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Appendix 3

Baldwin's Kentucky Revised Statutes Annotated48th Judicial Circuit - Franklin Family Court

Baldwin's Kentucky Revised Statutes Annotated
48th Judicial Circuit - Franklin Family Court
Appendices
KY RFFC App. 3
Appendix 3
Currentness
COMMONWEALTH OF KENTUCKY FRANKLIN CIRCUIT COURT DIVISION III--FAMILY COURT CIVIL ACTION NO. -CI-
IN RE: THE MARRIAGE OF
 
PETITIONER
AND
MANDATORY CASE DISCLOSURE ACKNOWLEDGMENT/STIPULATION
 
RESPONDENT
All sections must be completed. If the answer to a given section is “None,” “Not applicable,” or “Unknown,” answer that section accordingly. If a question requires further documentation or an additional schedule, please attach.
I, __________, declare under oath that my personal information is:
Name:
 
Address:
 
 
 
Social Security No.:
 
Date/Place of Birth:
 
Date/Place of Marriage:
 
Date of Separation:
 
Spouse's Name:
 
Spouse's Birth Date:
 
My occupation is:
 
I am currently employed at:
 
I earn __________ per __________ and work __________ hours (if paid hourly)
I am paid ( ) weekly ( ) monthly ( ) other __________.
My year to date earnings are __________ (attach four [4] most recent pay stubs).
My monthly gross income from employment is __________.
I hereby acknowledge that the information contained in __________'s mandatory Case
Disclosure is a true and accurate reflection of the financial disputes in the matter, and that there are no additional assets, debts, or issues that require disclosure, to the best of my knowledge and belief.
If maintenance is an issue, or if there are property distribution issues, please proceed to use the full mandatory Verified Disclosure form.
LAY WITNESSES
Name the lay witnesses (non-experts, i.e., friends, family members, etc.) you expect to call at trial and the issue(s) you expect them to testify about.
1.
 
 
2.
 
 
3.
 
 
4
 
 
5.
 
 
6.
 
 
EXPERT WITNESSES
Name the expert witnesses (doctors, accountants, etc.) you expect to call at trial and the issue(s) you expect them to address.
1.
 
 
2.
 
 
3.
 
 
4.
 
 
5.
 
 
6.
 
 
LENGTH OF TRIAL
How many days to you expect this trial to take? ___ hours ___ days.
OTHER LEGAL ACTIONS
Please give the name of the case, case number, and name of the Court or Administrative Agency for any case to which you are or have been a party within the last year, as well as a brief description of the nature of the case and the present status of the case.
1.
 
 
 
 
2.
 
 
 
 
3.
 
 
 
 
4.
 
 
 
 
REQUIRED SEPARATE ATTACHMENTS
You shall attach to this schedule:
1. Your three (3) most recent paycheck receipts or other documented evidence of earning for the last two (2) months if such paycheck receipts are not available;
2. A full and complete copy of your last three (3) federal income tax returns and the first page of your last three (3) State income tax returns.
I hereby certify that the above information is true to the best of my knowledge, information and belief.
 
 
PETITIONER( ) / RESPONDENT( )
Subscribed and sworn to before me this __________ day of __________, ___.
 
 
NOTARY PUBLIC,
STATE AT LARGE
My commission expires:
 
 
CERTIFICATE
It is hereby certified that a copy of the foregoing Mandatory Case Disclosure Acknowledgment/Stipulation (with attachments) was mailed on this __________ day of __________, __________, to:
 
 
 
 
 
 
 
 
 
 
Counsel for
Counsel for
 
 

Credits

HISTORY: Amended effective March 20, 2012.
Franklin Family Court App. 3, KY R FRANKLIN FAM CT App. 3
Current with amendments received through November 15, 2023. Some rules may be more current, see credits for details.
End of Document