When individuals find themselves navigating the complexities of financial disclosures in a legal context, such as during divorce proceedings, the Net Worth Statement form becomes an indispensable tool. Revised as of January 22, 2001, this document serves a pivotal role in the legal process by providing a comprehensive snapshot of one's financial situation, encompassing all assets, liabilities, income sources, and significant asset transfers. Specifically tailored to meet the requirements of DRL §236, the form requires meticulous attention to detail, mandating participants to declare everything from familial data—including the number of dependent children and details regarding alimony or child support—to a detailed breakdown of expenses ranging from housing and utilities to educational costs and recreational spending. The requirement to list expenses and income not only on a monthly but also on a weekly basis (with specified calculations for conversion) underscores the form's emphasis on precision and thoroughness. Furthermore, the inclusion of details on educational background, health status, and even household help highlights its comprehensive nature, designed to paint a full picture of one's financial health and obligations in the context of legal proceedings. This form, therefore, stands as a critical document for ensuring fairness and accuracy in financial disclosures, impacting decisions on asset division, maintenance, and support in a legal setting.
| Question | Answer |
|---|---|
| Form Name | Net Worth Statement Form |
| Form Length | 18 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 4 min 30 sec |
| Other names | how to fill out statement of net worth new york, statement of net worth new york pdf, networth statement forms, ny statement of net worth fillable form |
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Revised 1/22/01 |
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COURT |
COUNTY OF |
Index No. |
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Plaintiff, |
STATEMENT OF NET WORTH |
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– against – |
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(DRL §236) |
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Defendant. |
Date of commencement of action |
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Complete all items, marking "NONE," "INAPPLICABLE" AND "UNKNOWN," if appropriate |
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STATE OF |
COUNTY OF |
SS.: |
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, the |
(Petitioner) (Respondent) (Plaintiff) (Defendant) herein, being duly sworn, |
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deposes and says that the following is an accurate statement as of |
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, |
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of my net worth (assets of whatsoever kind and nature and wherever situated minus liabilities), statement of income from all sources and statement of assets transferred of whatsoever kind and nature and wherever situated:
I.FAMILY DATA:
(a) |
Husband's age |
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(c) |
Date married |
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(b) |
Wife's age |
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(d) |
Date (separated) (divorced) |
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(e) |
Number of dependent children under 21 years |
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(f) |
Names of children |
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Ages |
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(g) |
Custody of Children |
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Husband |
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Wife |
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Joint |
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(h) |
Minor children of prior marriage: |
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Husband |
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Wife |
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(i) |
Husband (paying) (receiving) $ |
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as alimony (maintenance) and/or $ |
child support. |
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Wife |
(paying) (receiving) $ |
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as alimony (maintenance) and/or $ |
child support. |
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(j) |
Custody of children of Husband's prior marriage: |
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Custody of children of Wife's prior marriage: |
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Name |
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Address |
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(k) |
Is marital residence occupied by |
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Husband |
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Wife |
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Both |
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(l)Husband's present address Wife's present address
(m)Occupation of Husband Occupation of Wife
(n)Husband's employer
(o)Wife's employer
(p)Education, training and skills (Include dates of attainment of degrees, etc.) Husband
Wife
(q)Husband's health
(r)Wife's health
(s)Children's health
II.EXPENSES: (You may elect to list all expenses on a weekly basis or all expenses on a monthly basis, however, you must be consistent. If any items are paid on a monthly basis, divide by 4.3 to obtain weekly payments; if any items are paid on a weekly basis, multiply by 4.3 to obtain monthly payment. Items included under "Other" should be listed separately with separate dollar amounts.)
