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Acknowledgment of Preliminary Final Verified Disclosure Statement

If you are a defendant in a divorce case in the State of Kentucky and want to verify the completion of the original case disclosure form, you have to use this form. Complete the form and submit it in order to verify the completion of the mentioned form.

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IN RE THE MARRIAGE OF:
_____	___________________________________     	PETITIONER	
and	 	
_____	___________________________________     	RESPONDENT	
All sections 	must	 be completed.  If an amount is unknown, write “unknown”, if the q\
uestion is inapplicable, write “N/A”.  	
If a question requires further documentation or an additional schedule, \
please attach.  If maintenance is an issue or 
there are property distribution issues, please proceed to use the full M\
andatory Case Disclosure Form.  
 I, _	_______________________________________, declare under oath that my pers\
onal information is:	
 	Name: ______________________________________________________	
 Address:  ____________________________________________________
       ____________________________________________________
      ____________________________________________________
 Age/Place birth: _______________________________________________
 Date/Place marriage:  __________________________________________
 Spouse’s name:  ______________________________________________
 Spouse’s age: ________________________________________________
 I am currently employed at: ______________________________________
 I earn _________________ per ________________ (weekly, monthly, etc.)
 	****** My 	total	 gross monthly income (from all sources) is _______________	
OTHE	R  LEGAL ACTIONS	
 Please give the style, the case number, and the name of the Court or administrative agency for any case you ar\
e 
a party in or have been within the last year as well as a brief descript\
ion of the nature of the case and present status.  
________________________________________________________________________\
_______________________
________________________________________________________________________\
_______________________
_____	________________________________________________________________________\
__________________	
REQ	UIRED ATTACHMENTS	
 “A”   =  to indicate that the requested document/information is at\
tached
 “U”   =  to indicate that the requested document/information is un\
available
             (Provide explanation on a separate page)
 “N/A” = if not applicable
I have provid	ed a	 copy of the following documents to opposing party or opposing counsel: \
 	
____  1.  My three (3) most recent pay stubs
____  2. A full and complete copy of my last Federal Tax Return
____  3. First pa	ge of my last State Tax Return	
ACKNOWLEDGMENT OF	q PRELIMINARY  	q FINAL VERIFIED 	DISCLOSURE STATEMENT*	
lex
et 
justitia	COMMONWEALTHOFKENTUCKY	COURTOFJUSTICE	
Case  No.  ____________________
Court        ____________________
County       ____________________
Division      ____________________	
q  AOC-238.3  Doc. Code: ACKPDS	
q  AOC-239.3  Doc. Code: ACKFDS	
Rev. 1-15
Page 1 of 2 
Commonwealth of KentuckyCourt of Justice   	  www.courts.ky.gov	
FCRPP 2 and FCRPP 3

q  AOC-238.3  Doc. Code    	q  AOC 239.3 Doc. Code 	
Rev- 1-15       	Disclosure of 	_____________________________________	
Page 2 of 2              Case No.  _________________________________________
	 I	hereby	acknowledge	that	the	information	contained	in	_____________________________’s	Verified	Disclosure	
Statement	is	a	true	and	accurate	reflection	of	the	financial	disputes	in	this	matter	and	that	there	are	no	additional	assets,	debts 	
or issues which require disclosure to the best of my knowledge and belie\
f.  Further, I hereby certify that the foregoing information 
is true to the best of my knowledge, information and belief.  
        ____________________________________________
       	 	q   Petitio	ner      	q   Respondent    	{check one	}	
ST	ATE OF __	__________________________   )	                       ) SS
COUNTY OF ____________________________  )
 Subscri	bed	 and sworn before me by 	____________________________	, this _____ day of _________________, 	
________.
 My commission expires:	 ______________________	
         ___	__	_________________________________	
        	  NOTARY PUBLIC/TITLE	
When  this  form  is  utilized  in  lieu  of  the AOC-238,  Preliminary  Verified  Disclosure  Statement,  unless  otherwise 
ordered by the 	Court	 or required by Local Rule, this form is NOT to be filed with the Court.  FCRPP 2(3).  However, 	
the  entire  form  and  all  attachments  are  to  be  exchanged  between  the  parties  within  45  days  of  service  of  the 
petition	 on the respondent, and objections thereto shall be exchanged within 20 days thereafter .	
When	 thi	s  form  is  utilized  in  lieu  of  the  AOC-239,  Final  Verified  Disclosure  Statement,  or  AOC-239.2,  Affidavit 	
of No 	Change  in  Circumstances,  pursuant  to  FCRPP  3(3),  this  form  is  to  be  filed  with  the  Court  no  later  than  5 	
days prior to the trial if property matters are in dispute at that trial.  A copy of this Acknowledgment shall also be 
provided to the o	pposing party 15 days prior to trial unless otherwise ordered by the Court.	
CERTIFICATE OF SERVICE	
 I HERE	BY CERTIFY that a copy of this 	Acknowledgment  Of  Verified  Disclosure  Statement	 (with schedules 	
and 	attachments) was served by 	q 	mail, postage prepaid, or 	q 	hand-delivery, or 	q electronic means, in accordance with 	
Kentucky Rule of Civil Procedure (CR) 5.02, on (	name	)  ___________________________________________________	
at (	address	)  ____________________________________________________________________\
_________________, 	
this the _______ day of __________	______________, _________.	
        __	__________________________________________	
        Signature
        q	 Attorney for  Petitioner  	q Attorney for Respondent	
        q	  Petitioner   	q  Respondent	
        Address	: 	
        ____________________________________________
        ____________________________________________
        ____________________________________________
                Phone: (     )  ________________________________
               Fax:  (     )   _________________________________
                          Email:  _____________________________________	
*NOTE
Next: Arkansas LLLP Application For Registration Form Previous: Application for Ex Parte Temporary Custody Order Form K Affidavit of Mover In Compliance With La. C.C.P. Art. 3945B
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