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Statement of Net Worth

Complete your NY Matrimonial Statement of Net Worth. All calculations are automatic — totals update as you type.

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Instructions: Complete all items. Mark fields as None, Inapplicable, or Unknown where appropriate. To convert weekly expenses to monthly, multiply by 4.3. Your progress is automatically saved in your browser. Use the Print button when complete to generate a copy for your attorney.
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Official Verification
Required — NY Supreme Court Matrimonial Form [UCS Rev.1/1/26]

SUPREME COURT OF THE STATE OF NEW YORK

STATE OF NEW YORK ) COUNTY OF ) ss.:
, the , being duly sworn, deposes and states that, subject to the penalties of perjury under the laws of New York, which may include a fine or imprisonment, that I understand that this document may be filed in an action or proceeding in a court of law and the following is a true and accurate statement, except as to matters alleged on information and belief and as to those matters I believe it to be true, as of , of my:
  1. net worth (assets of any kind and nature and wherever located minus liabilities)
  2. statement of income from all sources
  3. statement of assets transferred of any kind and nature and wherever located
  4. statement of expenses

Complete all items, marking "NONE", "INAPPLICABLE", and "UNKNOWN" if appropriate.

I. Family Data
II. Expenses (monthly basis — weekly × 4.3) TOTAL MONTHLY: $0
(a) Housing Total: $0
(a) Total Housing $0
(b) Utilities Total: $0
(b) Total Utilities $0
(c) Food Total: $0
(c) Total Food $0
(d) Clothing Total: $0
(d) Total Clothing $0
(e) Insurance Total: $0
(e) Total Insurance $0
(f) Unreimbursed Medical Total: $0
(f) Total Unreimbursed Medical $0
(g) Household Maintenance Total: $0
(g) Total Household Maintenance $0
(h) Household Help Total: $0
(h) Total Household Help $0
(i) Automobile Total: $0
(i) Total Automobile $0
(j) Education Costs Total: $0
(j) Total Education Costs $0
(k) Recreational Total: $0
(k) Total Recreational $0
(l) Miscellaneous Total: $0
(l) Total Miscellaneous $0
(m) Other Total: $0
(m) Total Other $0
TOTAL MONTHLY EXPENSES $0
III. Gross Annual Income GROSS ANNUAL: $0

List amounts as reported (or should be reported) on most recent Federal income tax return. Attach W-2s, 1099s, K-1s, tax returns, and two most recent paystubs.

(a) Gross Income from Tax Return
(b) Retirement / Tax-Deferred Deductions
(c) Additional Income Not in (a) Subtotal: $0
(d) Income Taxes Paid
GROSS ANNUAL INCOME (a + additional) $0
IV. Assets TOTAL ASSETS: $0

If any asset is held jointly with spouse or another, so state and set forth your respective shares.

A.1. Cash Total: $0
A.2. Checking Accounts Total: $0
A.3. Savings Accounts (incl. CDs, Treasury Notes) Total: $0
B.4. Investment Accounts / Securities / Broker / Mutual Funds Total: $0
C.5. Real Estate (at market value — do not deduct mortgage) Total: $0
D.6. Retirement Accounts (IRA, 401k, 403b, pension, deferred comp) Total: $0
E.7. Vehicles (Auto, Boat, Truck, Plane, Camper, Motorcycle) Total: $0
F.8. Jewelry, Art, Antiques, Furnishings, Precious Metals (>$500/item) Total: $0
G.9. Interest in Any Business Total: $0
H.10. Cash Surrender Value of Life Insurance Total: $0
I.11. Loans to Others and Accounts Receivable Total: $0
J.12. Contingent Interests (stock options, life estates, inheritances) Total: $0
K.13. Funds in Electronic Payment Apps (Venmo, PayPal, etc.) Total: $0
L.14. Cryptocurrency Total: $0
M.15. Other Assets (tax shelters, collections, judgments, patents, 529s, UGMA, trusts) Total: $0
TOTAL ASSETS $0
V. Liabilities TOTAL LIABILITIES: $0
A.1. Accounts Payable Total: $0
B.2. Credit Card Debt Total: $0
C.3. Mortgages Payable on Real Estate Total: $0
D.4. Home Equity and Other Lines of Credit Total: $0
E.5. Notes Payable Total: $0
F.6. Broker Margin Accounts Total: $0
G.7. Taxes Payable Total: $0
H.8. Loans on Life Insurance Policies Total: $0
I.9. Other Liabilities Total: $0
TOTAL LIABILITIES $0
VI. Assets Transferred

List all assets transferred in any manner during the preceding three years, or length of the marriage, whichever is shorter.

VII. Legal & Expert Fees

State all amounts paid to lawyers and experts in connection with your marital dissolution — name of professional, amounts, dates paid, and source of funds. Attach retainer agreement.

VIII. Other Financial Data

Other data concerning the financial circumstances of the parties that should be brought to the attention of the Court:

Statement of Net Worth filed in this proceeding
Required Attachments: Retainer Agreement  |  Most recent W-2, 1099s, K-1s, Income Tax Returns, and two most recent paystubs  |  Any written agreements between the parties (Prenuptial, Postnuptial, Separation, etc.)
Affirmation & Signature
The foregoing statements and a rider consisting of   page(s) annexed hereto and made a part hereof, have been carefully read by the undersigned.
I, , affirm this   day of   , under the penalties of perjury, under the laws of New York, which may include a fine or imprisonment, that the foregoing is true, except as to matters alleged on information and belief and as to those matters I believe it to be true, and I understand that this document may be filed in an action or proceeding in a court of law.
Signature

Sign on printed copy before submitting to the court.

Attorney Certification
Attorney Signature

Attorney signs on printed copy.

Required Attachments Checklist

Net Worth Summary

Total Monthly Expenses$0
Annualized Expenses (× 12)$0
Gross Annual Income$0
Total Assets (current value)$0
Total Liabilities (current debt)$0
NET WORTH (Assets − Liabilities) $0

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All values are calculated from amounts you enter above. Verify all figures with your attorney before submitting to the court.