Expenses listed:
Weekly
Monthly
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Type of Expense |
Description |
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Amount |
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(a) |
Housing |
Rent |
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Mortgage and amortization |
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Real estate taxes |
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Condominium charges |
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Cooperative apartment maintenance |
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Other |
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Housing Total |
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Type of Expense |
Description |
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Amount |
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(b) |
Utilities |
Fuel oil |
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Gas |
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Electricity |
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Telephone |
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Water |
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Other |
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Utilities Total |
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Type of Expense |
Description |
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Amount |
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(c) Food |
Groceries |
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Number of dependents |
School lunches |
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Lunches at work |
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including self: |
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Liquor/alcohol |
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Home entertainment |
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Other |
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Food Total |
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Type of Expense |
Description |
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Amount |
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(d) Clothing |
Husband |
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Number of dependents |
Wife |
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Children |
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including self: |
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Other |
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Clothing Total |
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Type of Expense |
Description |
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Amount |
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(e) |
Laundry |
Laundry at home |
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Number of dependents |
Dry cleaning |
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Other |
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including self: |
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Laundry Total |
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Type of Expense |
Description |
Amount |
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(f) |
Insurance |
Life |
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Homeowner's/tenant's |
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Fire, theft and liability |
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Umbrella policy |
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Medical plan |
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Dental plan |
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Optical plan |
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Disability |
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Workers' Compensation |
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Other |
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Insurance Total |
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Type of Expense |
Description |
Amount |
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(g) Unreimbursed |
Medical |
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Medical |
Dental |
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Optical |
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Pharmaceutical |
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Surgical, nursing, hospital |
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Other |
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Unreimbursed Medical Total |
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Type of Expense |
Description |
Amount |
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(h) Household |
Repairs |
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Maintenance |
Furniture, furnishings, housewares |
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Cleaning supplies |
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Appliances, including maintenance |
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Painting |
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Sanitation/carting |
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Gardening/landscaping |
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Snow removal |
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Extermination |
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Other |
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Household Maintenance Total |
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Type of Expense |
Description |
Amount |
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(i) |
Household Help |
Babysitter |
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Domestic (housekeeper, maid, etc.) |
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Nurse |
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Other |
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Household Help Total |
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3
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Type of Expense |
Description |
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Amount |
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(j) |
Automotive |
Payments |
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Vehicle # 1 |
Gas and oil |
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Repairs |
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Year: |
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Make: |
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Car wash |
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Registration and license |
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Personal: |
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Parking and tolls |
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Business: |
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Insurance |
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Other |
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Payments |
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Vehicle # 2 |
Gas and oil |
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Repairs |
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Year: |
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Make: |
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Car wash |
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Registration and license |
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Personal: |
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Parking and tolls |
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Business: |
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Insurance |
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Other |
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Automotive Total |
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Type of Expense |
Description |
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Amount |
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(k) |
Educational |
Nursery and |
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Primary and secondary |
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College |
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Religious instruction |
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School transportation |
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School supplies/books |
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Tutoring |
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School events |
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Other |
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Educational Total |
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Type of Expense |
Description |
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Amount |
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(l) |
Recreational |
Summer camp |
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Vacations |
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Movies |
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Theatre, ballet, etc. |
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Video rentals |
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Tapes, CD's, etc. |
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Cable television |
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Team sports |
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Dining out |
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Country club/pool club |
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Health club |
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Sporting goods |
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Hobbies |
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(continued on next page) |
Music/dance lessons |
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4
Type of Expense |
Description |
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Amount |
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(l) Recreational |
Sports lessons |
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(Continued) |
Birthday parties |
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Other |
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Recreational Total |
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Type of Expense |
Description |
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Amount |
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(m) Income Taxes |
Federal |
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State |
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City |
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Social Security and Medicare |
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Income Taxes Total |
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Type of Expense |
Description |
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Amount |
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(n) Miscellaneous |
Beauty parlor/barber |
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Beauty aids/cosmetics, drug items |
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Cigarettes/tobacco |
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Books, magazines, newspapers |
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Children's allowances |
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Gifts |
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Charitable contributions |
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Religious organization dues |
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Sunday School |
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Diaper service |
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Union and organization dues |
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Commutation and transportation |
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Veterinarian/pet expenses |
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Child support payments (prior marriage) |
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Alimony and maintenance payments (prior marriage) |
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Loan payments |
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Unreimbursed business expenses |
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Miscellaneous Total |
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Type of Expense |
Description |
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Amount |
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(o) Other |
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Other Total |
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Total Expenses: |
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5