Pretrial Affidavit {Exhibit C}

EXHIBIT C. PRETRIAL AFFIDAVIT SUPERIOR COURT OF WASHINGTON COUNTY OF CLALLAM In Re the Marriage of: Petitioner, v. Respondent. ) ) ) ) ) ) ) NO. PRETRIAL AFFIDAVIT OF STATE OF WASHINGTON ) )ss County of Clallam ) ______________, being first duly sworn on oath, deposes and says: I. GENERAL INFORMATION 1.1 Name of Wife: 1.2 Name of Husband: 1.3 Dependent Children: a. Of this marriage: Name Age: Age: Date of Birth: Date of Birth: Date of Birth Age With Whom Residing b. Of former marriages: Name Date of Birth Age With Whom Residing 1.4 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) $ $ $ American LegalNet, Inc. www.USCourtForms.com Other: $ Net Employment Income: Other income (per month): TOTAL DISPOSABLE INCOME: 2.2 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. 3.1 Retirement benefits ­ future Employee Monthly Contrib.. Husband: $ Wife: $ IV. MONTHLY LIVING EXPENSES Employee Accrued Contrib. % Accrued Age During Earliest Marriage Eligibility RETIREMENT BENEFITS Estimated Present Value 4.1 Affiant's current monthly living expenses, excluding the debts set forth in paragraph VII, are as follows: IV. Description of Item Fair Market Value COMMUNITY ASSETS Encumbrance Net Value Awarded to to(husband/wife) Totals: $ $ $ American LegalNet, Inc. www.USCourtForms.com VI. SEPARATE ASSETS Description of Item Fair Market Value Encumbrance Net Value Awarded to (husband/wife) Totals: $ $ $ VII. LIABILITIES Mo. Payment $ $ Unpaid Balance $ 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:_______ $___________________ $______(_____)_______) $___________________ $_______________ $___________________ $______(______)_____ $___________________ $_______________ Assumed by Husband/Wife Creditor Totals: American LegalNet, Inc. www.USCourtForms.com IN RE THE MARRIAGE OF ____________________ CLALLAM COUNTY CAUSE # PROPERTY VALUATION AND DISTRIBUTION, PAGE NO. ____ WIFE'S PROPOSED HUSBAND'S PROPOSED AWARDS AWARDS To wife at To husband To wife at To husband this value at this this value at this value value COURT'S AWARDS To wife at this value To husband at this value Court Remarks NO. Item of Property American LegalNet, Inc. www.USCourtForms.com