Wake Dom 19 Form – Fill Out and Use This PDF

The Wake Dom 19 form, officially known as the Equitable Distribution Inventory Affidavit, is a critical document used in the Family Court of Wake County, North Carolina. It is designed to provide a comprehensive inventory of the marital, divisible, and separate assets and debts between parties in a divorce proceeding, ensuring that the distribution is fair and equitable according to the laws of North Carolina. Individuals involved in these proceedings are required to fully disclose all relevant property and financial information to the best of their knowledge, underlining the importance of accuracy and completeness in filling out this form. To assist with equitable distribution claims and facilitate the legal process, consider clicking the button below to fill out your form meticulously.

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Wake Dom 19 Form PDF Details

In every marriage, the moment comes when couples must sometimes face the complexity of dividing their joint life, especially when that path leads to separation. At the heart of this process in North Carolina, within Wake County, lies the Wake Dom 19 form, a crucial document for those navigating through the intricacies of equitable distribution. This form, a beacon in the stormy seas of property and debt division, serves as an inventory affidavit, guiding both parties through a comprehensive listing of marital, divisible, and separate properties and debts as they stand at the time of separation. Ensuring accuracy and honesty, it requires a declaration under oath, bolstered by the requirement of notarization. By meticulously following the form’s guidelines, individuals engage in a structured disclosure process, paving the way for a fair assessment of what rightfully belongs to whom. Accommodated by detailed instructions, the form empowers individuals by detailing the necessity of including all assets and liabilities, necessitating complete transparency. With spaces to list everything from real estate to retirement accounts, alongside the stipulation for supporting documents, it underscores the gravity of achieving a just division. Equally, it provides a platform for contesting the classification or valuation of specific items, thus ensuring both parties have the opportunity to voice their concerns. Critical to the form’s purpose is the adherence to distinct definitions of marital, separate, and divisible properties, terms that carry significant weight in the ultimate division of assets and liabilities. Through the Wake Dom 19 form, individuals are beckoned to navigate the legal terrain of separation with integrity, precision, and an eye toward equitable resolution.

Question	Answer
Form Name	Wake Dom 19 Form
Form Length	33 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	8 min 15 sec
Other names	equitable distribution inventory affidavit wake dom nc, wake dom 10 fillable, wake dom form online, north carolina equitable distribution inventory form wake dom

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NORTH CAROLINA

COUNTY OF WAKE

___________________________________,

Plaintiff,

___________________________________,

Defendant.

The undersigned affiant, after being duly sworn as shown below, states as follows:

IN THE GENERAL COURT OF JUSTICE

DISTRICT COURT DIVISION

FILE NO. ____________________________

Assigned Judge:_______________________

EQUITABLE DISTRIBUTION

INVENTORY AFFIDAVIT

1.I am submitting this affidavit in accord with Rule 11 of the Tenth Judicial District Family Court Rules for Domestic Court and G.S. 50-21.

2.I have read and understand the "Instructions" which accompany this affidavit, and the information contained in this affidavit is true, accurate, and complete to the best of my ability.

3.I have made a full and complete disclosure of all marital, divisible and separate property/debts known to me. I have provided my best estimate as to the date of separation and present value of all assets and debts.

4.Certification: I hereby certify that all Disclosures required by any schedule on which I have listed property or debt have been served with this affidavit on the opposing party or his/her counsel.

5.This affidavit consists of this sheet and the ______ attached pages.

This the _____ day of __________________________, 20_______.
	__________________________________________________
	AFFIANT
STATE OF ________________	Plaintiff	Defendant
COUNTY OF ______________
Sworn and subscribed personally before me, this the ______ day of __________________ 20______.
__________________________________________________
Notary Public
My Commission Expires: _____________________________
WAKE-DOM-19 Page 1 of 33 (Rev. 02/10)		ED Affidavit for: □ Plaintiff or □ Defendant
		Date of Marriage: _____________________
		Date of Separation: ____________________

INSTRUCTIONS TO PARTIES FOR COMPLETION OF EQUITABLE DISTRIBUTION INVENTORY AFFIDAVIT (“EDIA”)

1.PLEASE READ THESE INSTRUCTIONS CAREFULLY. Your EDIA is an important document and must be fully and accurately prepared. Submission of

this EDIA is required in cases involving claims for Equitable Distribution (i.e., marital property/debt division) by the Tenth Judicial District Family Court Rules for Domestic Court (“Domestic Rules”), a copy of which is available in the Family Court Office on the 11th floor of the Wake County Courthouse. If you are not represented by counsel, you should obtain a copy of the Domestic Rules so that you can comply with them.

2.PLEASE READ THE EDIA FORM THOROUGHLY AND CAREFULLY. If you have any questions or are unsure how to list certain information, ask your attorney or review G.S. 50-20. Please print carefully or type all information.

3.The EDIA must substantially conform to this form. Your signature on Page 1 must be notarized.

