Balance Sheet

Note: This document can be sent by electronic means between the parties prior to it being filed at court. 		Name		
		File No		
		Date		Time	/pm	
		Before		

Ownership	Description	Applicants value	Respondents value	
ASSETS	
1		     	     	     	     	
2		     	     	     	     	
3		     	     	     	     	
4		     	     	     	     	
5		     	     	     	     	
6		     	     	     	     	
Total		$       	$      	
ADDBACKS	
7		     	     	     	     	
8		     	     	     	     	
Total		     	     	
LIABILITIES 	
9		     	     	     	     	
10		     	     	     	     	
11		     	     	     	     	
12		     	     	     	     	
Total		     	     	
SUPERANNUATION 	
Member	Name of Fund	Type of Interest	Applicants value	Respondents value	
13		     	     	     	     	     	
14		     	     	     	     	     	
15		     	     	     	     	     	
16		     	     	     	     	     	
17		     	     	     	     	     	
Total			     	     	
FINANCIAL RESOURCES	
Ownership	Description	Applicants value	Respondents value	
18		     	     	     	     	
19		     	     	     	     	
Total		     	     	

Notes

In relation to any disputed items and all disputed values for items a party should state, using the item number as a heading:
1.	Why an item should not be on the balance sheet.
2.	Whether expert evidence is required to resolve a dispute as to value and what steps have been taken to agree upon and appoint a single expert.
3.	Whether documents in the possession of the other party need to be provided before the value of an item can be agreed.
4.	Any other comment a party wishes to make in relation to the disputed item.

Item No		
     	     	
     	     	
     	     	
     	     	
     	     	
     	     	
     	     	
     	     	
     	     	

Approved by the Chief Justice/Chief Judge pursuant to rule 15.21 		0921V1