STATE OF NEW MEXICO
EIGHTH JUDICIAL DISTRICT COURT
COUNTY OF ___________________
_________________________,
Petitioner,
v. No. __________
_________________________,
Respondent.
________________________, by __________________________,
respectfully submits:
1. Schedule A - Personal and Financial Summary;
2. Schedule B - Community Property and Liabilities;
3. Schedule C - Separate Property and Liabilities;
4. Schedule D - Monthly Income and Expenses; and
5. Schedule E or F - Child Support Obligation.
_______________________________
Attorney for __________________
_______________________________
_______________________________
(505)-_____-__________
________________________________'S PERSONAL SUMMARY
Date of marriage: _____________________________
Date of separation: ___________________________
Children of this marriage: ____________________
(Name) (Age) (Date of Birth)
__________________________ _______ _________________
__________________________ _______ _________________
__________________________ _______ _________________
Husband Wife
1. Age/date of birth: ____ _________ _____ __________
2. Education: _______________ _________________
3. Employment: _______________ _________________
4. Gross annual
employment income: _______________ _________________
_______________ _________________
_______________ _________________
_______________ _________________
5. Other: _______________ _________________
STATE OF NEW MEXICO )
) ss.
COUNTY OF ___________ )
________________________, being first duly sworn upon oath,
deposes and states: That [he] [she] has read, knows and
understands the contents of this pleading, and the statements
herein are true of [his] [her] own knowledge and belief.
________________________________
Subscribed and sworn to before me this ____ day of
______________, ________.
________________________________
Notary Public
My commission expires: _____________________
We certify we have mailed a copy of
the foregoing to opposing counsel/
party of record this _____ day of
_________________________, ______.
___________________________________
__________________________ 'S COMMUNITY PROPERTY AND LIABILITIES
SCHEDULE
Neither party is required to submit a proposed distribution.
Any stipulation regarding value or distribution should be indicated
by an asterisk.
ASSETS:
Proposed
Value distribution
Husband Wife
1. Cash $_______ $_______ $_______
2. Checking/savings accounts:
a) #____________ Ck. ________ ________ ________
b) #_____________ Ck. ________ ________ ________
c) #_____________ Sav. ________ ________ ________
d) #_____________ CD's ________ ________ ________
e) #_____________ Cr. Un. ________ ________ ________
3. Stocks/bonds:
a) ____________ Sh. ____________ ________ ________ ________
b) ____________ Sh. ____________ ________ ________ ________
4. Insurance:
(Face Amount) (Cash Value)
