1.
[
{
"id": "5896710161615478536",
"form_id": "241004353452040",
"ip": "104.28.229.161",
"created_at": "2024-04-23 04:43:36",
"status": "ACTIVE",
"new": "1",
"flag": "0",
"notes": "",
"updated_at": null,
"answers": {
"plaintiffsDate": [
"Plaintiff’s date of birth",
{
"month": "04",
"day": "01",
"year": "2024",
"datetime": "2024-04-01 00:00:00"
}
],
"defendantsDate": [
"Defendant’s date of birth",
{
"month": "04",
"day": "02",
"year": "2024",
"datetime": "2024-04-02 00:00:00"
}
],
"dateMarried": [
"Date married",
{
"month": "04",
"day": "02",
"year": "2024",
"datetime": "2024-04-02 00:00:00"
}
],
"namesAnd": [
"Names and dates of birth of Child(ren) of the marriage",
"trial"
],
"minorChildren": [
"Minor child(ren) of prior marriage",
"trial"
],
"custodyOf": [
"Custody of child(ren) of prior marriage",
"trial"
],
"plaintiffsPresent": [
"Plaintiff’s present address",
"address 1"
],
"defendantsPresent": [
"Defendant’s present address",
"address 2"
],
"occupationemployerOf": [
"Occupation/Employer of Plaintiff",
"dentist"
],
"occupationemployerOf591": [
"Occupation/Employer of Defendant:",
"doctor"
],
"totalHousing": [
"TOTAL: HOUSING",
"16168"
],
"totalUtilities": [
"TOTAL: UTILITIES",
"340643"
],
"totalFood": [
"TOTAL: FOOD",
"1297"
],
"totalClothing": [
"TOTAL: CLOTHING",
"7520"
],
"totalInsurance": [
"TOTAL: INSURANCE",
"29837"
],
"totalUnreimbursed": [
"TOTAL: UNREIMBURSED MEDICAL",
"28987"
],
"totalHousehold": [
"TOTAL: HOUSEHOLD MAINTENANCE",
"24846"
],
"totalHousehold668": [
"TOTAL: HOUSEHOLD HELP",
"16564"
],
"totalEducation": [
"TOTAL: EDUCATION",
"14796"
],
"totalRecreational": [
"TOTAL: RECREATIONAL",
"11097"
],
"totalIncome": [
"TOTAL: INCOME TAXES (monthly totals)",
"7398"
],
"totalmiscellaneous": [
"TOTAL: MISCELLANEOUS",
"17262"
],
"other733": [
"Other",
"Other Name: what\r\nAmount: 1233"
],
"other734": [
"Other",
"Other Name: thhe\r\nAmount: 1233"
],
"other735": [
"Other",
"Other Name: trial\r\nAmount: 1233"
],
"other736": [
"Other",
"Other Name: rtre\r\nAmount: 1233"
],
"totalother": [
"TOTAL: OTHER",
"4932"
],
"ifAny": [
"If any child or other member of your household is employed, set forth name and that person’s annual income:",
"Name: 131\r\nAnnual Income: 1233"
],
"totalcash": [
"TOTAL: CASH",
"1233"
],
"mortgagecoopLoan872": [
"Mortgage/Co-op Loan",
"231"
],
"homeEquity874": [
"Home Equity Line of Credit/Second Mortgage",
"1314"
],
"typeA875": [
"Real Estate Taxes (if not included in mortgage payment)",
"12313"
],
"typeA876": [
"Homeowners/Renter’s Insurance",
"1313"
],
"homeownersAssociationmaintenance877": [
"Homeowner’s Association/Maintenance charges/Condominium Charges",
"144"
],
"typeA878": [
"Rent",
"441"
],
"other879": [
"Other",
"412"
],
"fuelOilgas883": [
"Fuel Oil/Gas",
"1241"
],
"typeA884": [
"Electric",
"123"
],
"typeA885": [
"Telephone (land line)",
"331241"
],
"typeA886": [
"Mobile Phone",
"1241"
],
"typeA887": [
"Cable/Satellite TV",
"4141"
],
"typeA888": [
"Internet",
"414"
],
"typeA889": [
"Alarm",
"414"
],
"typeA890": [
"Water",
"414"
],
"typeA891": [
"Other",
"1414"
],
"groceries892": [
"Groceries",
"1231"
],
"typeA893": [
"Dining Out/Take Out",
"33"
],
"typeA894": [
"Other",
"33"
],
"yourself895": [
"Yourself",
"445"
],
"typeA896": [
"Child(ren)",
"5511"
],
"typeA897": [
"Dry Cleaning",
"1123"
],
"typeA898": [
"Other",
"441"
],
"life900": [
"Life",
"414"
],
"typeA901": [
"Fire, theft and liability and personal articles policy",
"441"
],
"typeA902": [
"Automotive",
"112"
],
"typeA903": [
"Umbrella Policy",
"4141"
],
"typeA904": [
"Medical Plan",
"4141"
],
"typeA905": [
"Medical Plan for yourself (Including name of carrier and name of insured)",
"4141"
],
"typeA906": [
"Medical Plan for children (Including name of carrier and name of insured)",
"1231"
],
"typeA907": [
"Dental Plan",
"1431"
],
"typeA908": [
"Optical Plan",
"4141"
],
"typeA909": [
"Disability",
"4141"
],
"typeA910": [
"Worker’s Compensation",
"4141"
],
"typeA911": [
"Long Term Care Insurance",
"1231"
],
"typeA912": [
"Other",
"131"
],
"medical924": [
"Medical",
"4141"
],
"typeA925": [
"Dental",
"4141"
],
"typeA926": [
"Optical",
"4141"
],
"typeA927": [
"Pharmaceutical",
"4141"
],
"typeA928": [
"Surgical, Nursing, Hospital",
"4141"
],
"typeA929": [
"Psychotherapy",
"4141"
],
"typeA930": [
"Other",
"4141"
],
"repairsmaintenance931": [
"Repairs/Maintenance",
"4141"
],
"typeA932": [
"Gardening/landscaping",
"4141"
],
"typeA933": [
"Sanitation/carting",
"4141"
],
"typeA934": [
"Snow Removal",
"4141"
],
"typeA935": [
"Extermination",
"4141"
],
"typeA936": [
"Other",
"4141"
],
"typeA939": [
"Babysitter",
"4141"
],
"typeA940": [
"Other",
"4141"
],
"domestichousekeeper941": [
"Domestic (housekeeper, etc.)",
"4141"
],
"nannyauPairchild942": [
"Nanny/Au Pair/Child Care",
"4141"
],
"typeA": [
"Automobiles (please add a row for every extra automobile)",
"[{\"Year\":\"1993\",\"Make\":\"Ford\",\"Use\":\"Personal\",\"Lease or Loan Payments (indicate lease term)\":\"123\",\"Gas and Oil\":\"311\",\"Repairs\":\"122\",\"Car Wash\":\"44\",\"Parking and Tolls\":\"551\",\"Other\":\"12\"},{\"Year\":\"2009\",\"Make\":\"Ferrari\",\"Use\":\"Business\",\"Lease or Loan Payments (indicate lease term)\":\"414\",\"Gas and Oil\":\"4\",\"Repairs\":\"414\",\"Car Wash\":\"4141\",\"Parking and Tolls\":\"11\",\"Other\":\"223\"},{\"Year\":\"1990\",\"Make\":\"Hyundai\",\"Use\":\"Personal\",\"Lease or Loan Payments (indicate lease term)\":\"1233\",\"Gas and Oil\":\"1233\",\"Repairs\":\"1233\",\"Car Wash\":\"1233\",\"Parking and Tolls\":\"1233\",\"Other\":\"1233\"}]"
],
"nurseryAnd963": [
"Nursery and Pre-school",
"1233"
],
"primaryAnd964": [
"Primary and Secondary",
"1233"
],
"college965": [
"College",
"1233"
],
"postgraduate966": [
"Post-Graduate",
"1233"
],
"schoolTransportation967": [
"School Transportation",
"1233"
],
"religiousInstruction968": [
"Religious Instruction",
"1233"
],
"schoolSuppliesbooks969": [
"School Supplies/Books",
"1233"
],
"schoolLunches970": [
"School Lunches",
"1233"
],
"tutoring971": [
"Tutoring",
"1233"
],
"schoolEvents972": [
"School Events",
"1233"
],
"childrensExtracurricular973": [
"Child(ren)’s extra-curricular and educational enrichment activities (Dance, Music, Sports, etc.)",
"1233"
],
"other974": [
"Other",
"1233"
],
"vacations975": [
"Vacations",
"1233"
],
"moviesTheatre976": [
"Movies, Theatre, Ballet, Etc.",
"1233"
],
