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Clark County, Ohio |
FILED
IN THI COURT
ve OF COMMON PLEAS APR 04 2024 - v
RSG sons
DIVISION Common Pleas Court
COUNTY, OHIO ielisca M. Tuttle, Clerk
!
Coralyn B. Pritckard caseNo. 24 DRO 139
Plaintiff/Petifioner 1
Judge.
vs./and
1 Magistrate
Michee FE Prrkchord
Defendant/Petitioner 2
: Check local court rules to determine when this form must be filed. List ALL OF YOUR PROPERTY AND
DEBTS, THE PROPERTY AND DEBTS OF YOUR SPOUSE, AND ANY JOINT PROPERTY OR DEBTS. You must
provide the most recent value for each asset and balance owed for each debt. Do not leave any category blank. For each
item, if none, put “NONE.” If you do not know exact figures for any item, give your best estimate, and put “EST.” If more
space is needed, add additional pages.
AFFIDAVIT OF PROPERTY AND DEBT
Affidavit of C.Ord\ypj X. vritchory
(Print Name)
1. REAL ESTATE INTERESTS
Address Present Fair Titled To Mortgage Balance Equity
Market Value
19452. Cyens Meoauasr 25% GIL, 196 Lecunenlanc $ Dl, bile. §
Soury Kuedia On “ARM
29992 Cyueuls Atenasio $_//4, FF0 Cyairtig Die $.
Sout Vemma Ot Caeaeyl M1 eHaee
Pei TtHarD
TOTAL SECTION I: REAL ESTATE INTERESTS: §.
il, OTHER ASSETS
Category Description Value
A. Vehicles and Other Certificate (Include model and year of
of Title Property automobiles, trucks, motorcycles,
boats, motors, motor homes, trailers,
ATVs, snowmobiles, jet skis, etc.)
1. 617 Suoueu. Qurencx’ _Geay Sut Mieunee Pertcunees 16400
2, Sol GMC Sucueoan Brace SUV Heuer. Hate $
1SUCT
Supreme Court of Ohio Page 1 of 5
Uniform Domestic Relations Form — Affidavit 2
AFFIDAVIT OF PROPERTY AND DEBT
Approved under Ohio Civil Rule 84
Amended: June 1, 2021
Gatesory Description TitledTo Value
R00S Honion Gacousing Suet. Henne. Ferreunen
B. Financial Accounts (Include checking, savings, CDs,
POD accounts, money market
accounts, etc.)
PNG ~ od Gey + 2 WINGS VOIT. g_ (250d
USAA LCdetieisy Joie 240
Caeca Pye +
Maustindaront Bansic / CHEtii ny cers MEP 40
C. Pensions & Retirement (Include profit-sharing, IRAs,
Plans 401(k) plans, etc. Describe each -
type of plan)
HrCoeme. Greonz Cr ry PeENSion + Y03b Cacavns Ferrome ¢ 239,093 /534.9%
Maoison Heat 05 b Catium) Parrenseo $
Toner Spuintus Plast VA ~ USAemy Micagea. Pareuneo ¢ 87%30/410, 255°
Cnuiteotfencruec Yitk ~ Srocs Oeriss Micuaa Parrouaes $ (5950
Makan STANLEY RotH (2A ~Teno 712A Miguaer Peieuaed € 763660 /4/24 000
Makgan STANLEY Traoirianac (2A Carown PercHned $ /F38F
D. Publicly Held Stocks, (Name of company and number of
Bonds, Securities & Mutual shares)
Funds
None
Supreme Court of Ohio
Uniform Domestic Relations Form — Affidavit 2
AFFIDAVIT OF PROPERTY AND DEBT
Approved under Ohio Civil Rule 84
Amended: XXXX, 2021 Page 2 of 5
Gategory Description
E, Closely Held Stocks & Other (Type of ownership and number of
Business Interests and Name shares)
of Company
Aine $
$
F. Life Insurance (Company (Insured Life) Cash Value and
Name and Term or Whole Life) Loan Balance, if
any
Oestean SoutHeen MEP ¢_/000-
Taevesr Wore ee cee $_ [6600 —
$
$
G. Furniture & Household
Goods, Furnishings, and
Appliances .
H. Safe Deposit Box
(Give location and contents)
Nose
1. All Other Assets Not Listed (If necessary, attach additional
Above (including jewelry, art, pages)
tools, firearms, and other
collectibles) ~
Motaan Stoney AivestMenT ACcua NTS CéPL MEP $ 4H,
$
TOTAL SECTION Il: OTHER ASSETS: $
Supreme Court of Ohio
Uniform Domestic Relations Form — Affidavit 2
AFFIDAVIT OF PROPERTY AND DEBT
Approved under Ohio Civil Rule 84
Amended: XXXX, 2021 Page 3 of 5
Ml. SEPARATE PROPERTY CLAIMS
Separate property includes, but is not limited to, property owned before marriage and gifts or inheritances to
only one spouse.
Description Why do you claim Present Fair Market
this as separate Value
property?