a) $____________ $___________ $________ $________
Loan- $________ $________
b) $____________ #___________ $________ $________
5. Real estate:
a) __________________________ $_______
Mortgage ($________/mo) _________
REC ($________/mo) _________
Cost/sale ($________/%) _________ ________ ________
________
b) __________________________ $_______
Mortgage ($________/mo) _________
REC ($________/mo _________
Cost/sale ($________/%) _________ ________ ________ ________
6. Vehicles:
a) ________________ $_________
Lien ($_________/mo) ____________
a) ________________ $_________
Lien ($_________/mo) __________ ________ ________ ________
7. Business assets: ____________ ________ ________ ________
8. Household furniture/goods ________ ________ ________
9. Tax refunds ________ ________ ________
10. IRA/Keogh/Annuity ________ ________ ________
11. Retirement ________ ________ ________
12. Retirement ________ ________ ________
13. Other Total Assets ________ ________ ________
TOTAL ASSETS $_______ $_______ $_______
LIABILITIES: (mo/paymt) Value Husband Wife
a. ________________ ($__________) ________ ________ ________
b. ________________ $__________) ________ ________ ________
c. _______________ ($__________) ________ ________ ________
d. ________________ ($__________) ________ ________ ________
e. ________________ ($__________) ________ ________ ________
f. ________________ ($__________) ________ ________ ________
g. ________________ ($__________) ________ ________ ________
h. _______________ ($__________) ________ ________ ________
i. ________________ ($__________) ________ ________ ________
j. ________________ ($__________) ________ ________ ________
k. ________________ ($__________) ________ ________ ________
l. _________________ ($__________) ________ ________ ________
m. Tax Liability ($__________) ________ ________ ________
TOTAL LIABILITIES $_______ $_______ $_______
ESTIMATED NET ASSETS $_______ $_______ $_______
Equalization of Assets $_______ $_______
EQUAL ASSETS $_______ $_______
___________________________'S SEPARATE PROPERTY AND LIABILITIES
SCHEDULE
ASSETS: Husband Wife
1. Checking and Savings Accounts:
a) _________Bk Check #_________ $_______ $_______
b) _________Bk Check #_________ ________ ________
c) ______________ CD. #_________ ________ ________
d) ___________ Cr.Un. #_________ ________ ________
2. Stocks/Bonds:
a) ______________ Sh. __________ ________ ________
b) ______________ Sh. __________ ________ ________
3. Insurance: (Face Amount) (Cash Value)
a) ________ #________ $_______ $_______
Loan Balance ________ ________ ________
b) ________ #________ $_______ $_______
Loan Balance ________ ________ ________
4. Household Furniture/Goods: ________ ________
5. Real Estate: (Pres.Val.)
a) ____________________ $_______
Mortgage ($__________/mo) ________
REC ($__________/mo) ________ ________ ________
b) ____________________ $_______
Mortgage ($__________/mo) ________
REC ($__________/mo) ________ ________ ________
6. Vehicles:
a) ___________________________ ________ ________
b) ___________________________ ________ ________
7. Other:
a) ___________________________ ________ ________
b) ___________________________ ________ ________
c) ___________________________ ________ ________
Total Separate Assets $_______ $_______
LIABILITIES:
a) ___________________________ $_______ $_______
b) ___________________________ ________ ________
c) ___________________________ ________ ________
Total Separate Liabilities $_______ $_______
NEW SEPARATE PROPERTY $_______ $_______
INCOME:
1. Gross monthly employment income $_______
Deductions:
Federal withholding,
Single/married: _____ exemption(s) $_______
State withholding ________
FICA ________
Medical insurance for
child/children ________
Total deductions ________
Net monthly employment income $_______
2. Other income $_______
a) child support ________
b) alimony ________
c) other (specify) ________
d) other (specify) ________
Total other income ________
TOTAL MONTHLY INCOME $_______
EXPENSES:
a. Child support/alimony $_______
b. Residence: rent/mortgage $_______
Taxes ________
Insurance ________
Maintenance/repairs ________
Utilities: gas ________
water/refuse ________
electricity ________
telephone ________
other ________ ________
c. Vehicle: Payment $_______
Gasoline ________
Maintenance/repairs ________
Insurance/license
(per year) ________ ________
d. Food: Groceries/household supplies $_______
Meals out ________
School lunches ________ ________
e. Clothing: Yours $_______
Child/children ________
Cleaning ________ ________
f. Medical: Insurance premiums-yours $_______
Not covered by insurance/
deductible ________
Dental ________
Prescriptions ________
Counseling/therapy ________ ________
g. Life Ins.: Yours $_______
child/children ________ ________
h. Child care: babysitting/nursery $_______
Allowances ________
Tuition ________
School activities ________
Camps ________ ________
i. Entertainment/vacations: ________
j. Retirement/IRA: ________
k. Incidentals:
Church donations $_______
Dues ________
Gifts ________
Newspapers/magazines/books ________
Personal groom (barbers, etc.) ________ ________
1. Debt Reduction/other:
a) reserve for income tax ________ ________
b) ________
c) ________
d) ________
TOTAL MONTHLY EXPENSES $_______
________________________'S BASIC VISITATION MONTHLY CHILD SUPPORT
SCHEDULE
Custodial Other
Parent Parent Combined
1. Gross monthly income $_______ $_______ $_______
2. Percentage of combined income ____% ____% 100%
3. Number of children: ______
4. Basic support from Table A $_______
5. Children's health/dental
insurance premium ________ ________ ________
6. Work-related child care ________ ________ ________
7. Total support $_______
8. Each parent's obligation ________ ________
9. Total of Lines 5 and 6 ________ ________
10. Each parent's obligation ________ ________
11. __________________ pays ____________________ $________ per month.
12. Extraordinary expense allocation:
a. Medical, therapy, orthodontic
dental and eyecare ____% ____%
b. Private schooling ____% ____%
c. Other ____% ____%
PART I - BASIC SUPPORT:
Father Mother Combined
1. Gross monthly income $_______ $_______ $_______
2. Percentage of combined income ____% ____% 100%
3. Number of children: _____
4. Basic support from Table B $_______
5. Each parent's share
(Line 4 x each parent's
Line 2) $_______ $_______
6. Each parent's time of
care of child ____% ____%
7. Amount retained (Line 5 x
Line 6 for each parent) $_______ $_______
8. Each parent's obligation $_______ $_______
9. Amount transferred $_______
PART II - ADDITIONAL PAYMENTS:
10. Child's health/dental
insurance premium $_______ $_______ $_______
11. Work-related child care ________ ________ ________
12. Total additional payments $_______ $_______ $_______
13. Each parent's obligation $_______ $_______
14. Amount transferred $_______ $_______
15. Line 9 $_______
16. Line 14 $_______
17. ________________ pays ________________ each month $_______
PART IV - ALLOCATION OF EXTRAORDINARY EXPENSES:
18. Medical, therapy, orthodontic
dental and eyecare ____% ____%
19. Private schooling ____% ____%
20. Other ____% ____%
[Rule 14, approved, effective January 1, 1991; LR8-108C NMRA; as
amended, provisionally and recompiled, effective July 1, 2000 until
statewide domestic rules and forms are adopted by the Supreme Court.]