4.The EDIA contains numerous Schedules on which various categories of property and debt are listed. The purpose of the EDIA is to provide a complete and accurate inventory (i.e., list) of all property and all debt (whether marital or separate) that existed on the date you and your spouse separated, and to provide information about what has happened to property or debt since the date of separation. Each asset or debt should be listed separately. If you need more room to list additional property or debt on a particular schedule, please add additional sheets of paper as necessary to give complete information about your property and debt.

5.You may omit sections or categories of assets that do not apply to your case.

6.Please indicate if you are the plaintiff (i.e., the person who first filed a claim for Equitable Distribution) or the defendant (i.e., the person against whom the initial claim was filed) by checking the applicable box. Also, “DOM” means the date on which you and your spouse were married and “DOS” means the date on which you and your spouse physically moved apart from one another. Please include these two dates where indicated.

7.IMPORTANT!! DISCLOSURES (i.e., supporting documents) are required for each asset and/or debt listed on your E DIA. The par ticular documents

that you are required to produce along with your completed EDIA are listed at the top of each Schedule of the EDIA. Any time that you list an asset or debt on a particular schedule, ma ke sure to check the instructions at the top of that Schedule – these instructions will t ell you what Disclosure s are required to be produced as supporting documents for what you have listed.

8.Schedule XIII of this affidavit should be completed only if you are seeking an unequal distribution of marital property. If you are seeking an equal distribution, omit Schedule XIII from your affidavit. An equal distribution is presumed equitable. If you are seeking an unequal distribution of marital property, you must provide a detailed explanation as to each specific factor that you believe the court should consider in awarding you an unequal division of the marital property. See pages 26 and 27.

9.In addition to listing property and debt, there is a place at the end of each Schedule for you to list your CONTENTIONS. This section allows you to make notes about facts or legal issues related to the classification, value, or distribution of a particular asset or debt that you would like for the other side (i.e., your spouse and his/her attorney) and the Court to consider. For example, if you contend that a certain asset was purchased in part with your separate property, you would state the facts related to this in the Contentions section on that Schedule.

10.If you are not represented by an attorney, North Carolina law and the Domestic Rules nevertheless apply to you and it is your responsibility to fully comply with these instructions. Only the Certificate of Service for the EDIA is filed with the Clerk of Superior Court. The rest of the EDIA is served on the other side pursuant to the Domestic Rules, but is not filed with the Clerk. All filings with the Clerk should be done at the Wake County Courthouse, 316 Fayetteville Street, Raleigh, North Carolina 27601. It is important to consult the Domestic Rules regarding Equitable Distribution claims in order to determine all of the deadlines and other procedural rules that apply to your case.

11.The second party to file his/her EDIA should list assets and debts in the same order and using the same asset numbers as the original filing party whenever possible.

WAKE-DOM-19 Page 2 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

12.Deliberate omissions or misstatements of fact in your EDIA may subject you to sanctions by the Court.

13.The following are the statutory definitions for “Marital”, “Separate”, and “Divisible” Assets:

a.“Marital property” means all real and personal property acquired by either spouse or both spouses during the course of the marriage and before the date of the separation of the parties, and presently owned, except property determined to be separate property or divisible property. Marital property also includes all vested and nonvested pension, retirement, and other deferred compensation rights, and vested and nonvested military pensions eligible under the Federal Uniformed Services Former Spouses’ Protection Act. It is presumed that all property acquired after the date of marriage and before the date of separation is marital property except property which is separate property.

b.“Separate property” means all real and personal property acquired by a spouse before marriage or acquired by a spouse by bequest, devise, descent, or gift during the course of the marriage. However, property acquired by gift from the other spouse during the course of the marriage shall be considered separate property only if such an intention is stated in the conveyance. Property acquired in exchange for separate property shall remain separate property regardless of whether the title is in the name of the husband or wife or both and shall not be considered to be marital property unless a contrary intention is expressly stated in the conveyance. The increase in value of separate property and the income derived from separate property shall be considered separate property. All professional licenses and business licenses which would terminate or transfer shall be considered separate property.

c.“Divisible property” means all real and personal property as set forth below:

i.All appreciation and diminution in value of marital property and divisible property of the parties occurring after the date of separation and prior to the date of distribution, except that appreciation or diminution in value which is the result of postseparation actions or activities of a spouse shall not be treated as divisible property.

ii.All property, property rights, or any portion thereof received after the date of separation but before the date of distribution that was acquired as a result of the efforts of either spouse during the marriage and before the date of separation, including, but not limited to, commissions, bonuses, and contractual rights.

iii.Passive income from marital property received after the date of separation, including, but not limited to, interest and dividends.

iv.Increases in marital debt and financing charges and interest related to marital debt.

