Rule 1920.75. Form of Inventory

The inventory required by Pa.R.C.P. No. 1920.33(a) shall be substantially in the following form:

(Caption)INVENTORYOF

(Plaintiff) (Defendant) files the following inventory of all property owned or possessed by either party at the date of separation and all property transferred within the preceding three years.

(Plaintiff) (Defendant) verifies that the statements made in this inventory are true and correct. (Plaintiff) (Defendant) understands that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. (Plaintiff) (Defendant)

ASSETS OF THE PARTIES

(Plaintiff) (Defendant) marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages.

( ) 1. Real Property

( ) 2. Motor vehicles

( ) 3. Stocks, bonds, securities and options

( ) 4. Certificates of deposit

( ) 5. Checking accounts, cash

( ) 6. Savings accounts, money market and savings certificates

( ) 7. Contents of safe deposit boxes

( ) 8. Trusts

( ) 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries)

( ) 10. Annuities

( ) 11. Gifts

( ) 12. Inheritances

( ) 13. Patents, copyrights, inventions, royalties

( ) 14. Personal property outside the home

( ) 15. Business (list all owners, including percentage of ownership, and officer/director positions held by a party with company)

( ) 16. Employment termination benefits—severance pay, worker’s compensation claim/award

( ) 17. Profit sharing plans

( ) 18. Pension plans (indicate employee contribution and date plan vests)

( ) 19. Retirement plans, Individual Retirement Accounts

( ) 20. Disability payments

( ) 21. Litigation claims (matured and unmatured)

( ) 22. Military/V. A. benefits

( ) 23. Education benefits

( ) 24. Accounts receivable, including loans and mortgages payable to a party

( ) 25. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute)

( ) 26. Other

MARITAL PROPERTY

(Plaintiff) (Defendant) lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date of separation: Item NumberDescriptionof PropertyNames ofAll OwnersEstimated Value atDate of Separation

NON MARITAL PROPERTY

(Plaintiff) (Defendant) lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property: Item NumberDescriptionof PropertyReason forExclusionEstimated Value atDate of MarriageEstimated Value atDate of Separation

PROPERTY TRANSFERRED Item NumberDescriptionof PropertyDate ofTransferConsider-ationPerson toWhom Trans-ferredEstimated Value atDate of Separation

LIABILITIES Item NumberDescriptionof PropertyNames ofAll CreditorsNames ofAll DebtorsEstimated Value atDate of Separation

Official Note

See Pa.R.C.P. No. 1930.1(b). This rule may require attorneys or unrepresented parties to file confidential documents and documents containing confidential information that are subject to the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania .