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A.3#37=CIQYag1.a.i.(1)(a)(i)1)a) i)(;3$2#  0  .3  0  (.(3($ !USUS.,      0  (#$  0  }TABLE A   HTABLE C"Arial Regular~TABLE D< 9Z+ Courier New  ,cAZArial (CEKQW]cioAutoList2A.A.A.A.A.A.A.A.A.^TABLE B    8 ($USUS.,    1    & %XX_&%%& Someoftheseitemsmaynotapplytosupportormaintenancecomputations.#& %%&##XX%& U#:TABLE FTABLE E  ,  dYYYY)!dxdx ffff)!dxdx&0 d d[Y Y# !USUS.,  _9  X]XXX $_h8]XXdd8DISSOLUTIONOFMARRIAGEFINANCIALDECLARATIONFORM  STATEOFINDIANA:CIRCUITANDSUPERIORCOURTSOFLAKECOUNTY   INRETHEMARRIAGEOF:0 h 0h(#h(#CauseNo.  Ԁ x   @ t(#(#    `     h   WifeorHusband & v   and0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(# B(#(#    `     h      `     h   WifeorHusband   FINANCIALDECLARATIONOF:     p   DATED: x   p     `      Thisdeclarationisconsideredmandatorydiscoveryandmustbeexchanged <  betweenthepartieswithin60daysoftheinitialfilingoftheDissolutionofMarriage. $t Partiesnotrepresentedbycounselarerequiredtocomplywiththesepractices.Failure  \ byeitherpartytocompleteandexchangethisformasrequiredwillauthorizethecourt D toimposesanctionssetforthinRule6oftheLakeCountyRulesofFamilyLaw.If , appraisalsorverificationsarenotavailablewithin60daysthefrommustbeexchanged  within60dayswithanotationthatappraisalsorverificationsarebeingobtainedand  thentheDeclarationshallbesupplementedwithin30daysthereafter.  Husband: `     h   0  Wife: p      x  d(#(# Address: `     h   0  Address:     x  0(#(#    `     h   0   p      x  L(#(# Soc.Sec.No.:    h   0  Soc.Sec.No.:   x  (#(# Badge/PayrollNo.:    h   0  Badge/PayrollNo.:   x  ! (#(# Occupation: `     h   0  Occupation:     x  `#"(#(# Employer: `     h   0  Employer:     x  ,%| $(#(# Datestartedthisemployment: h   0  Datestartedthisemployment: &H"&(#(# BirthDate: `     h   0  BirthDate:     x  ($((#(#   DateofMarriage:   h      p    *%*   DateofPhysicalSeparation:     p    +9',   DateofFiling:   h      p     B-(. h 9   +P  ListNames,datesofbirth,andsocialsecuritynumbersofallchildrenofthis  relationship,whetherbybirthoradoption:  e   `     h   0   p      x  bs#s#    `     h   0   p      x   s#s#    `     h   0   p      x   ds#s# i  ListNamesanddatesofbirthofanyotherchildrenlivingattheresidenceofthe S   personresponding(identifyifthesearechildrenoftherespondingparty)andforeach 9   suchpersonindicatetheamountofsupport,ifany,thatisreceived: o     `     h   0   p      x  U s#s#    `     h   0   p      x  ^ s#s#    `     h   0   p      x   s#s#  PartI.INCOMEANDEXPENSESSTATEMENT F   AttachCOMPLETEcopiesofyourFederalIncomeTaxReturnsforthelast  threetaxableyearsincludingallW2'sand1099's.Alsoattachproofofallwages   earnedinthepresentyearuptothedateofyourresponse. Ifcurrentwage  statementshowsyeartodatewagesanditemizeddeductionsthisissufficient.Ifcurrent  wagestatementdoesnotindicateyeartodateearningsanddeductionsattachthe8 x mostrecentpaystubs. ^ e   `     h      p   PersonResponding  D  A.Grossyearly incomefromSalaryandWages, 0 includingcommissions,bonuses,allowancesand l overtime,receivedinmostrecentyear.0    0pT$T$0pT$pT$   x   (# 0@(#T$T$0@(# T$ T$0@(# T$ T$RT$T$  Averagegrosspayper payperiod(indicatewhether ! youarepaidweeklyeach2weeks,ortwicepermonth)0     x   (#  "T$T$  B.GrossMonthlyIncomeFromOtherSources% #  1       "$   ListandexplainindetailanyRentsreceived,Dividendincome,orPension, x#% Retirement,SocialSecurity,Disabilityand/orUnemploymentInsurancebenefitsorany ^$& othersourceincludingPublicassistance,foodstamps,andchildsupportreceivedforany D% ' childnotbornofthepartiesofthismarriage. *&z!