EXHIBIT C - Washington State Courts Washington Courts



EXHIBIT C. PRETRIAL AFFIDAVIT

SUPERIOR COURT OF Washington

COUNTY OF CLALLAM

)

In Re the Marriage of: ) NO.

)

Petitioner, ) PRETRIAL AFFIDAVIT OF

v. )

Respondent. )

)

STATE OF WASHINGTON )

)ss

County of Clallam )

______________, being first duly sworn on oath, deposes and says:

I. GENERAL INFORMATION

1.1 Name of Wife: Age: Date of Birth:

1.2 Name of Husband: Age: Date of Birth:

3. Dependent Children:

a. Of this marriage:

Name Date of Birth Age With Whom Residing

b. Of former marriages:

Name Date of Birth Age With Whom Residing

4. Support, maintenance and attorney fees I (request) (am willing to pay):

a. Monthly support for each dependent child $

b. Monthly maintenance for _______ months $

c. Attorney fees $

II. INCOME AND EMPLOYMENT

2.1 Husband:

a. Employer:

b. Position:

c. Average gross monthly wage: $

d. Deductions:

Withholding tax: $

Social Security (FICA) $

Other: $

Net Employment Income: $

Other income (per month): $

TOTAL DISPOSABLE INCOME: $

2. Wife:

a. Employer:

b. Position:

c. Average gross monthly wage: $

d. Deductions:

Withholding tax: $

Social Security (FICA) $

Other: $

Net Employment Income: $

Other Income (per month): $

TOTAL DISPOSABLE INCOME: $

III. RETIREMENT BENEFITS

3.1 Retirement benefits – future

Employee Employee % Accrued Age Estimated

Monthly Accrued During Earliest Present

Contrib.. Contrib. Marriage Eligibility Value

Husband: $

Wife: $

IV. MONTHLY LIVING EXPENSES

1. Affiant’s current monthly living expenses, excluding the debts set forth in paragraph VII, are as follows:

IV. COMMUNITY ASSETS

Description Fair Market

of Item Value Encumbrance Net Value Awarded to

to(husband/wife)

Totals: $ $ $

VI. SEPARATE ASSETS

Description Fair Market

of Item Value Encumbrance Net Value Awarded to

(husband/wife)

Totals: $ $ $

VII. LIABILITIES

Mo. Unpaid Assumed by

Creditor Payment Balance Husband/Wife

Totals: $ $ $

VIII. SUMMARY

Assets to Husband: $___________________

(Debts) to Husband: $______(_____)_______)

(Less) plus judgment/lien) $___________________

TOTAL: $_______________

Assets to Wife: $___________________

(Debts) to Wife: $______(______)_____

(Less) plus judgment/lien) $___________________

TOTAL: $_______________

IX. OTHER FACTORS

If any hearing on financial issues (e.g. physical disabilities, dependent children of prior marriages, etc.)

(Signature)

SUBSCRIBED AND SWORN TO before me this ____ day of _____, 20____.

____________________________________

Notary Public in and for the State of

Washington. Commission Expires:_______

IN RE THE MARRIAGE OF ____________________ CLALLAM COUNTY CAUSE #

PROPERTY VALUATION AND DISTRIBUTION, PAGE NO. ____

WIFE’S PROPOSED HUSBAND’S PROPOSED COURT’S AWARDS

AWARDS AWARDS

|NO. |Item of Property |To wife at |To husband |To wife at |To husband |To wife |To husband at |Court Remarks |

| | |this value |at this value |this value |at this value |at this value |this value | |

| | | | | | | | | |

| | | | | | | | | |

| | | | | | | | | |

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