset, who owns the asset, the location, list the policy or account number (if any).)

Plaintiff (Current

agreed upon value)

Defendant (Current

agreed upon value)

$ $

$ $

$ $

$ $

$ $

Total Value of Other Financial Assets to Each Person $ $

10. Debts and Liabilities:

a. (Choose one)

Plaintiff and Defendant DO NOT have any outstanding debts or liabilities.

Plaintiff and Defendant agree on how to divide their debts and liabilities.

b. Plaintiff and Defendant shall pay as their own the debts and liabilities listed in

their column.

c. Plaintiff and Defendant listed all debts and liabilities they know of on Exhibit A.

Any debts and liabilities not listed on Exhibit A shall be paid by the person whose name

is on the debt or liability.


Description of Debts and Liabilities (Describe each debt/ liability as clearly as possible. Include who the debt is owed to, purpose of the debt, whose name is on the debt and account numbers. Do not include mortgages on real estate.)

Plaintiff (Current amount owed)

Defendant (Current amount owed)

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

Total Debts and Liabilities to be Paid by Each Person $ $

11. Summary: Plaintiff Defendant

Real Estate (Paragraphs 1, 2, and 3) $ $ Vehicles and Watercraft (Paragraph 4) $ $ Household Goods/Furniture/Furnishings (Paragraph 5) $ $ Pensions/Retirement Plans (Paragraphs 6 and 7) $ $ Business or Farm Interests or Assets (Paragraph 8) $ $ Other Financial Assets (Paragraph 9) $ $ Mortgages on Real Estate (Paragraphs 1, 2, and 3) - $ - $ Debts and Liabilities (Paragraph 10) - $ - $

(Debts & Mortgages subtracted from Assets) Total $ $


Plaintiff’s Signature:

I, , Plaintiff, state under

penalty of perjury that the information in this Exhibit A: Confidential Division of Property and

Debts and Values is true and correct, and that I have read, understand, and agree to be bound

by this agreement.

Dated this _____ day of _______________________, 20_____.

(Signature of Plaintiff)

(Plaintiff’s Printed Name)

(Address) (City, State, Zip Code) (Telephone Number)

STATE OF )

COUNTY OF )SS

Signed and sworn to before me on , 20 ____ by

.

(Notary Public or Clerk of Court)

If Notary, my commission expires:

(Defendant’s signature follows on Page 13 of 13.)


Defendant’s Signature:

I, , Defendant, state under

penalty of perjury that the information in this Exhibit A: Confidential Division of Property and

Debts and Values is true and correct, and that I have read, understand, and agree to be bound

by this agreement.

Dated this _____ day of _______________________, 20_____.

(Signature of Defendant)

(Defendant’s Printed Name)

(Address) (City, State, Zip Code) (Telephone Number)

STATE OF )

COUNTY OF )SS

Signed and sworn to before me on , 20 ____ by

.

(Notary Public or Clerk of Court)

If Notary, my commission expires:

form 4 exhibit a property debt listing

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