(    `     h 0  0T$T$0pT$T$0pT$pT$   x  'F#*T$T$    `     h 0  0T$T$0pT$T$0pT$pT$   x  O)$,T$T$    `     h 0  0T$T$0pT$T$0pT$pT$   x  &%XX]*%.T$T$ H #X]X%&!#C.SELECTEDLIVINGEXPENSES:Listnamesandrelationsofeachmemberofthe  householdoftheRespondingpartywhoseexpensesareincluded.      `     h   0   p      x  tT$T$    `     h   0   p      x  T$T$    `     h   0   p      x   & vT$T$  #Foreachexpenseattachverificationofpayment evenifitisnotspecificallyrequested k   onthisformpleasenotethatIndianausesanIncomeSharesmodelfordetermining W   supportandthusinmostcasestheexpensesthatapartyhasordoesnothavearenot =  relevantindeterminingsupportundertheIndianaSupportGuidelines. Howeverif you #s  claimyourexpensesjustifyadeviationfromthesupportguidelinesattachadetailedlistof _  expensestogetherwithverificationofsame. E     `     h      p   PersonResponding +   RentorMortgagepayments(residence)  0  0pT$T$0pT$pT$   x  0@8#(#(#0@8# (# (#0@8#x(#x(#0@8#x(#x(#0@8#x(#x(# @8# T$T$ RealPropertyTaxes(residence)ifnotincluded  inmortgagepayment0  0hT$T$0hT$hT$0T$T$0pT$T$0pT$pT$   x  eT$T$ RealPropertyInsurance(residence)ifnotincluded 1 inmortgagepayment0  0hT$T$0hT$hT$0T$T$0pT$T$0pT$pT$   x  gT$T$ Costof all MedicalInsurancespecifytimeperiod 3 Attachverificationofpaymentifnotonpaystub0 p 0pT$pT$   x  T$T$ Costof only thatmedicalinsurancethatisrelatedtothe  childrenofthisactionspecifytimeperiodattach  verificationfromemployerorinsurancecompany0 p 0pT$pT$   x  mT$T$ Childcarecosts topermitwork specifytime 9!! period(perday,week,month)attachverification0 p 0pT$pT$   x  %"u"T$T$ PreSchoolCosts(specifytimeperiodweek, #A$ semesteroryear)0 0 T$ T$0hT$T$0hT$hT$0T$T$0pT$T$0pT$pT$   x   (# $' %T$T$ SchoolTuitionpersemester(GradeorHighSchool)0 p 0pT$pT$   x  &!'T$T$ BookCostspersemester(GradeorHighSchool)0 p 0pT$pT$   x  o(#)T$T$  ForPostHighSchoolAttachseparatelistwith A*%+ explanationofloansandscholarshipsandgrants0 p 0pT$pT$   x  -+}&,T$T$ Childsupportpaidforchildrenotherthanthoseinvolvedin ,O(. thiscaseattachproofofpayment0  0T$T$0pT$T$0pT$pT$   x   (# &%XX]-5)/T$T$  (83 ! ! #X]X%&3#&%XX]X]X%&D.INALLCASESINVOLVINGCHILDSUPPORT: PrepareandattachanyIndiana  ChildSupportGuidelineWorksheet(withdocumentationverifyingyourincome);or,  supplementwithsuchaWorksheetwithinten(10)daysoftheexchangeofthisForm.    Further,ifthereexistsaparentingplanorpatternthenstatethenumberof h overnightsthenoncustodialparentwillhavethechildduringtheyear. N   Theyearlynumberofovernightsis   p      x   j  E.POSTHIGHSCHOOLEDUCATIONEXPENSE  6   Ifanyofthechildrensubjecttothiscaseareattendingposthighschoolclasses,or  "  willattendwithinthenextsixmonthslistthefollowinginformationforeachsuchstudent.     Furtherattachtothisfinancialaffidavitanydocumentationyouhaveinsupportof   theseanswers.    0  NameofStudent:   h      p   b T$T$   NameofSchool:   h      p        CostofSchoolperyear: h      p    d   RoomandBoard(ifapplicable)     p   "9 m   Identifyallstudentfinancialaidincludinggrants,scholarships,andloansandfor S eachindicatewhatitisandhowmuchwillbereceived: 9    `     h      p      x   o    `     h      p      x   x    `     h      p      x   !  <  Noteinthosecaseswhereitisappropriatepartiesmaywanttoengageinadditional *z discoveryconcerningassetsthatmightbeappliedtoeducationsuchasIRAs,401Ksetc. ` NotefurtherthatwithdrawalsfromIRAsforeducationalexpensesdonotsuffera10% F penalty(IRCcodesec72(t)2(e). ,   F . DebtsAndObligations :(Includecreditunion)attachadditionalsheetsasneeded.  " Indicateanyspecialcircumstances,i.e.,premaritaldebts,debtsinarrearsonthedateof !# physicalseparation,ordateoffilingandtheamountornumberofpaymentsinarrears. z"$  ATTACHACOPYOFTHEMOSTRECENTSTATEMENTFOREACHLISTEDDEBT `#% *eYddd Xdd Xdd XT$T$,dd ,dd ,dd +  $8% '8%  $ CreditorsName&PersonsonAccount  '% ( ' Balance '% ) ' MonthlyPayment % *   'f"+ R !'f",R R! 'f"-R   (#. R !(#/R R! (#0R    *Z%1 R ! *Z%2R R!  *Z%3R   +&4 R !+&5R R! +&6R   ,N(7 R !,N(8R R!,N(9R   $_+P $ +$, +  #&%XX]4#/ %& PARTII.NETWORTHATTACHALLAVAILABLEDOCUMENTATIONTO  VERIFYVALUES     X]X /Listallpropertyownedeitherindividuallyorjointly.Indicationwhoholdsorhowthe  titleisheld:(H)Husband,(W)Wife,or(J)Jointlyorotherappropriateindication.WHERE  SPACEISINSUFFICIENTFORCOMPLETEINFORMATIONORLISTINGPLEASE | ATTACHSEPARATEPAGE. b   A. HouseholdFurnishings :(ValueofFurniture,Appliances,andEquipment,asawhole . ~ Youneednotitemizeindicatewhetheryouusereplacementcostor garagesalevalue)  j    `     h 0     p      x   6 T$T$    B. Automobiles,Boats,Snowmobiles,Motorcycles,Etc. :   *eY#pdddd dd dd eYT$T$, dd,,dd,dd, dd+  $   @$Automobile/driver '8 @ @'Ownership '8 @ @'Value 8 @ BalanceOwed/Creditor  8    b   b   b   b   ,   ,   ,   ,   V   V   V  V  Sourceforvalue:KelleyBlueBook l  &%XX]X]X%&C . CashandDepositAccounts :(including ALL banks,savingsandloanassociations, :  creditunions,thriftplans,mutualfunds,certificateofdeposit,savingsand/orchecking &v! accounts,IRAsandannuities). Thisalsoincludeslistingthecontentsofanysafety  \" depositboxes .Useadditionalpageifnecessary.  H# *eYd d dd ,dd,dd dd eY#T$T$,b dd ,dd ,ydd ,9dd +  $% $Name ofInstitution/TypeofAccount '.~& '  Owner(s) '.~' '  AccountNo. '.~( '  Balance .~)   *   +   ,   -   (!x.   (!x/   (!x0   (!x1   "2   "3   "4   "5   $l6   $l7   $l8  $l9   D. Securities: (Stocks,Bonds,Etc)useadditionalpageifnecessary  'Z"; *eYddb dd b dd ydd y9dd 9eYT$T$,dd ,dd ,Ydd ,dd ,dd +  (,$=(,$   CompanyName  @)$>   Owner(s)  @)$? Shares  @)$@ AccountNo.  @)$A Value  @)$B   * &C   * &D   * &E   * &F   * &G   4,'H   4,'I   4,'J   4,'K   4,'L   -(M   -(N   -(O   -(P  -(Q  #&%XX]4M#X]X%&  .*Q E. RealEstate :(attachseparatesheetwiththefollowinginformationforeachseparate  pieceofrealestate).  Address: `     h   0  TypeofProperty:   x   (# hT$T$      `     h   0  DateofAcquisition: x   (# 4 T$T$ OriginalCost:    h   0  Owner(s):     x   PT$T$ 0  0` T$T$0 ` T$` T$0 T$ T$0hT$T$0hT$hT$0T$T$PresentValue:   x    T$T$    `     h     BasisforValuation: x        `     h     (Attachappraisalifobtained) ~  1stMORTGAGEBALANCEASOFDATEOFANSWER:     x   0  Otherliens(amountandtype): h      p      x   L Monthlypaymentoneachmortgage:1st:   p   2nd:   x    Towhompaid:    h      p      x   0   T$T$ Taxes(ifnotincludedinMtg.payment):   p      x   (#  ` Insurance(ifnotincludedinMtg.payment):   p      x   (#  ,| SpecialAssessments(includingutilityorcondoassessments):   x   (#  H IdentifyIndividualcontributionstotherealestate(forexample,inheritance,premarital  assets,personalloans,etc.):     `     h      p      x   v!     `     h      p      x   B#"    `     h      p      x    %^ $  F. RetirementPlans :Listmonthlyamountyouwouldbeentitledtoatearliestretirement  date(indicatingthatdate)ifyoustoppedworktoday.Yourresponseshouldindicatedate  ofvaluation.Further,ifitisadefinedinterestplanlistpresentamountinplananddateof h valuation. N Also,identifywhoseplanitisandlistboththenameandtheaddressofadministratorof  j planindicatewhetherplanisvestedifnotvested,indicatewhenitwillvest:  P *"eY*dddd dd Ydd Ydd dd eYT$T$,X dd,,dd,Xdd,cdd,edd+  $    @$NameofPlan '0  @ @'Ownership '0  @ @'Vested '0  @ @'MonthlyBenefit '0  @ @'PresentValue 0 @                       $t    $t    $t    $t    $t                       Attachdocumentsfromeachplanverifyinginformation.Ifnotyetreceived,attacha  copyofyourwrittenrequesttotheplan(s).    G.LifeInsurance :Givenameofinsured,beneficiary,companyissuing,policy#,typeof X! insurance(term,wholelife,group),facevalue,cashvalueandanyloansagainstinclude D" plansprovidedbyemployer: *z# *&eY'ddX ddX ,dd,XddXcddcedde"eY*T$T$,Fdd ,Fdd ,dd ,dd ,dd ,dd +  F%F Company Z& PolicyNo.  @' @Ownership 'Z(@ @'Beneficiary 'Z)@ @'FaceAmount 'Z*@ @'Type Z+@ CashValue Z, LoanAmount  @-    .    /    0    1    2    3   44   45   46   47   48   49   :   ;   <   =   >  ?   H.BusinessorProfessionalInterests :Indicatename,share,typeofbusiness,value !@ lessindebtedness,etc.: "A    `     h      p      x   |#B    `     h      p      x   $% D    `     h      p      x   .&~!F o I.OtherAssets :(thisincludescoin,stamporguncollectionsorotheritemsofunusual m(#I value).Useadditionalpagesasneeded: Y)$J    `     h      p      x   ?*%K    `     h      p      x   +&M    `     h      p      x    ,A(O rPARTIII.VERIFICATION     Ideclare,underthepenaltyofperjury,thattheforegoing,includinganyvaluations t andattachments,istrueandcorrectandthatIhavemadeacompleteandabsolute Z disclosureofallofmyassetsandliabilities.Furthermore,Iunderstandthatif,inthefuture, @  itisproventothiscourtthatIhaveintentionallyfailedtodisclosureanyassetorliability,I & v maylosetheassetandmayberequiredtopaytheliability.Finally,Iacknowledgethat  \ sanctionsmaybeimposedagainstme,includingreasonableattorneysfeesandexpenses  B incurredintheinvestigation,preparationandprosecutionofanyclaimoractionthatproves  (  myfailuretodiscloseincome,assetsorliabilities.    DATE:_________________0 h 0hT$hT$   p      x   (#  p  PARTYSSIGNATUREV T$T$  PARTIV.0 ` ATTORNEYSCERTIFICATION$` T$` T$    Ihavereviewedwithmyclienttheforegoinginformation,includinganyvaluations  andattachments,andsignthiscertificateconsistentwithmyobligationunderTrialRule11  oftheIndianaRulesofProcedure. x DATE: `    0 h      p      x  *zhT$hT$   0 ` 0 ` T$` T$0 T$ T$0hT$T$ATTORNEY`hT$hT$ &%XX] o  AFFIDAVITOFSERVICE  >"! U|  I,affirmunderthepenaltiesofperjurythatonthe________dayof_______________________,򀀀,service ## ofatrueandcompletecopyoftheaboveandforegoingpleadingorpaperwasmadeuponeachpartyorattorneyofrecord @$$ hereinbydepositingthesameintheUnitedStatesMailinenvelopesproperlyaddressedtoeachofthemandwithsufficient $8 % firstclasspostageaffixed. % & @ BY:______________________________________ &0"( & %%&#&%%& ~##X]X%&|#