Abu
$
TOTAL SECTION Ill: SEPARATE PROPERTY CLAIMS: $
IV. DEBT
List ALL OF YOUR DEBTS, your spouse's debts, and any joint debts. Do not leave any category blank. For each item,
if none, put “NONE.” If you don’t know exact figures for any item, give your best estimate, and put “EST.” If more space
is needed to explain, please attach an additional page with the explanation and identify which question you are
answering.
Type Name of Creditor Name on Total Debt Monthly
Account Due Payment
A. Secured Debt (Mortgages,
Car, etc.)
Oneuneo
Penaney Meera nae Fae Cacat Mip haga Gaile Fal $PH/0
6 66 $ 03D
Quo MueTUAGE a ” $94 4.99 $_ 650
AqicuqepD
SUF SUBREU OuTeAce egur Pat Cecor Untant PEITCHARD $ Aor “7000 3_ 595
n
SOF GHC Suoueban USAA $ 3 433
“
Hanlon Goons 4 Heston $ 3 25F —
B. Unsecured Debt (Credit
cards, medical bills, other
debts)
>
Descaver Chea CRAME? 3/2000 5 5000
GooryEar = MEP $506 ¢_700
Aue Derar —____ 3 _H37 5 430
Supreme Court of Ohio
Uniform Domestic Relations Form ~ Affidavit 2
AFFIDAVIT OF PROPERTY AND DEBT
Approved under Ohio Civil Rule 84
Amended: XXXX, 2021 Page 4 of 5
Type Nameof Creditor Name on Total Debt _ Monthly
Account Due Payment
4. Lowes 7 9 04S g_ (0S
5 tlucora USA ? MEP 5 tT $ 292 .¥F
TOTAL SECTION IV: DEBT: $
V. BANKRUPTCY
Filed by Date of Filing Date of Type of Case Current
Discharge or (Ch. 7, 14, 12, Monthly
Relief from 13) Payments
Stay
1 Nine $ $
$ $
TOTAL SECTION V: BANKRUPTCY: $
OATH OR AFFIRMATION
(Do not si ig!gn until Notary Public is present)
|, (print name).
of my knowledge and
Carolys
Ga R ftehercl
0. swear or affirm that | have read this Affidavit and, to the best
lief, the facts and information stated in this Affidavit are true, accurate, and complete. |
understand that if | do not tell the truth, | may be subject to penalties for perjury.
ONahyp LEZ
Your Sign4ture
STATE OF nit ) )
county
or Mo ig omery
Sworn to or affirmed before me by. Coralyn n. Prikevordhis l Sey of Apri } 34
PATRICIA Y HORSTMAN C oY Poubmon
Notary Public
26 Signature of Nofary Public
2h = State of Ohio
My Comm. Expires
June 15, 2026 Rance Y. Horsbnon,
Printed Name of’Notary Public
(Affix seal here) Commission Expiration batt S025
Uniform Domestic Relations Form — Affidavit 2
AFFIDAVIT OF PROPERTY AND DEBT
Approved under Ohio Civil Rule 84
Amended: XXXX, 2021 Page 5 of 5
Preview
Clark County, Ohio | FILED IN THI COURT ve OF COMMON PLEAS APR 04 2024 - v RSG sons DIVISION Common Pleas Court COUNTY, OHIO ielisca M. Tuttle, Clerk ! Coralyn B. Pritckard caseNo. 24 DRO 139 Plaintiff/Petifioner 1 Judge. vs./and 1 Magistrate Michee FE Prrkchord Defendant/Petitioner 2 : Check local court rules to determine when this form must be filed. List ALL OF YOUR PROPERTY AND DEBTS, THE PROPERTY AND DEBTS OF YOUR SPOUSE, AND ANY JOINT PROPERTY OR DEBTS. You must provide the most recent value for each asset and balance owed for each debt. Do not leave any category blank. For each item, if none, put “NONE.” If you do not know exact figures for any item, give your best estimate, and put “EST.” If more space is needed, add additional pages. AFFIDAVIT OF PROPERTY AND DEBT Affidavit of C.Ord\ypj X. vritchory (Print Name) 1. REAL ESTATE INTERESTS Address Present Fair Titled To Mortgage Balance Equity Market Value 19452. Cyens Meoauasr 25% GIL, 196 Lecunenlanc $ Dl, bile. § Soury Kuedia On “ARM 29992 Cyueuls Atenasio $_//4, FF0 Cyairtig Die $. Sout Vemma Ot Caeaeyl M1 eHaee Pei TtHarD TOTAL SECTION I: REAL ESTATE INTERESTS: §. il, OTHER ASSETS Category Description Value A. Vehicles and Other Certificate (Include model and year of of Title Property automobiles, trucks, motorcycles, boats, motors, motor homes, trailers, ATVs, snowmobiles, jet skis, etc.) 1. 