"musicdigital977": [
"Music (Digital or Physical Media)",
"1233"
],
"recreationClubs978": [
"Recreation Clubs and Memberships",
"1233"
],
"activitiesFor979": [
"Activities for yourself",
"1233"
],
"healthClub980": [
"Health Club",
"1233"
],
"summerCamp981": [
"Summer Camp",
"1233"
],
"birthdayParty982": [
"Birthday party costs for your child(ren)",
"1233"
],
"other983": [
"Other",
"1233"
],
"federal984": [
"Federal",
"1233"
],
"state985": [
"State",
"1233"
],
"city986": [
"City",
"1233"
],
"socialSecurity987": [
"Social Security and Medicare",
"1233"
],
"numberOf988": [
"Number of dependents claimed in prior tax year",
"1233"
],
"listAny989": [
"List any refund received by you for prior tax year",
"1233"
],
"beautyParlorbarberspa990": [
"Beauty parlor/Barber/Spa",
"1233"
],
"toiletriesnonprescriptionDrugs991": [
"Toiletries/Non-Prescription Drugs",
"1233"
],
"booksMagazines992": [
"Books, magazines, newspapers",
"1233"
],
"giftsTo993": [
"Gifts to others",
"1233"
],
"charitableContributions994": [
"Charitable contributions",
"1233"
],
"religiousOrganizations995": [
"Religious organizations dues",
"1233"
],
"unionAnd996": [
"Union and organization dues",
"1233"
],
"commutationExpenses997": [
"Commutation expenses",
"1233"
],
"veterinarianpetExpenses998": [
"Veterinarian/pet expenses",
"1233"
],
"childSupport999": [
"Child support payments (for Child(ren) of a prior marriage or relationship pursuant to court order or agreement)",
"1233"
],
"alimonyAnd1000": [
"Alimony and maintenance payments (prior marriage pursuant to court order or agreement)",
"1233"
],
"loanPayments1001": [
"Loan payments",
"1233"
],
"unreimbursedBusiness1002": [
"Unreimbursed business expenses",
"1233"
],
"safeDeposit1003": [
"Safe Deposit Box rental fee",
"1233"
],
"investmentIncome1004": [
"Investment income, including interest and dividend income, reduced by sums expended in connection with such investment",
"1233"
],
"workersCompensation": [
"Worker’s compensation (indicate percentage of amount due to lost wages)",
"1233"
],
"disabilityBenefits1006": [
"Disability benefits (indicate percentage of amount due to lost wages)",
"1233"
],
"unemploymentInsurance1007": [
"Unemployment insurance benefits",
"1233"
],
"socialSecurity": [
"Social Security benefits",
"1233"
],
"supplementalSecurity1009": [
"Supplemental Security Income",
"1233"
],
"publicAssistance1010": [
"Public assistance",
"1233"
],
"foodStamps1011": [
"Food stamps",
"1233"
],
"veteransBenefits1012": [
"Veterans benefits",
"1233"
],
"pensionsAnd1013": [
"Pensions and retirement benefits",
"1233"
],
"fellowshipsAnd1014": [
"Fellowships and stipends",
"1233"
],
"annuityPayments1015": [
"Annuity payments",
"1233"
],
"listAny": [
"List any maintenance and/or child support you are receiving pursuant to court order or agreement",
"1233"
],
"other1017": [
"Other",
"1233"
],
"location1018": [
"Location",
"1233"
],
"sourceOf1019": [
"Source of Funds",
"1233"
],
"amountAs1020": [
"Amount as of date of commencement",
"1233"
],
"currentAmount1021": [
"Current amount ",
"1233"
],
"id1036": [
"id",
"0007"
],
"enterYour": [
"Enter your email",
"x@x.com"
]
},
"__IMTLENGTH__": 1,
"__IMTINDEX__": 1
}
]
2.
