Missouri Statement of Property and Debt and Separation Agreement Form
For listing all of the properties, assets, and debts in a divorce case, the Missouri Statement of Property and Debt and Separation Agreement Form has to be completed and submitted.
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Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page 1 of ___ ___
IN THE CIRCUIT COURT O F ____ ___ ___ ___ ___ __ _____ __, M ISSOURI (Count y wher e c our t is located)
In r e the Mar riage o f
_________________ _____________ __________________ __ _________ (First) (Middl e) (Las t) (Jr./Sr./III)
Petitioner , Case N o. ______ _____ _
-and -
Division N o. _________ ___ _________________ _____________ __________________ __ _________ (First) (Middl e) (Las t) (Jr./Sr./III)
Respondent .
S tatem ent of P roper ty and De bt a nd
P ropos ed S epa rati on A gr eem ent
Are you Petition er or the R espon den t? (Check one o f these b oxes )
I am the Petitio ne r. ( The pa rty th at filed the or igina l pe tition)
I am the R esponde nt. (The pa rty tha t answers the or igina l pe tition f iled by hi s or he r spous e)
Are you the H usband or the Wi fe?
(Chec k one of the se b oxes )
I am the Wi fe.
I am the H usba nd.
W hat d oes t his do cum ent c ov er ?
The re are two p arts t o t his do cum ent. P art O ne is you r di vision o f prope rty and d ebt and P art Two
pe rtains to s pou sal sup por t or “maintena nce.” This do cum ent doe s not pertain t o child s up por t or
custody . I ssue s addr essing child s up por t and custody are containe d i n a pa renting plan.
Do I h av e to file this docum ent?
Yes. Y ou m ust file this docum ent w ith eithe r your “Petition f or D issolution o f Marriage” or your
“Answer,” even i f it is no t signe d by bot h pa rties.
W hat is a se par at ion ag reem ent?
It is an a greement in w hich you a nd y our spous e agree to a distribu tion of prope rty and de bt and t o
prov isions con cerning m aintena nce a nd a ttorne y’s fees. If bot h y ou a nd y ou s pous e sign t his
doc um ent, it is called a “Sepa ration A greement.” It doe s no t include prov isions for child custody and
child s up por t.
Form CAFC040-04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page 2 of ___ ___
Can the co urt do som ething di fferent than what I hav e p ropose d?
Absolutely. E ven i f bo th y ou a nd y our spous e ha ve signe d the ag reem ent , the court is not bo und by
it. I f the cou rt find s t ha t your ag reem ent is “u nc on sci ona ble” or doe s not di vide all pr ope rty and
marital de bt, it w ill not be appr ov ed by the cour t. The cour t can di vide the pr ope rty in a ny manne r it
cons ide rs fair, a nd it m ay or m ay not or de r m aintena nc e to b e pa id.
Part On e – D iv is io n o f P roperty and D ebt
W ha t is the m os t c om m on m istak e u nrepresented p ar ties m ak e in their
dissolu tion c as e?
W ithou t a d ou bt it is the fai lu re to c or rectly list all m ar ital an d non m ar ital
prop erty an d m arital d ebt . The rest of this for m e xpla ins in d etai l h ow to
av oi d this m istak e.
How do I c om plete P art O ne?
Part O ne con sists of the se instruc tion s and six ta bles.
Tab le 1 - Mar ital prop erty to be rece ived by Wi fe
Tab le 2 - Mar ital prop erty to be rece ived by H usba nd
Tab le 3 - N on marital pr ope rty to be received by W ife
Tab le 4 - Non marita l pr ope rty to be received by H usba nd
Tab le 5 - D ebts to b e pa id b y W ife
Tab le 6 - D ebts to b e pa id b y H usba nd
You m ust list all of your m arital and nonm arital prop erty and m arital de bt on on e of these six
tab les.
Use a s epa rate r ow for eac h item of p rope rty or debt. You s hou ld dr aw a line throug h a ll row s
tha t do no t contain an i tem of pr ope rty. T his is very impor tant because som eone coul d alter this
doc um ent after you ha ve signe d i t. Keep a copy of this doc um ent after you ha ve signe d i t.