14.The following is a list of abbreviations used in this affidavit:

a.FMV: Fair Market Value

b.DOS: Date of Separation

c.DOM: Date of Marriage

d.H: Husband

e.W: Wife

f.Jt: Joint (as in joint names listed on a title)

WAKE-DOM-19 Page 3 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

		TABLE OF SCHEDULES
Schedule I:	Marital Assets – A list of all of the following assets that you, your spouse, or you and your spouse jointly acquired after the DOM and before the
	DOS, and that were still owned on the DOS:
	A.	Real Estate
	B.	Transportation
	C.	Stocks and Bonds
	D.	Bank Accounts & IRA Accounts
	E.	Artwork, Metals, and other Collectables
	F.	Notes and Income Producing Assets
	G.	Jewelry
	H.	Animals
	I.	Intellectual Properties
	J.	Business Interests
	K.	Household Goods, Silver, China and Crystal
	L.	Cash Value Life Insurance
	M.	Retirement Accounts (excluding IRAs)
	N.	Miscellaneous
Schedule II:	Marital Debts – A list of all debts incurred by you, your spouse, or by you and your spouse jointly after the DOM and before the DOS, for the joint
	benefit of you and your spouse.
Schedule III:	Separate Assets – A list of all assets presently owned by you that were acquired by you PRIOR to the DOM, acquired by you after the DOS, or that
	you received by gift or inheritance during the marriage, that you contend belong separately to you and are not marital assets to be divided.
Schedule IV:	Separate Debts -- A list of all debts incurred by you or your spouse that were NOT incurred between the DOM and the DOS, or that were incurred
	during the marriage and prior to the DOS, but not for the joint benefit of the parties.
Schedule V:	Divisible Property – (Assets and Debts) – A list of all property meeting the definition of “divisible property” (see above).
Schedule VI:	Commissions, Bonuses, or other Property received after DOS but earned prior to DOS
Schedule VII:	Passive Income received after DOS from Marital Property
Schedule VIII:	Post DOS Increases to Marital Debt, Financing Charges, and Interest Charges
Schedule IX:	Post DOS Disposal of Marital Property
Schedule X:	Post DOS Reduction of Marital Debt
Schedule XI:	Contributions to Separate Property of Other Spouse
Schedule XII:	Property Acquired after DOS
Schedule XIII:	Contentions for property acquired after DOS
Schedule XIII:	Contentions For An Unequal Distribution Of Marital/Divisible Property
WAKE-DOM-19 Page 4 of 33 (Rev. 02/10)			ED Affidavit for: □ Plaintiff or □ Defendant
			Date of Marriage: _____________________
			Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

A. Real Estate

DISCLOSURES REQUIRED: Documents related to the purchase of the property (e.g., settlement statement); Promissory note(s) that are secured by Deed(s) of Trust on property; Account statement(s) from lender showing the DOS and current note balance(s); Documents showing the cost of any improvements made; Deed conveying the property to you and/or your spouse; County tax value; Appraisals or market analyses performed on the property within the 2 years prior to DOS or at any time since DOS, if any; Written estimates of any repairs you contend are needed to the property; Documents to support any contentions made by you about the asset.

		Date	Tax Basis				DOS
#		Acquired	Tax Basis	Who Has	What is Your	Fair	DOS
#		Acquired	(i.e., Purchase	Who Has	What is Your	Fair	Principal		Present
Asset		& How	(i.e., Purchase	Current	Proposed	Market	Principal	Present	Present
	Description of Asset	& How	Price + Cost of	Current	Proposed	Market	Balance(s) of All	Present	Loan
	Description of Asset	Titled	Price + Cost of	Possession?	Distribution?	Value on	Balance(s) of All	FMV	Loan
		Titled	Improvements	Possession?	Distribution?	Value on	Loans Secured by	FMV	Balance(s)
		(H, W or	Made)	(H/W)	(H/W)	DOS	Property
		JT)	Made)				Property
		JT)
A1

A2

A3

A4

A5

Asset #

SCHEDULE I: MARITAL ASSETS

A. Real Estate Contentions

	Description of Asset	The Affiant makes the following contentions relating to each parcel of real estate
	Description of Asset	listed above:
		listed above:

WAKE-DOM-19 Page 5 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

B. Transportation

DISCLOSURES REQUIRED: Title of asset; Notes or other evidence of debt related to the purchase of asset; Documents showing fair market value of asset on DOS and presently; Account statements showing loan balance on DOS and currently; Documents to support any contentions made by you regarding the asset.

#		Date	Who Has	What is Your	Fair	Note
Asset	Year, Make, Model of Asset &	Acquired &	Who Has	What is Your	Market	Note	Present	Present
	Year, Make, Model of Asset &	Acquired &	Current	Proposed	Market	balance on	Present	Present
	Lienholder	Title Owner	Current	Proposed	Value on	balance on	FMV	Debt
	Lienholder	Title Owner	Possession?	Distribution?	Value on	DOS	FMV	Debt
		(H, W, or JT)			DOS
B1

B2

B3

B4

B5

Asset #

SCHEDULE I: MARITAL ASSETS

B. Transportation Contentions

Description of Asset	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 6 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

C. Stocks, Bonds, Mutual Funds and Stock Options1

DISCLOSURES REQUIRED: Complete account statements for each asset listed for the 6 months preceding the DOS and on DOS (or as close to DOS as possible); Current account statement; Statements showing balance of any loans against the account on DOS and presently; Documents to support any contentions made by you regarding the asset.

Asset #

Description of Asset,	Date Acquired	Who Has	What is Your	Account	Loan	Present	Present
Location & Account	& Title Owner	Current	Proposed	Value on	Balance on	Account
							Debt
Number	(H, W, or JT)	Possession?	Distribution?	DOS	DOS	Value

SCHEDULE I: MARITAL ASSETS

C. Stocks, Bonds and Mutual Funds Contentions

Asset #

Description of Asset

The Affiant makes the following contentions relating to the assets listed above:

1If the stocks and/or bonds are held in a brokerage account it is acceptable to provide the name and account number of each brokerage account and to provide copies of the brokerage account statements showing the DOS and present fair market value of the accounts in accord with the local rules. If the stocks and/or bonds are not held in a brokerage account, list the stocks and/or bonds individually.

WAKE-DOM-19 Page 7 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

D. Bank Accounts (checking, savings, money market), Credit Union Accounts, Certificates of Deposits,

DISCLOSURES REQUIRED: Complete account statements for each asset listed for the 6 months preceding the DOS and on DOS (or as close to DOS as possible); Current account statement; Documents to support any contentions made by you regarding the asset.

Asset #

Description of Asset, including Account	Date Acquired	Who Has	What is Your	Account Balance	Present Account
	&	Who Has	What is Your
	&	Current	Proposed
Number2	Title Owner	Current	Proposed	on DOS	Balance
	(H, W, or JT)	Possession?	Distribution?
	(H, W, or JT)

SCHEDULE I: MARITAL ASSETS

D. Bank Accounts Contentions

Asset #

Description of Assets

The Affiant makes the following contentions relating to the assets listed above:

2Include name of financial institution; account numbers, if known, and the type of account (checking, savings, etc.)

WAKE-DOM-19 Page 8 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE 1: MARITAL ASSETS

E. Artwork and Other Collectibles3

DISCLOSURES REQUIRED: Documents showing purchase price and fair market value of asset at time of purchase; Appraisals performed within 2 years of DOS or any time after DOS; Documents to support any contentions made by you regarding the asset.

Asset #

	Date Acquired	Who Has	What is Your	Purchase	Fair Market
Description of Asset	& Title Owner	Current	Proposed			Present FMV
				Price	Value on DOS
	(H, W, or JT)	Possession?	Distribution?

SCHEDULE 1: MARITAL ASSETS

E. Artwork and Other Collectibles Contentions

Asset #

Description of Assets

The Affiant makes the following contentions relating to the assets listed above:

3If the assets listed serve as security for any indebtedness, identify the name of the creditor; the amount of indebtedness at DOS and presently beside each asset.

WAKE-DOM-19 Page 9 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

F.Promissory Notes (owed to either party); Tax Refunds, and other debts owed to either party

DISCLOSURES REQUIRED: Copy of promissory note(s); Copy of tax return showing amount of refund owed; Documents to support any contentions made by you regarding the asset.

Asset #

Description of Asset, Location, Terms of	Date Acquired	Who Has	What is Your Proposed	Amount Owed
				by Debtor on	Present
Note, Monthly Payment Amount	& Title Owner	Current
			Distribution?	DOS	Amount Owed
(Principal & Interest)	(H, W, or JT)	Possession?

SCHEDULE I: MARITAL ASSETS

F.Promissory Notes and Tax Refunds Contentions

Asset #

Description of Asset

The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 10 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

G. Jewelry

DISCLOSURES REQUIRED: Documents showing purchase price and fair market value of asset at time of purchase; Appraisals performed within 2 years of DOS or any time after DOS; Account balance on DOS and currently for any debt related to the purchase of the asset; Documents to support any contentions made by you regarding the asset.

Asset #

G10

G11

G12

G13

G14

G15

G16

Description of Asset & Lienholder

Date Acquired & Title Owner

(H, W, or JT)

Who Has

Current

Possession?

What is Your

Proposed

Distribution?

Fair Market

Value on DOS

and Loan

Balance, if any

Present

FMV and Loan

Balance

WAKE-DOM-19 Page 11 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

Asset #

SCHEDULE I: MARITAL ASSETS

G. Jewelry Contentions

Description of Assets	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 12 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

H. Animals4

DISCLOSURES REQUIRED: Documents showing purchase price and fair market value of animal at time of purchase; Appraisals performed within 2 years preceding DOS or any time after DOS; Account balance on DOS and currently for any debt related to the purchase of the animal; Documents to support any contentions made by you regarding the asset.

Asset #

	Date Acquired	Who Has	What is Your		Fair Market	Present
				Purchase	Value on DOS
Description of Asset & Lien holder	& Title Owner	Current	Proposed			FMV and
				Price	and Loan
	(H, W, or JT)	Possession?	Distribution?			Loan Balance
					Balance, if any

SCHEDULE I: MARITAL ASSETS

H. Animals Contentions

Asset #

Description of Assets

The Affiant makes the following contentions relating to the assets listed above:

4There is no requirement to list household pets. This exhibit refers to horses, farm animals, animals raised for monetary gains, or show animals..

