Form 2C-E-167 "Asset and Debt Statement" - Hawaii

What Is Form 2C-E-167?

This is a legal form that was released by the Hawaii Family Court - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2017;
  • The latest edition provided by the Hawaii Family Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 2C-E-167 by clicking the link below or browse more documents and templates provided by the Hawaii Family Court.

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Download Form 2C-E-167 "Asset and Debt Statement" - Hawaii

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[
] Plaintiff/Petitioner [ ] Defendant/Respondent
IN THE FAMILY COURT OF THE SECOND CIRCUIT
STATE OF HAWAI’I
)
FC-_____
No.
_______________
)
)
ASSET AND DEBT STATEMENT
Plaintiff,
)
)
vs.
)
)
)
Defendant.
)
__________________________________ )
ASSET AND DEBT STATEMENT
[ ] Plaintiff/Petitioner [ ] Defendant/Respondent
[ ]Both Parties
1. Cash (on hand or held by others for me)
$__________________
2. CREDIT UNION ACCOUNTS:
Name
Title (P,DJ)
Credit Balance
Debt Balance
_________ ____________
____________
_________________________________________
_________ ____________
____________
_________________________________________
_________ ____________
____________
_________________________________________
_________ ____________
____________
_________________________________________
RG-AC-508 (5/17)
2C-E-167
(Rev. 4/2017)
[
] Plaintiff/Petitioner [ ] Defendant/Respondent
IN THE FAMILY COURT OF THE SECOND CIRCUIT
STATE OF HAWAI’I
)
FC-_____
No.
_______________
)
)
ASSET AND DEBT STATEMENT
Plaintiff,
)
)
vs.
)
)
)
Defendant.
)
__________________________________ )
ASSET AND DEBT STATEMENT
[ ] Plaintiff/Petitioner [ ] Defendant/Respondent
[ ]Both Parties
1. Cash (on hand or held by others for me)
$__________________
2. CREDIT UNION ACCOUNTS:
Name
Title (P,DJ)
Credit Balance
Debt Balance
_________ ____________
____________
_________________________________________
_________ ____________
____________
_________________________________________
_________ ____________
____________
_________________________________________
_________ ____________
____________
_________________________________________
RG-AC-508 (5/17)
2C-E-167
(Rev. 4/2017)
3. BANK AND SAVINGS ACCOUNTS:
(Include Trustee Accounts)
Company & Branch
Type of Account
Title
Current Balance
(P,DJ)
4. SECURITIES:
(Stocks, Bonds, Mutual Funds, Certificates of Deposit, etc.)
Company
Title
Date of
Cost
Market Value
Debt Owed
(P,DJ)
Acquisition
Against
5. VEHICLES:
(Autos, Trucks, Motorcycles, Trailers, Campers, Boats, etc.)
Year
Make
Title
Current Market Value
Debt Owed Against
(P,DJ)
6. REAL PROPERTY:
Address
Fee or
Title
Date of
Cost
Current Gross
Total Debt
Lease
(P,DJ)
Acquisition
Value
Owed
7. LIFE INSURANCE:
Company
Person Insured
Face
Beneficiary
Title
Cash
Debt Owed
Amount
(P,DJ)
Value
Against
8. RETIREMENT; PENSION; PROFIT SHARING ACCOUNTS:
Employer or Company
Title
Type of Plan
Years in
Total Value
(P,DJ)
Plan
9. ALL OTHER MAJOR ASSETS:
(Furniture, Household Effects, Art, Stamps, Coins, Tools, Equipment, Jewelry, Accounts
Receivable, Investment Assets, Business Assets, Cemetary Plots or Niches, Tax Refunds Due, etc.)
General Description
Title
Estimated
Debt Owed
(P,DJ)
Gross Value
Against
10. PROPERTY HELD IN TRUST FOR OR BY THIRD PERSON/S: (
Aside from Bank & Savings Accounts
Noted in paragraph 3)
Description
Trustee(s)
Beneficiaries
Value
Debt Owed
Against
11. ALL OUTSTANDING DEBTS
: (Include those listed parts 2, 4, 5, 6, 7, 9, and 10 above, in addition to all
credit cards, charges, finance companies, and personal loans.)
Creditor
Debtor
Security
Mo/Yr Debt
Total Balance
Min. Monthly
(P,DJ or Other)
Incurred
Owed
Payment
Total Debt in Plaintiff’s Name Alone: $__________________________________
Total Debt in Defendant’s Name Alone: $________________________________
Total Debt in Joint Names: $__________________________________________
CERTIFICATION
I hereby declare under the penalty of perjury that I have supplied the information used in
this Asset and Debt Statement and have reviewed this statement and I certify that the
information is accurate, complete and correct.
___
__________________
_________________________________
Date
Plaintiff’s/Petitioner’s Signature
_____________________
_________________________________
Date
Defendant’s/Respondent’s Signature
RESET FORM
2C-E-167
(Rev. 4/2017)
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