Court Rules


Rule 68 - Dissolution of Marriage

Rule 68 - Form 6804D - Asset Statement in Support of Application for Pendente Lite Order

IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
FAMILY COURT DIVISION
At Kansas City At Independence
IN RE THE MARRIAGE OF:

_____________________________________
Petitioner
and Case No. ___________________

_____________________________________
Respondent

ASSET STATEMENT IN SUPPORT OF
APPLICATION FOR PENDENTE LITE ORDER
____________________________
Name
1. Financial Accounts certificates of deposit, credit unions
and money market accounts

2. Securities
List total current value of all stocks, $__________
bonds, mutual funds and other securities
except those in retirement or IRA accounts

3. Life Insurance Cash Value
List cash value of all life insurance policies $__________

4. Cash on Hand $__________

5. Retirement Accounts
List all IRA's, 401K's, thrift plans and all $__________
other retirement or pension plans which have
a current account balance

6. Annuities
List current value of all annuities $__________


STATE OF MISSOURI )
) ss.
COUNTY OF JACKSON )

__________________, of lawful age and having been duly sworn, acknowledges being the _________________ in the above case and having knowledge of all the facts stated in the above and foregoing Asset Statement in Support of Application for Pendente Lite Order and states that all the facts therein are true.
___________________________________
Affiant
Subscribed and sworn to before me this ____ day of ___________, 19___.

___________________________________
My Commission Expires: Notary Public
Adopted by Court en banc 3/22/96
Effective 4/22/96
6804D