WAKE-DOM-19 Page 13 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

I.Intellectual Property (Patents, Copyrights, Trademarks)5

DISCLOSURES REQUIRED: Documents showing all information required in the “Identifying Information” column, below;

Documents to support any contentions made by you regarding the asset.

	Identifying Information:
	(1) Office where registered, or
	patented, or where patent
#	application is pending;		Who Has	What is Your	Name & Address of each	Fair Market
#	(2) Patent #, trademark or	Title	Who Has
Asset	(2) Patent #, trademark or	Title	Current				Present
	copyright registration #	Owner	Current	Proposed	licensee: amount &	Value on	Present
	copyright registration #	Owner	Possession	Proposed	licensee: amount &	Value on	FMV
	(3) Title, mark or trade name	(H, W, or JT)	Possession	Distribution?	frequency of payments	DOS	FMV
	(4) Brief Description		?
	(5) Dates filed and issued
	(6) Original price or costs to
	create and to register.
I1

I2

I3

Asset #

SCHEDULE I: MARITAL ASSETS

I. Intellectual Property Contentions

Description of Assets	The Affiant makes the following contentions relating to the assets listed above:

5If the intellectual property identified serves as security for any indebtedness, identify the amount of indebtedness (DOS and present) and the name of the creditor.

WAKE-DOM-19 Page 14 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

J.Business Interests (Corporation, Partnerships, LLCs, etc.)

DISCLOSURES REQUIRED: Documents showing all information required in the “Description of Asset” column, below, including organizational documents (e.g., Articles of Incorporation. Articles of Organization), Operating Agreement(s); Year-end Profit & Loss Statements and Balance Sheets for 2 full years preceding DOS and monthly P&Ls and Balance Sheets year to date up to DOS and since DOS; Tax returns filed by entity for 2 years prior to DOS and since DOS; Documents to support any contentions made by you regarding the asset.

Asset #

Description of Asset & Location

(Include whether incorporated, sole proprietorship, partnership, joint venture, etc.). Identify each partner/shareholder and the percentage of ownership for each person so identified.

Date

Acquired & Title

Owner (H, W, or JT)

Original Price

of Interest

Who Has

Current

Possession?

What is Your

Proposed

Distribution?

Fair Market Value of

Entity on DOS6

Current

FMV

Asset #

SCHEDULE I: MARITAL ASSETS

J. Business Interests Contentions

Description of Asset	The Affiant makes the following contentions relating to the assets listed above:

6 For each entity identified.	ED Affidavit for: □ Plaintiff or □ Defendant
WAKE-DOM-19 Page 15 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

K. Household Goods and Special Collections

DISCLOSURES REQUIRED: Documents showing purchase price and fair market value of asset at time of purchase; Appraisals performed within 2 years preceding the DOS or any time after DOS; Account balance on DOS and currently for any debt related to the purchase of the asset; Documents to support any contentions made by you regarding the asset.

#		Date Acquired &	Who Has	What is Your	Fair Market Value on	Present
Asset	Description of Asset & Lien holder	(H, W, or JT)	Possession?	Distribution?	if any	Present
Asset		(H, W, or JT)	Possession?	Distribution?	if any	FMV and Loan Balance
		Title Owner	Current	Proposed	DOS and Loan Balance,

K1

K2

K3

K4

K5

K6

K7

K8

K9

K10

K11

K12

K13

K14

K15

K16

WAKE-DOM-19 Page 16 of 33 (Rev. 02/10)					ED Affidavit for: □ Plaintiff or □ Defendant
					Date of Marriage: _____________________
					Date of Separation: ____________________

#		Date Acquired &	Who Has	What is Your	Fair Market Value on	Present
Asset	Description of Asset & Lien holder	(H, W, or JT)	Possession?	Distribution?	if any	Present
Asset		(H, W, or JT)	Possession?	Distribution?	if any	FMV and Loan Balance
		Title Owner	Current	Proposed	DOS and Loan Balance,

K17

K18

K19

K20

K21

K22

K23

K24

K25

K26

K27

K28

K29

K30

K31

K32

K33

K34

K35

K36

WAKE-DOM-19 Page 17 of 33 (Rev. 02/10)					ED Affidavit for: □ Plaintiff or □ Defendant
					Date of Marriage: _____________________
					Date of Separation: ____________________

#		Date Acquired &	Who Has	What is Your	Fair Market Value on	Present
Asset	Description of Asset & Lien holder	(H, W, or JT)	Possession?	Distribution?	if any	Present
Asset		(H, W, or JT)	Possession?	Distribution?	if any	FMV and Loan Balance
		Title Owner	Current	Proposed	DOS and Loan Balance,

