Blumberg version Net Worth form/DRL 236 - …

Revised 11/98 COURTCOUNTY OF Index No. _____ Plaintiff, STATEMENT OF- against - NET Worth (DRL 236) Date of commencement of action_____Complete all items, marking "NONE," "INAPPLICABLE" and "UNKNOWN," if appropriate)STATE OF COUNTY OF SS.:, the (Petitioner) (Respondent) (Plaintiff) (Defendant) herein, beingduly sworn, deposes and says that the following is an accurate statement as of_____, of my net Worth (assets of whatsoever kind and nature and whereversituated minus liabilities), statement of income from all sources and statement ofassets transferred of whatsoever kind and nature and wherever DATA:(a)Husband's age _____(b)Wife's age _____(c)Date married _____(d)Date (separated)(divorced) _____(e)Number of dependent children under 21 years _____(f)Names and ages of children_____(g)Custody of Children _____Husband _____Wife(h)Minor children of prior marriage.

II. EXPENSES: (You may elect to list all expenses on a weekly basis or all expenses on a monthly basis, however, you must be consistent. If any items

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