Form 4A-214. Community property and liabilities schedule.

[For use with Rule 1-123 NMRA] 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. COMMUNITY PROPERTY AND DEBTS SCHEDULE Neither party is required to submit a proposed distribution. Any stipulation regarding value or distribution should be indicated by an asterisk. ASSETS Value Petitioner Respondent Combined 1. Cash $___________ $___________ $___________ 2. Financial institution accounts:1 $___________ $___________ $___________ a. __________ Account#________ $___________ $___________ $___________ b. __________ Account#________ $___________ $___________ $___________ c. __________ Account#________ $___________ $___________ $___________ d. __________ Account#________ $___________ $___________ $___________ 3. Stocks, bonds and mutual funds: a. __________ Sh. ___________ $___________ $___________ $___________ b. __________ Sh. ___________ $___________ $___________ $___________ c. __________ Sh. ___________ $___________ $___________ $___________ 4. Insurance policies: a. Company ___________________ [Face amount $______________] Cash value $___________ $___________ $___________ Loan balance $ ___________ $___________ $___________ $___________ b. Company ___________________ [Face amount $______________] Cash value $___________ $___________ $___________ Loan balance $ ___________ $___________ $___________ $___________ 5. Real estate: a. __________ $___________ Mortgage ($/mo) $___________ REC ($/mo) $___________ Cost of sale ($/%) $___________ $___________ $___________ $___________ b. __________ $___________ Mortgage ($/mo) $___________ REC ($/mo) $___________ Cost of sale ($/%) $___________ $___________ $___________ $___________ 6. Vehicles: a. __________ $___________ Lien ($/mo) $___________ $___________ $___________ $___________ b. __________ $___________ Lien ($/mo) $___________ $___________ $___________ $___________ 7. Business assets $___________ $___________ $___________ 8. Household furniture and goods $___________ $___________ $___________ 9. Tax refunds $___________ $___________ $___________ 10. IRA/Keogh/Annuity $___________ $___________ $___________ 11. Retirement $___________ $___________ $___________ 12. Retirement $___________ $___________ $___________ 13. Other total assets $___________ $___________ $___________ Total assets $___________ $___________ $___________ DEBTS (Mo/Pmt) Value: Petitioner: Respondent: 1. _____________ $(_______) $___________ $___________ $___________ 2. _____________ $(_______) $___________ $___________ $___________ 3. _____________ $(_______) $___________ $___________ $___________ 4. _____________ $(_______) $___________ $___________ $___________ 5. Tax Liability $(_______) $___________ $___________ $___________ Total debts: $(_______) $___________ $___________ $___________ ESTIMATED NET ASSETS: $___________ $___________ $___________ Equalization of Assets: $___________ $___________ $___________ EQUAL ASSETS: $___________ $___________ $___________ 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