K37

K38

K39

K40

K41

K42

K43

K44

K45

K46

K47

K48

K49

K50

K51

K52

K53

K54

K55

K56

WAKE-DOM-19 Page 18 of 33 (Rev. 02/10)					ED Affidavit for: □ Plaintiff or □ Defendant
					Date of Marriage: _____________________
					Date of Separation: ____________________

Asset #

SCHEDULE I: MARITAL ASSETS

K. Household Goods Contentions

Description of Asset	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 19 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

L. Life Insurance, including Cash Value

DISCLOSURES REQUIRED: Copy of policy, including owner, insured and current beneficiary designation; Statement showing cash surrender value of policy on DOS and currently; Account balance on DOS and currently for any loans against the policy; Documents to support any contentions made by you regarding the asset.

#	Description of Policy;	Date Acquired	Who Has	What is Your		Loan	Present Cash
Asset	Policy #; Owner,	Date Acquired	Who Has	What is Your	Cash Value on	Loan	Present Cash
	Policy #; Owner,	& Title Owner	Current	Proposed	Cash Value on	Balance on	Value/Loan	Current Beneficiary
	Insured, and Original	& Title Owner	Current	Proposed	DOS	Balance on	Value/Loan	Current Beneficiary
	Insured, and Original	(H, W, or JT)	Possession?	Distribution?	DOS	DOS	Balance
	Beneficiary
L1

L2

L3

L4

L5

L6

Asset #

SCHEDULE I: MARITAL ASSETS

L. Cash Value of Life Insurance Contentions

Description of Assets	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 20 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

M. Defined Benefit and Defined Contribution Pension Plans; 401(k) Plans; 403(b) Plans; Profit Sharing Plans; Deferred

Compensation Plans and all other Retirement Benefits, including IRA accounts

DISCLOSURES REQUIRED: Complete account statements for each account listed for the 6 months (or two quarters) preceding the

DOS and on DOS (or as close to DOS as possible); Current account statement; Statements showing balance of any loans against the account on DOS and presently; Documents showing current beneficiary of account; Documents to support any contentions made by you regarding the asset.

Asset #

Description of Asset, including	Date Acquired &	Who Has	What is Your	Account Balance on	Present	If applicable,
					Account
Account Number, and current	Title Owner	Current	Proposed	DOS/Loan Balance		Monthly
					Balance/Loan
beneficiary	(H, W, or JT)	Possession?	Distribution?	on DOS		Payment
					Balance

SCHEDULE I: MARITAL ASSETS

M. Contentions Regarding Defined Benefit and Defined Contribution Pension Plans; Deferred

Compensation Plans; 401(k) accounts; IRA accounts; and all other Retirement Benefits

CONTENTIONS

Description of Asset	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 21 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE I: MARITAL ASSETS

N. Miscellaneous

List here any marital assets that do not fall into Categories A through M, such as airline miles, hotel points, etc.

DISCLOSURES REQUIRED: Account statement on DOS (or as close to DOS as possible); Current account statement; Documents to support any contentions made by you regarding the asset.

Asset #

Description of Asset	Date Acquired &	Who Has	What is Your	VALUE/NO. OF	PRESENT
	Title Owner	Current	Proposed		VALUE/NO. OF
				MILES ON DOS
	(H, W, or JT)	Possession?	Distribution?		MILES

SCHEDULE I: MARITAL ASSETS

N. Miscellaneous Contentions

Asset #

Description of Asset

The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 22 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE II: MARITAL DEBTS

DISCLOSURES REQUIRED: Complete account statements for each account listed (e.g., monthly credit card statements ,monthly mortgage statements) for the 6 months preceding the DOS and on DOS (or as close to DOS as possible); Current account statement; Documents showing all payments made on debt since DOS and by whom; Documents to support any contentions made by you regarding the debt.

#Debt

Name & Address of Creditor,

Account Number

Name of Person(s) Who

is The Obligor on the

Debt

Reason Debt Incurred and Month and year Debt incurred

Amount owed on

DOS

Amount

currently owed

Who has paid the debt since DOS and amount that has been paid

SCHEDULE II: MARITAL DEBTS CONTENTIONS

Debt #

Description of Debt

The Affiant Makes the Following Contentions Relating to the

Debts Listed Above

WAKE-DOM-19 Page 23 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE III: SEPARATE ASSETS

DISCLOSURES REQUIRED: Documents showing date asset was acquired and by whom and purchase price; Account statement on

DOS (or as close as possible); Appraisals performed within 2 years preceding DOS or since DOS; Documents supporting your contention that the asset is your separate property.

#
Asset	Description of Asset
	Description of Asset

WAKE-DOM-19 Page 24 of 33 (Rev. 02/10)

Date Acquired & Reason	Purchase Price	DOS FMV	Present FMV
Separate	Purchase Price	DOS FMV	Present FMV
Separate

ED Affidavit for: □ Plaintiff or □ Defendant

Date of Marriage: _____________________

Date of Separation: ____________________

Asset #

SCHEDULE III: SEPARATE ASSETS CONTENTIONS

Description of Asset	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 25 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE IV: SEPARATE DEBTS

DISCLOSURES REQUIRED: Documents showing date debt was incurred and by whom and amount of debt; Account statement on

DOS (or as close as possible); Documents supporting your contention that the debt is separate.