W hat is m ar ital p roperty?
RSMo §452.3 30 de fine s m arital pr ope rty. Usua lly m arital pr op erty is prope rty acqui red by eithe r
spous e dur ing the m arriage of the pa rties ot her tha n prope rty acqui red by gift, inh eritanc e, or in
exc ha ng e f or no nm arital prope rty. T his m eans tha t al l wag es ear ned du ring the m arriag e ar e m artial
prope rty. A ll pr ope rty ow ne d by the parties is pr esum ed t o be m arital prope rty.
Nonm arital pr ope rty can be conv erted t o m arital prope rty by pl acing a spo use’s name on a n
accoun t or title. A lso, a m arital interest can be acqu ired i n no nm arital prope rty by the cont ribution o f
marital assets to the increase in v alue of the nonm arital pr ope rty. F inally, inc om e from nonm arital
prope rty dur ing the m arriag e of the parties i s m arital prope rty.
Mar ital prop erty to be awarde d t o W ife shou ld be listed i n Table 1 a nd m arital pr ope rty to be
awarde d t o H usba nd shou ld be listed in Table 2.
W hat is n on m ar ital p roperty?
Nonm arital pro pe rty is p rope rty that w as ac qui red prior to the m arriag e or prop erty tha t w as acqu ired
dur ing the m arriage by gift, inhe ritance, o r in exc hang e for nonm arital prope rty. N onm arital pr ope rty
is som etimes a lso cal led “s epa rate prop erty.” A ddi tiona lly, som e st ate teache r retirem ent bene fits a re
cons ide red nonm arital. R SMo. §169 .572.
No nm arital pr ope rty to be awarde d to W ife shoul d be listed in Table 3 a nd nonm arital prope rty to
be awarde d to H usband s ho uld be listed i n Table 4.
Form CAFC040-04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page 3 of ___ ___
Can p roperty b e m ar ital an d n onm ar ital?
Yes. I f an i tem of pr ope rty is pa rtly m arital and pa rtly nonm arital, the n it shou ld b e listed und er both
the m arital and n onm arital sect ion s. F or exa mple, if one pa rty ha d e arned pe nsion be ne fits for five
years pr ior to the m arriage and c on tinue d to e arn the same pe nsion b ene fits for five years dur ing the
marriage, one- half or 50 % of t he pe nsion a nd retirem ent be nefits ar e m arital and one -ha lf or 50% are
nonm arital. I n t ha t situa tion, t he pe nsion and retirement be nefits w oul d be listed bot h un de r m arital
and nonm arital pr ope rty.
W ha t is “fair m arket v alue”?
This i s t he amount som eone w oul d p ay for this item of pr ope rty tod ay. I t is not w ha t the prope rty
cost w hen y ou pur cha sed i t. A ten y ear old autom obi le ha s a value far less tha n the amount you pa id
for the autom obi le.
W ha t d oes “s ecu rity” m ea n?
The m ortgage on a ho me is tradition ally secu red by the hom e. W he n y ou f ina nc e the pur cha se of an
autom obi le, the com pa ny that loa ns you the m one y is listed on t he title to the automobi le. The y too
ha ve a sec urity interest in y our car. U sua lly, a de bt is s ecur ed by an i tem of pr ope rty if the pe rson t o
whom you ow e the m one y can t ake the item of pr ope rty if you f ail to pa y the de bt. The s che du les of
de bt ask you t o l ist any security for tha t de bt. Y ou m ust also list the prop erty tha t secures the de bt
unde r the pr op erty listing s.
W hat if I don ’t agree w ith this “Prop osed Separation A gree m ent”?
You m ust take app ropr iate actions to p rotect your interests. C ONS UL T A L AW YER. D o not fail to
respo nd i f you ha ve be en se rved w ith the se pa pe rs as the cou rt m ay proc eed w ithou t any furthe r
not ice to you.
Do w e h ave to l ist o ur prop erty even if w e’ve a lready di vided i t?
Yes, i t m ust st ill be i nclud ed on one of the tab les.
W hat p roperty should I list on this f orm ?
AL L PROP ERTY AND M AR ITAL DE BT m ust be divide d i n a di ssolution o f m arriage pr oc eeding .
Your di ssolution of m arriage m ay not be final unless this i s don e.
This inc lude s the follow ing type s of prop erty and de bt:
• Real estate
• Motor vehicles
• Bank accoun ts
• Pension a nd retirement plans and p rofit sha ring pl ans
• Stoc ks, bond s or other securities
• Life insuranc e
• Cash on h and
• Hous eho ld g oods
• Person al goods
• Trust in terests
• Busine sses or pa rtne rships
• Debts ow ed t o y ou o r your spous e by ot he rs
• Any int erest in p end ing litigation o r suits to be filed
• Farm equi pm ent, a nimals or crops
• Interest s in cont racts m ade and no t pe rformed
• Othe r ass ets.
Form CAFC040-04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page 4 of ___ ___
W hat d ebts sh ould I list on this f orm ?
You s hou ld l ist all loa ns from any indi vidua l, ba nk , c redit card c om pa ny , c redit un ion, s aving s and
loa n association o r ot he r lendi ng institution . I nc lude all debts ow ed by eithe r you or your spo use.
Make sure to list all credit cards and a ny amount s ow ed pur suant to any ba nk rupt cy or ot he r
repa yment pl an s.
Debts tha t the W ife sho uld pa y are to be listed i n Table 5 a nd D ebts tha t the H usband s hou ld pa y
are to be listed i n T able 6.
Do I h av e to list p roperty even if m y sp ou se’s n am e is n ot on it?
Yes, y ou m ust list all prop erty ow ne d by you a lone , by your spous e alone , and by you a nd y our
spous e tog ether. You m ust lis t p rope rty even i f it is no t in joint na mes. A ny pr op erty in w hich eithe r
you or your spous e claim A NY interest w ha tsoever, M UST be listed.
In many instanc es, y ou w ill not be able to s ell your pr ope rty or receive your retirement unl ess you
prov e tha t the se items w ere listed in y our dissolution o f m arriage judg ment.
Do I h ave to l ist p rop erty that either o f u s is buying a t th e p res ent tim e?
YES. Y ou m ust list all pr ope rty that eithe r you or you r spou se is pu rchasing by making mont hly
pa ym ents. S o, even i f you ow e m one y on your car or hom e, it still must be listed. A ctua lly , it m ust
be listed twice: o nc e as an item of pr ope rty and on ce a s a de bt secu red by the pro perty.
Do I h av e to list p roperty I o wned b efor e the m ar riag e?
Yes. This i s no rmally nonm arital prop erty, but und er som e ci rcum stan ces it m ay be con sidered
marita l pr op erty.
Do I h av e to list p roperty m y sp ou se owned before the m ar riag e?
Yes. Just as you ha d to l ist prope rty you ow ne d be fore the m arriage, y ou s houl d a lso l ist pr ope rty
your spous e ow ne d b efore the m arriage. O nc e again, this is no rmally nonm arital prope rty, but unde r
som e ci rcum stan ces it m ay be con sidered m arital prope rty.
I don ’t kn ow w hat m y sp ouse ow ns s o h ow can I l ist it?
You s hou ld hi re a lawyer to ass ist you. A l awy er ha s the ability to a ssist y ou i n l ocating th e asse ts of
your spous e.
M y m other a dd ed m y nam e t o her house, but I have n ot p aid a ny m on ey tow ard t he
purchase. Do I s till h ave to l ist this p roperty?
Yes. This w oul d nor mally be nonm arital pr op erty, but you s till have to list it.
Do I h ave to l ist p roperty th at I a cquired a fte r th e sep aration ?
You a re still m arried s o any pr ope rty or debt that you h ave acqui red since your m arriage ha s to be
inc lude d.
W hat h ap pens i f I don ’t l ist al l the p rop erty a nd m ar ital d ebt?
It w oul d be a VERY B IG mistake not to l ist all your prope rty and m arital de bt. Your di ssolution of
marriage m ay not be final, and y our spo use w ill be able to c om e ba ck in t he future and t ry and g et this
item of pr ope rty. I n s ome cases, y ou m ay not be able to r eceive your pe nsion or sell your pr op erty
withou t proof tha t your dissolution o f m arriage judg ment listed the prop erty.
Form CAFC040-04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page 5 of ___ ___
Should I list m y p ension inform at ion even though I am n ot entitled to receive an y
ben efits a t th e p res ent ti m e?
Yes.
Does t his m ean that I hav e to list every d ish and tow el th at w e ow n?
No. Y ou do no t ne ed t o list pr ope rty if it is of m inimal value . I f the item of pr ope rty is w orth l ess
tha n $ 100.00, y ou m ay omit it from your list.
W hat if I acquire s om e p rop erty or de bt a fte r I fi le m y case?
If you a cqui re any add ition al prope rty or debt dur ing the time this case is pe nd ing , y ou must not ify
the cour t of that fact at the time of your he aring . I f you di spo se of any pr ope rty or pa y of f any de bt
dur ing the time this case is pe ndi ng , y ou m ust not ify the cou rt of tha t fact at the time of your he aring .
W hat if I r un o ut o f space on one or m ore of th e tables?
You m ay make copi es of any of the six tables if you ne ed a ddition al room for m ore pr ope rty or debt.
W he n y ou ha ve listed all the pr op erty and de bt, y ou s houl d num be r the pag es. M ake sure y ou w rite
“Not A pp licable” or “N/A” in e ach bo x unde r “Item of Prope rty” or “Item of D ebt” tha t you do no t
fill. (Som eone cou ld fill this in l ater w ith s om e ot he r information)
After you h ave com ple ted P ar t On e, you shou ld c om plete P ar t Two o f this
doc um ent which p ertai ns to s pou sal s uppor t or m ai ntenan ce.
Im por tant
This d oc um ent is p lac ed in a cou rt file , w hich is an op en d ocum ent av ai labl e to
the p ublic. I n listing yo ur b ank o r o ther a cc ounts, o r your credit ca rd o r o ther
debt , d o n ot inclu de the e ntire ac cou nt n um be r. Y ou shou ld inclu de on ly
enough inform ation to d ist inguish your account from o ther a ccounts o wned b y
you an d you r spou se. F or e xam ple , in listing a c redit c ard n um be r, you shou ld
inclu de on ly the las t fou r d igits o f the a ccount, s uch a s xxxx-xxx x-xxx x-1234.
Form CAFC040-04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
TABL E 1. M ARI TAL P RO PERT Y TO BE AW ARDE D T O W IFE - The f ollow ing m arital proper ty is to be com e t he sole
and separ ate proper ty of WIFE. N ONMAR ITAL PR OPER TY OF WIFE SH OULD BE L IST ED IN TABL E 3 .
Ite m of P rope rty Presen t Fair
Market Value
Wh at is the
monthly
income from
this property?
Is there an
amount owed on
this property?
Pa rty with
Possession of
this Property
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
TABL E 2. M ARI TAL P RO PERT Y TO BE AW ARDE D T O HUS BAND - The f ollow ing marital pr oper ty is to be come the
sole and separ ate pr oper ty of HUS BAND . N ONMARITAL PROPERTY OF HUS BAND SH OULD BE L IST ED IN TABL E 4.
Item of P rope rty Presen t Fair
Market Value
Wh at is the
monthly
income from
this property?
Is there an
amount owed on
this property?
Pa rty with
Possession of
this Property
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
TABL E 3. NO NMARI TAL P RO PERT Y TO BE AW ARDE D TO W IFE - The f ollow ing no nm arital pr oper ty is to be come
the s ole and separ ate pr oper ty of WIFE. M AR ITAL PR OPER TY OF WIFE SHOULD BE L ISTED IN TABL E 1 .
Item of P rope rty Presen t Fair
Market Value
Wh at is the
monthly
income from
this property?
Is there an
amount owed on
this property?