[
{
"Plaintfitts Date of Birth": {
"month": "04",
"day": "01",
"year": "2024",
"datetime": "2024-04-01 00:00:00"
},
"Defendant's Date of Birth": {
"month": "04",
"day": "02",
"year": "2024",
"datetime": "2024-04-02 00:00:00"
},
"Date Married": {
"month": "04",
"day": "02",
"year": "2024",
"datetime": "2024-04-02 00:00:00"
}
}
]
5.
[
{
"data": "IMTString(1192606): SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF
---------------------------------------------------------------------X
Plaintiff, STATEMENT
OF NET WORTH
DATED:
- against -
Index No.
Date Action Commenced:
Defendant.
----------------------------------------------------------------------X
Complete all items, marking “NONE”, “INAPPLICABLE” and “UNKNOWN”, if appropriate
STATE OF NEW YORK )
)ss.:
COUNTY OF _________ )
_______________________, the Plaintiff/Defendant herein, being duly sworn, deposes and says that, subject to the penalties of perjury, the following is an accurate statement as of ________, __ , 20_ _ , of my net worth (assets of whatsoever kind and nature and wherever situated minus liabilities), statement of income from all sources and statement of assets transferred of whatsoever kind and nature and wherever situated and statement of expenses:
I. FAMILY DATA
| (a) | Plaintiff’s date of birth: | 04-01-2024 |
| (b) | Defendant’s date of birth: | 2024-04-02 00:00:00 |
| (c) | Date married: | 2024-04-02 00:00:00 |
| (d) | Names and dates of birth of Child(ren) of the marriage: | trial |
| (e) | Minor child(ren) of prior marriage: | trial |
| (f) | Custody of child(ren) of prior marriage: | trial |
| (g) | Plaintiff’s present address: | address 1 |
| | Defendant’s present address: | address 2 |
| (h) | Occupation/Employer of Plaintiff: | dentist |
| | Occupation/Employer of Defendant: | doctor |
II. EXPENSES: (List your current expenses on a monthly basis. If there has been any change in these expenses during the recent past please indicate). Items included under “other” should be listed separately with separate dollar amounts.)