#	Name & Address of Creditor,	Name(s) of person		Pre-marital
Debt		who is listed on the		Pre-marital
		who is listed on the	Basis for Separate Classification	Balance	DOS Balance	Current Balance
	Account Number	debt	Basis for Separate Classification	Balance	DOS Balance	Current Balance
	Account Number	debt		(if any)
		(H/W/JT7 )		(if any)

1

2

3

4

If the debt is in joint names, identify the party who you claim is responsible for the debt.

SCHEDULE V: DIVISIBLE PROPERTY

(Passive Increases And Decreases To Value Of Marital Property After DOS)

For any asset or item of marital property that you listed previously, list the asset and the increase or decrease in value since DOS. List any decreases in value in parentheses.

DISCLOSURES REQUIRED: Documents showing the increase or decrease in value, such as account statements since DOS.

#
Property		Item of Property
		Item of Property

7If joint, note which party should be responsible for payment.

WAKE-DOM-19 Page 26 of 33 (Rev. 02/10)

Reason for Passive Increase or Decrease	Amount of Increase or	Net Value of Item Now
Reason for Passive Increase or Decrease	(Decrease) since DOS	Net Value of Item Now
	(Decrease) since DOS

SCHEDULE VI:

ED Affidavit for: □ Plaintiff or □ Defendant

Date of Marriage: _____________________

Date of Separation: ____________________

COMMISSIONS, BONUSES, ROYALTIES, PROPERTY, ETC., RECEIVED AFTER

DOS BUT EARNED PRIOR TO DOS

DISCLOSURES REQUIRED: Documents showing the amount of and date on which income was received (e.g., copy of the check) as well as any documents that support your contention that the income was earned during the marriage and prior to the DOS.

#Asset

Description of Item and where it is currently located	Received by	Date Received	Amount Received
Description of Item and where it is currently located	H/W or Joint	Date Received	Amount Received
	H/W or Joint

SCHEDULE VII:

“PASSIVE” INCOME RECEIVED AFTER DOS FROM MARITAL PROPERTY

(e.g., interest and dividends, etc.)

List all income received after the DOS as a result of ownership of a marital assets, e.g., rental income, dividends, interest, etc.

DISCLOSURES REQUIRED: Documents showing the income received, such as checks showing income received and account statements showing interest earned since DOS.

#Asset

Description of Item

Party Currently in

Possession

Received by H /

W or Joint

Date Received

Amount Received

WAKE-DOM-19 Page 27 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE VIII:

INCREASES TO MARITAL DEBT, FINANCING

CHARGES AND INTEREST CHARGES AFTER DOS

This schedule should be completed with reference back to the list of marital debts set out previously. For example, if you listed a charge card as a marital debt and the balance due has increased since DOS, you should identify that debt and increase here. Please keep all debts listed in a consistent order.

DISCLOSURES REQUIRED: Documents showing the increased balance, such as account statements since DOS.

Debt #

Description of Debt

DOS Balance

Current Balance

Reason for increase and total amount of financing charges

WAKE-DOM-19 Page 28 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE IX:

DISPOSAL OF MARITAL PROPERTY AFTER DOS

List all marital assets that have, since date of separation, been totally or partially sold, transferred, consumed, or destroyed, by you or by the other party, including but not limited to sale of property, withdrawal of funds from accounts, and purposeful or negligent destruction of property. Identify the amount of money or other consideration resulting from the disposal, who caused the disposal (H, W or Joint) and what has been done with the net proceeds, if any (i.e., debts paid, other property acquired, funds held in bank, etc.). If the property was used to pay marital debts, you should indicate that on the appropriate schedule. If the property was used to acquire other property after DOS, the newly acquired property may still be marital property and should be identified on this affidavit.

DISCLOSURES REQUIRED: Documents showing the sale or transfer of any marital asset and the disposition of the proceeds (such as check(s) received from purchaser); any written estimates of repairs for damage done to marital property; documents showing the purchase of any asset with marital sales proceeds; account statements showing withdrawal of funds from marital accounts; account statements showing payment of marital debt with proceeds from sale of marital asset(s); any other documents that support any allegation made by you of post-DOS disposal of marital assets.

Asset #

Description of Item

Reason for Disposal of Marital Property and Who Disposed of Property

Money or Other

Consideration Received

Use of Proceeds

WAKE-DOM-19 Page 29 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE X:

REDUCTION OF MARITAL DEBT AFTER DOS

List payments you have made on marital debt since the date of separation. List each debt by using the number you used on prior schedules. You should have listed the balance on such debts as of DOS on the prior schedules; therefore, there is no need to list the DOS balance here.