617 Suoueu. Qurencx’ _Geay Sut Mieunee Pertcunees 16400 2, Sol GMC Sucueoan Brace SUV Heuer. Hate $ 1SUCT Supreme Court of Ohio Page 1 of 5 Uniform Domestic Relations Form — Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Gatesory Description TitledTo Value R00S Honion Gacousing Suet. Henne. Ferreunen B. Financial Accounts (Include checking, savings, CDs, POD accounts, money market accounts, etc.) PNG ~ od Gey + 2 WINGS VOIT. g_ (250d USAA LCdetieisy Joie 240 Caeca Pye + Maustindaront Bansic / CHEtii ny cers MEP 40 C. Pensions & Retirement (Include profit-sharing, IRAs, Plans 401(k) plans, etc. Describe each - type of plan) HrCoeme. Greonz Cr ry PeENSion + Y03b Cacavns Ferrome ¢ 239,093 /534.9% Maoison Heat 05 b Catium) Parrenseo $ Toner Spuintus Plast VA ~ USAemy Micagea. Pareuneo ¢ 87%30/410, 255° Cnuiteotfencruec Yitk ~ Srocs Oeriss Micuaa Parrouaes $ (5950 Makan STANLEY RotH (2A ~Teno 712A Miguaer Peieuaed € 763660 /4/24 000 Makgan STANLEY Traoirianac (2A Carown PercHned $ /F38F D. Publicly Held Stocks, (Name of company and number of Bonds, Securities & Mutual shares) Funds None Supreme Court of Ohio Uniform Domestic Relations Form — Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 2 of 5 Gategory Description E, Closely Held Stocks & Other (Type of ownership and number of Business Interests and Name shares) of Company Aine $ $ F. Life Insurance (Company (Insured Life) Cash Value and Name and Term or Whole Life) Loan Balance, if any Oestean SoutHeen MEP ¢_/000- Taevesr Wore ee cee $_ [6600 — $ $ G. Furniture & Household Goods, Furnishings, and Appliances . H. Safe Deposit Box (Give location and contents) Nose 1. All Other Assets Not Listed (If necessary, attach additional Above (including jewelry, art, pages) tools, firearms, and other collectibles) ~ Motaan Stoney AivestMenT ACcua NTS CéPL MEP $ 4H, $ TOTAL SECTION Il: OTHER ASSETS: $ Supreme Court of Ohio Uniform Domestic Relations Form — Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 3 of 5 Ml. SEPARATE PROPERTY CLAIMS Separate property includes, but is not limited to, property owned before marriage and gifts or inheritances to only one spouse. Description Why do you claim Present Fair Market this as separate Value property? Abu $ TOTAL SECTION Ill: SEPARATE PROPERTY CLAIMS: $ IV. DEBT List ALL OF YOUR DEBTS, your spouse's debts, and any joint debts. Do not leave any category blank. For each item, if none, put “NONE.” If you don’t know exact figures for any item, give your best estimate, and put “EST.” If more space is needed to explain, please attach an additional page with the explanation and identify which question you are answering. Type Name of Creditor Name on Total Debt Monthly Account Due Payment A. Secured Debt (Mortgages, Car, etc.) Oneuneo Penaney Meera nae Fae Cacat Mip haga Gaile Fal $PH/0 6 66 $ 03D Quo MueTUAGE a ” $94 4.99 $_ 650 AqicuqepD SUF SUBREU OuTeAce egur Pat Cecor Untant PEITCHARD $ Aor “7000 3_ 595 n SOF GHC Suoueban USAA $ 3 433 “ Hanlon Goons 4 Heston $ 3 25F — B. Unsecured Debt (Credit cards, medical bills, other debts) > Descaver Chea CRAME? 3/2000 5 5000 GooryEar = MEP $506 ¢_700 Aue Derar —____ 3 _H37 5 430 Supreme Court of Ohio Uniform Domestic Relations Form ~ Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 4 of 5 Type Nameof Creditor Name on Total Debt _ Monthly Account Due Payment 4. Lowes 7 9 04S g_ (0S 5 tlucora USA ? MEP 5 tT $ 292 .¥F TOTAL SECTION IV: DEBT: $ V. BANKRUPTCY Filed by Date of Filing Date of Type of Case Current Discharge or (Ch. 7, 14, 12, Monthly Relief from 13) Payments Stay 1 Nine $ $ $ $ TOTAL SECTION V: BANKRUPTCY: $ OATH OR AFFIRMATION (Do not si ig!gn until Notary Public is present) |, (print name). of my knowledge and Carolys Ga R ftehercl 0. swear or affirm that | have read this Affidavit and, to the best lief, the facts and information stated in this Affidavit are true, accurate, and complete. | understand that if | do not tell the truth, | may be subject to penalties for perjury. ONahyp LEZ Your Sign4ture STATE OF nit ) ) county or Mo ig omery Sworn to or affirmed before me by. Coralyn n. Prikevordhis l Sey of Apri } 34 PATRICIA Y HORSTMAN C oY Poubmon Notary Public 26 Signature of Nofary Public 2h = State of Ohio My Comm. Expires June 15, 2026 Rance Y. Horsbnon, Printed Name of’Notary Public (Affix seal here) Commission Expiration batt S025 Uniform Domestic Relations Form — Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 5 of 5