Pa rty with
Possession of
this Property
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Hu sband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
TABL E 4. NO NMARI TAL P RO PERT Y TO BE AW ARDE D TO HUS BAND - The f ollow ing n onmarital proper ty is to
bec ome the sole an d s epar ate pr oper ty of HUS BAND . M AR ITAL PR OPER TY OF HUS BAND SH OULD BE L IST ED IN TABL E 2 .
Item of P rope rty Presen t Fair
Market Value
Wh at is the
monthly
income from
this property?
Is there an
amount owed on
this property?
Pa rty with
Possession of
this Property
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Hu sband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6. No
Wife Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tables 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List debt in Tabl es 5 or 6.
No
Wife
Husband Other
(Do not deduct amount owed f rom this value)
Yes - List deb t in Tabl es 5 or 6.
No
Wife
Husband Other
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
TABL E 5. DE BT S TO BE P AID BY W IFE - List all loans from any individual, ba nk, credit card c om pany , credit uni on,
savings an d loan a ssociation o r ot her lending institution w hich ar e to be pai d by WIFE. Wife is to inde mnify and hol d Husband
har mless for all deb ts listed on Tabl e 5.
The c redi tor’s rights to collect thes e deb ts from Husband are NOT af fected w ithout the consent of the creditor.
Item of D ebt Current
Balance
Mont hly
Payment
What is the s ecurity for
this debt , if any ? (This proper ty should be listed in Tables 1 through 4)
Marital or Separ ate
Debt
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
TABL E 6. DE BT S TO BE P AID BY HUS BAND - List all loans from any individual , ban k, credi t card c om pany , credit
uni on, savings and loan a ssociation or other lend ing institution w hich ar e to b e p aid by HUS BAND . Husband i s to indem nify and ho ld
Wife h armless for all de bts listed on T able 6.
Th e credi tor’s rights to collect thes e deb ts from Wife are N OT af fected w ithout the c ons ent of the creditor.
Item of D ebt Current
Balance
Mont hly
Payment
What is the s ecurity for
this debt , if any ? (This proper ty should be listed in Tables 1 through 4)
Ma rital or Separ ate
Debt
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
No nmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Marital
Nonmarital Both Unknow n
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
Part T wo – M aint ena nc e a nd O ther Prov isions
WHAT IS M AIN TENAN CE ?
Maint ena nc e is m oney paid on a regular schedule by one spouse to the other after the dissolution of
marriag e. It m ay be fo r a set period of time or it m ay be for an indefinite period of time. It usually
terminates upon the death of either party or the remarriage of the party receiving m aintenance unless the
parties agree ot herwise. It m ay or m ay not be su bject to future m odification upon a showing of changed
circu mstances. Maintenance used to b e referred to a s “alimon y.”
MAINTENA NC E T O W IFE (Chec k one and only one o f the se b oxes.)
The court la cks jurisdiction to enter any orders wi th respect to m aintenance of the W ife.
No m aintenance is to be paid to W ife by Husband. This agreement is not subject to modification.
Husban d shall p ay to Wife the sum of ___ ___ ___ ___ p er m onth as an d fo r m aintenan ce. S aid
maint ena nc e is _____ __ su bject to m odification. Said m aintenance shall t erminate upon the death of
either party, the remarriage of W ife, or at such earlier time as set forth herein.
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ __
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ __
MAINTENA NC E T O HUSBAND (Chec k one and only one of the se b oxes.)
The court la cks jurisdiction to enter any orders wi th respect to m aintenance of the Husban d.
No m aintenance is to be paid to Husban d by W ife. This ag reement is not subject to modification.
Wife shall pay to Husban d the sum of ___ ___ ___ ___ p er m onth as an d fo r m aintenan ce. S aid
maint ena nce is _____ __ su bject to m odification. Said m aintenance shall t erminate upon the death of
either pa rty, the remarriage of Hu sband, or at such earlier time as set forth herein.
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ __
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ __
WAGE W ITHHOLDING FOR M AINTENANCE
(Answer only if m aintena nc e is to be paid by either party.)
Income wi thholding shall b e prepared by the ob ligee and issued by the Circuit Clerk upon the effective
date of this order.
Income wi thholding shall n ot issue for the following reason(s):
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ _.
NO N-MAINTENANCE PAYMENT FRO M ONE PART Y TO THE OTHER P ART Y
___ ___ ___ ___ ___ _ shall p ay to _____ ___ ___ ___ __ the sum of ____ ___ ___ __ a s and for
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ____.
ATTORN EY’S FEES
Neither pa rty is to receive attorney’s fees from the other pa rty.
Wife shall p ay to ______ ___ ____ ___ ___ __ t he su m of __ ____ ___ ___ _ a s a nd for Husb and’s a ttorney’s
fees herein.
Husban d shall pay to _____ ____ ___ ___ ___ ___ the su m of ____ ___ ___ ___ a s a nd for W ife’s a ttorney’s
fees herein.
ADDITIONAL PROVISIONS:
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ _
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ _
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ _
____ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ _
Form CAFC040 -04/01/200 9
Statem ent of Proper ty and D ebt and P rop os ed S epar ation Agreem ent – Page __ ____ of ____ __
I c ertify un der oath that I have given m y spo us e a c opy of this Statem ent of Prop erty and D ebt pur sua nt
to M issour i Supr em e C our t Rule 43. 01( d) by: (You MUST check at leas t ONE of the f ollowing three box es)
Serving a c opy with t he pe tition . Mai ling a c op y to m y spous e or his or her attorney on ____ ___ ___ __ ___, 20 ___ __ at the
following addr es s: __________________ _________ __________________ _________ ________________ (Street) __________________ _______ __________________ _____________ _ (City) (State) (Zip)
Hand ing a c op y to m y spou se or hi s or her attorne y on ____ ___ ___ __ ___, 20 ___ __. Sen ding a cop y to m y spou se or hi s or her at torne y by fax to ____ ___ ___ __ ___ __ __ (telephone
num ber ) on ___ ___ ___ ___ ___, 20__ ___ at ___ ___ ___ ___ (time ). Instructions : The following information MUST be filled in before a notary public. Your Statement of Property and D ebt is required to be ve rified before a notary public.
COUNTY O F ____ ___ ___ )
) ss.
ST AT E O F _____ ___ ___ _ )
Wife, of lawful age, bei ng duly sworn on h er oat h, states that she i s the Wife na med h erein an d
that the f ac ts stated in this Statem ent of Proper ty and Debt are t rue ac cording h er bes t know ledge an d
bel ief, an d t hat she agr ees with the terms and c ondi tions set forth her ein.
Further , Wife s tates that she ex ec uted t his Statem ent of Proper ty an d D ebt as he r free ac t and
deed .
► _____ ___ ___ ___ ___ __ ____ ___ ___ __ ___ ____ ___ ___ __ ___ ___ ___ _____ ___ ___ __
WIFE – SIGN HE RE WIFE – PRINT YOUR N AME H ERE
Subs cribed a nd s worn t o this ___ __ da y of ___ __ ___ _____ ___ __, 20 ___ _.
____ ___ ___ __ ___ ___ ___ ___
Notary Publ ic
My C om mission E xpires :
COUNTY O F ____ ___ ___ )
) ss.
STATE O F _____ ___ ___ _ )
Hus ban d, of lawful ag e, bei ng d uly sworn on his oath, states tha t he is the H us band n am ed
her ein a nd t hat the f ac ts stated in this Statem ent of Proper ty an d D ebt are t rue ac cording his bes t
know ledge an d b elief, and that he a grees with t he t erms and c on ditions set forth h erein.
Further , Hus ban d s tates that he ex ec uted t his Statem ent of Proper ty an d D ebt as hi s free ac t and
deed .
► _____ ___ ___ ___ ___ __ ____ ___ ___ __ ___ ____ ___ ___ __ ___ ___ ___ _____ ___ ___ __
HU SBAND – SIGN H ER E HUS BAND – PR INT YOUR NAM E H ER E
Subs cribed a nd s worn t o this ___ __ da y of ___ __ ___ _____ ___ __, 20 ___ _.
____ ___ ___ __ ___ ___ ___ ___
Notary Publ ic
My C om mission E xp ires:
Form CAFC040 -04/01/200 9
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