DISCLOSURES REQUIRED: Documents showing the payments you have made on marital debt since the DOS and the source of funds used to make the payments, such as account statements, cancelled checks, check registers, loan or credit card account statements reflecting payments received by lender; any other documents that evidence your payment on marital debt after the DOS.

Debt #

Marital Debt as Identified Prior

Dollar amount of payments

you made since DOS

Source of Funds for Payments Made by You

Balance Owed Now

SCHEDULE XI:

CONTRIBUTIONS TO SEPARATE PROPERTY OF OTHER SPOUSE

If there was an increase in value during the course of your marriage to an item claimed by the other party as his or her Separate Property and you claim you made a direct contribution to the increase in value of that item during the marriage, answer the following:

Debt #

Description of Item

What is the amount of your contributions, or how much did your contributions add to the value of the asset

Detailed Explanation of Your Contributions

WAKE-DOM-19 Page 30 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE XII:

PROPERTY ACQUIRED AFTER DATE OF SEPARATION

List here property acquired by you with funds acquired by you after the date of separation and which is your property.

DISCLOSURES REQUIRED: Documents showing the asset purchased (e.g., title, bill of sale), the source of funds used to purchase the asset (e.g., account statements, cancelled checks, check registers, credit card account statements, or loan documents); any other documents that evidence the use of your separate income or property, including debt incurred solely by you after the DOS, to acquire the asset.

Asset #

Asset and Lien holder and related Account number

Possession H/W/Joint

Purchase Price and source of funds used to

purchase the property

Present

FMV

Asset #

SCHEDULE XIII:

CONTENTIONS FOR PROPERTY ACQUIRED AFTER DATE OF SEPARATION

Description of Assets	The Affiant makes the following contentions relating to the assets listed above:

WAKE-DOM-19 Page 31 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

SCHEDULE IX:

CONTENTIONS FOR AN UNEQUAL DISTRIBUTION OF MARITAL PROPERTY

List below factors for the Court to consider in determining whether an equal division of marital property would not be equitable in your case. Only complete this schedule if you are s eeking an unequal division of marital property. Please provide a detailed explanation as

to each specific factor listed in the order in which they are listed.

	FACTORS	DETAILED EXPLANATION

1.	The income, property, and liabilities of each party at the time the division of
	property is to become effective.

2.	Any obligation for support arising out of a prior marriage.

3.	The duration of the marriage and the age and physical and mental health of both
	parties.

4.	The need of a parent with custody of a child or children of the marriage to
	occupy or own the marital residence and to use or own its household effects.

5.	The expectation of pension, retirement, or other deferred compensation rights
	that are not marital property.

6.	Any equitable claim to, interest in, or direct or indirect contribution made to the
	acquisition of such marital property by the party not having title, including joint
	efforts or expenditures and contributions and services, or lack thereof, as a
	spouse, parent, wage earner, or homemaker.
7.	Any direct or indirect contribution made by one spouse to help educate or
	develop the career of the other spouse.

8.	Any direct contribution to an increase in the value of separate property which
	occurs during the course of the marriage.

9.	The liquid or nonliquid character of all marital property and divisible property.

10.	The difficulty of evaluating any component asset or any interest in a business,
	corporation or profession, and the economic desirability of retaining such asset or
	interest, intact and free from any claim or interference by the other party.
11.	The tax consequences to each party.

11.a.	Acts of either party to maintain, preserve, develop, or expand; or to waste,
	neglect, devalue or convert the marital property or divisible property, or both,
	during the period after separation of the parties and before the time of
	distribution.
12.	Any other factor which the court finds to be just and proper.

	WAKE-DOM-19 Page 32 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
		Date of Marriage: _____________________
		Date of Separation: ____________________

NORTH CAROLINA

COUNTY OF WAKE

___________________________________,

Plaintiff,

___________________________________,

Defendant.

IN THE GENERAL COURT OF JUSTICE

DISTRICT COURT DIVISION

FILE NO. ___________________________

Assigned Judge:_________________________

CERTIFICATE OF SERVICE

(EQUITABLE DISTRIBUTION INVENTORY AFFIDAVIT)

CERTIFICATE OF SERVICE (TO BE FILED WITH CLERK OF COURT)

I, ____________________________________________, the undersigned, do hereby certify that a copy of the foregoing Equitable

Distribution Inventory Affidavit was served in the following manner:

By depositing a copy in the US Mail in a properly addressed, postpaid envelope to: _____________________________________________

________________________________________________________________________________________________________________

By hand delivery to: _______________________________________________________________________________________________

By facsimile to: ___________________________________________________		Fax No.: ___________________________________
Other: _________________________________________________________________________________________________________
Date: _____________________________	___________________________________________________________________
	Plaintiff	Defendant

Attorney for Plaintiff

Attorney for Defendant

WAKE-DOM-19 Page 33 of 33 (Rev. 02/10)	ED Affidavit for: □ Plaintiff or □ Defendant
	Date of Marriage: _____________________
	Date of Separation: ____________________

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