(a) | | Housing: Monthly | |
| 1. | Mortgage/Co-op Loan | 231 |
| 2. | Home Equity Line of Credit/Second Mortgage | 1314 |
| 3. | Real Estate Taxes (if not included in mortgage payment) | 12313 |
| 4. | Homeowners/Renter’s Insurance | 1313 |
| 5. | Homeowner’s Association/Maintenance charges/Condominium Charges | 144 |
| 6. | Rent | 441 |
| 7. | Other | 412 |
| | TOTAL: HOUSING | 16168 |
(b) | | Utilities: Monthly | |
| 1. | Fuel Oil/Gas | 1241 |
| 2. | Electric | 123 |
| 3. | Telephone (land line) | 331241 |
| 4. | Mobile Phone | 1241 |
| 5. | Cable/Satellite TV | 4141 |
| 6. | Internet | 414 |
| 7. | Alarm | 414 |
| 8. | Water | 414 |
| 9. | Other | 1414 |
| | TOTAL: UTILITIES | 340643 |
(c) | | Food: Monthly | |
| 1. | Groceries | 1231 |
| 2. | Dining Out/Take Out | 33 |
| 3. | Other | 33 |
| | TOTAL: FOOD | 1297 |
(d) | | Clothing: Monthly | |
| 1. | Yourself | 445 |
| 2. | Child(ren) | 5511 |
| 3. | Dry Cleaning | 1123 |
| 4. | Other | 441 |
| | TOTAL: CLOTHING | 7520 |
(e) | | Insurance: Monthly | |
| 1. | Life | 414 |
| 2. | Fire, theft and liability and personal articles policy | 441 |
| 3. | Automotive | 112 |
| 4. | Umbrella Policy | 4141 |
| 5. | Medical Plan | 4141 |
| | 5A. Medical Plan for yourself (Including name of carrier and name of insured) | 4141 |
| | 5B. Medical Plan for children (Including name of carrier and name of insured) | 1231 |
| 6. | Dental Plan | 1431 |
| 7. | Optical Plan | 4141 |
| 8. | Disability | 4141 |
| 9. | Worker’s Compensation | 4141 |
| 10. | Long Term Care Insurance | 1231 |
| 11. | Other | 131 |
| | TOTAL: INSURANCE | 29837 |
(f) | | Unreimbursed Medical: Monthly | |
| 1. | Medical | 4141 |
| 2. | Dental | 4141 |
| 3. | Optical | 4141 |
| 4. | Pharmaceutical | 4141 |
| 5. | Surgical, Nursing, Hospital | 4141 |
| 6. | Psychotherapy | 4141 |
| 7. | Other | 4141 |
| | TOTAL: UNREIMBURSED MEDICAL | 28987 |
(g) | | Household Maintenance: Monthly | |
| 1. | Repairs/Maintenance | 4141 |
| 2. | Gardening/landscaping | 4141 |
| 3. | Sanitation/carting | 4141 |
| 4. | Snow Removal | 4141 |
| 5. | Extermination | 4141 |
| 6. | Other | 4141 |
| | TOTAL: HOUSEHOLD MAINTENANCE | 24846 |
(h) | | Household Help: Monthly | |
| 1. | Domestic (housekeeper, etc.) | 4141 |
| 2. | Nanny/Au Pair/Child Care | 4141 |
| 3. | Babysitter | 4141 |
| 4. | Other | 4141 |
| | TOTAL: HOUSEHOLD HELP | 16564 |
(i) | | Automobile: Monthly (List data for each car separately) | |
| | Year:{v.Auto_year} Make:{v.Auto_Make} Use:{v.auto.use} | |
| 1. | Lease or Loan Payments (indicate lease term) |
| | Year:{auto_year} Make:{auto_make} Use:{auto_use} | | | 1. | Lease or Loan Payments (indicate lease term) | {lease_vehicle} | | 2. | Gas and Oil | {gas_oil} | | 3. | Repairs | {repairs} | | 4. | Car Wash | {car_wash} | | 5. | Parking and tolls | {tolls} | | 6. | Other | {other_auto} |
| | Year:{auto_year} Make:{auto_make} Use:{auto_use} | | | 1. | Lease or Loan Payments (indicate lease term) | {lease_vehicle} | | 2. | Gas and Oil | {gas_oil} | | 3. | Repairs | {repairs} | | 4. | Car Wash | {car_wash} | | 5. | Parking and tolls | {tolls} | | 6. | Other | {other_auto} |
| | Year:{auto_year} Make:{auto_make} Use:{auto_use} | | | 1. | Lease or Loan Payments (indicate lease term) | {lease_vehicle} | | 2. | Gas and Oil | {gas_oil} | | 3. | Repairs | {repairs} | | 4. | Car Wash | {car_wash} | | 5. | Parking and tolls | {tolls} | | 6. | Other | {other_auto} |
"
}
]
|