4A-215. Separate property and liabilities schedule.
STATE OF NEW MEXICO
COUNTY OF ___________________________
_____________________ JUDICIAL DISTRICT
______________________________________,
Petitioner,
v. No. _________________
_______________________________________,
Respondent.
SERVE THIS FORM ON THE OTHER PARTY. DO NOT FILE WITH THE COURT.
SEPARATE
PROPERTY AND DEBTS SCHEDULE
ASSETS:
Petitioner Respondent
1. Checking & Savings Accounts:
a. __________ Bk, Ck. # ___________ $ __________ $ _________
b. __________ Bk, Sav. # __________ $ __________ $ _________
c. __________ CD #______________ $ __________ $ _________
d. __________ Cr Un #____________ $ __________ $ _________
2. Bonds/Stocks:
a. __________ Sh. _______________ $ __________ $ _________
b. __________ Sh. _______________ $ __________ $ _________
3. Financial institution accounts:1
a. __________ Account # __________ $ __________ $ _________
b. __________ Account # __________ $ __________ $ _________
c. __________ Account # __________ $ __________ $ _________
d. __________ Account # __________ $ __________ $ _________
4. Stocks, bonds and mutual funds:
a. __________ Sh. _______________ $ __________ $ _________
b. __________ Sh. _______________ $ __________ $ _________
c. __________ Sh. _______________ $ __________ $ _________
5. Insurance policies:
a. Company _________________
Policy No. _________________
Face amount $ _____________
Cash value $ _______________
Loan balance $ _____________ $ __________ $ _________
b. Company _________________
Policy No. ________________
Face amount $_____________
Cash value $_______________
Loan balance $ _____________ $ __________ $ _________
6. Real estate:
a. _______________
Present value $ ________________
Mortgage ($/mo) $ ______________
REC ($/mo) $ __________________ $ __________ $ _________
b. ___________________________
Present value $ ________________
Mortgage ($/mo) $ ______________
REC ($/mo) $ __________________ $ __________ $ _________
7. Vehicles:
a. _______________ $ __________ $ _________
Lien ($/mo) $ __________ $ _________
b. _______________ $ __________ $ _________
Lien ($/mo) $ __________ $ _________
8. Business assets $ __________ $ _________
9. Household furniture and goods $ __________ $ _________
10. Tax refunds $ __________ $ _________
11. IRA/Keogh/Annuity $ __________ $ _________
12. Retirement $ __________ $ _________
13. Retirement $ __________ $ _________
14. Other total assets $ __________ $ _________
Total Separate Assets: $ __________ $ _________
DEBTS:
a. _______________________ $ __________ $ _________
b. _______________________ $ __________ $ _________
c. _______________________ $ __________ $ _________
d. _______________________ $ __________ $ _________
Total Separate Debts: $ __________ $ _________
NET SEPARATE PROPERTY: $ __________ $ _________
I, _______________________, affirm under penalty of perjury under the laws of the State of New Mexico that I am the [ ] Petitioner (or) [ ] Respondent in the above-entitled cause, and I know and understand that the contents of this Schedule are true to the best of my knowledge and belief.
___________________________________________
Signature of party Date
___________________________________________
Name (print)
___________________________________________
Mailing address (print)
___________________________________________
City, state, and zip code (print)
___________________________________________
Telephone number
[Approved, effective November 1, 2000 until November 1, 2001; approved, effective November 1, 2001; 4A-132 recompiled and amended as 4A-215 by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No.14-8300-011, effective for all pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014.]