DocuSiqn Envelope ID: 7DCF950C-7AEE-4919-968D-E67D634EFDEA
`Filing # 169555383 E-Filed 03/24/2023 10:08:29 AM
`
`IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT
`IN AND FOR PALM BEACH COUNTY, FLORIDA
`CASE NO: 2021DR009447
`
`IN RE: THE MATTER OF
`
`HARRISON BARKER,
`
`Petitioner,
`
`and
`
`SHLOMITAZOULAY,
`
`Respondent._IPETITIONER’S UPDATED CERTIFICATE OF COMPLIANCE WITH MANDATORY
`NOT A CERTIFIED COPY
`
`I, HARRISON BARKER, certify that I have complied with the mandatory disclosure required by
`Florida Family Law Rule 12.285 as follows:
`1. FOR TEMPORARY FINANCIAL RELIEF, ONLY:
`The date the following documents were served:.
`[Check all that apply. State with specificity the documents being produced; if sufficient space is not
`provided, you may attach additional papers with this form and refer to them in the space provided.]
`a._Financial Affidavit
`_Florida Family Law Rules of Procedure Form 12.902(b) (short form)
`Florida Family Law Rules of Procedure Form 12.902(c) (long form)
`b.All complete federal and state personal income tax, gift tax, and foreign tax returns for
`the past 3 years; including all attachments, including IRS forms W-2, 1099, and K-1, and
`all accompanying schedules and worksheets comprising the entire tax return; or
`_Transcript of tax return as provided by IRS form 4506-T; or
`IRS forms W-2, 1099, and K-1 for the past year because the income tax return for
`the past year has not been prepared; and for any of the prior 2 years beyond the
`past year if tax returns for any of those years have not been filed.
`c.Pay stubs or other evidence of earned income for the 6 months before the compliance
`with the disclosure requirements for temporary relief. The following are produced:
`
`DISCLOSURE
`
`ONLY THE COMPLETED FORM IS FILED WITH THE COURT.
`EXCEPT FOR THE FINANCIAL AFFIDAVIT AND CHILD SUPPORT GUIDELINES
`WORKSHEET, NO DOCUMENTS SHALL BE FILED IN THE COURT FILE WITHOUT A
`PRIOR COURT ORDER. THE DOCUMENTS LISTED BELOW ARE TO BE GIVEN TO THE
`OTHER PARTY.
`
`*** FILED: PALM BEACH COUNTY, FL JOSEPH ABRUZZO, CLERK. 03/24/2023 10:08:29 AM ***
`
`

`

`DocuSign Envelope ID: 7DCF950C-7AEE-4919-968D-E67D634EFDEA
`
`Barker and Azoulay
`Case No. 2021DR009447
`Certificate of Compliance with
`Mandatory Disclosure
`Page 2 of 4
`
`
`
`
`2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF:
`[Check all that apply. State with specificity the documents being produced; if sufficient space is
`not provided, you may attach additional papers with this form and refer to them in the space
`provided.]
`
`
`__X__ Financial Affidavit: Previously provided
`_____ Florida Family Law Rules of Procedure Form 12.902(b) (short form)
`_____ Florida Family Law Rules of Procedure Form 12.902(c) (long form)
`
`__N/A__ All complete federal and state personal income tax, gift tax, and foreign
`tax returns, for the past 3 years; including all attachments, including IRS forms
`W-2, 1099, and K-1, and all accompanying schedules and worksheets
`comprising the entire tax return;
`_____ Transcript of the tax return as provided by IRS form 4506-T; or
`_____ IRS forms W-2, 1099, and K-1 for the past year because the income tax
`return for the past year has not been prepared; and for any of the prior 2
`years beyond the past year if tax returns for any of those years have not
`been filed.
`
`
`__X__ Pay stubs or other evidence of earned income for the 6 months before the
`compliance with these disclosure requirements for initial or supplemental
`proceedings. The following are produced:
` Paystubs for the period of December 2022 through March 2023 are
`attached hereto.
`_N/A___ A statement identifying the source and amount of all income for the 6
`months before the compliance with these disclosure requirements for initial or
`supplemental proceedings, if not reflected on the pay stubs produced. The
`following are produced:
`
`__N/A__ All loan applications, financial statements, credit reports, or any other
`form of financial disclosure, including financial aid forms, prepared for any
`purpose or used for any purpose within the 24 months preceding the compliance
`with these disclosure requirements for initial or supplemental proceedings. The
`following are produced:
`
`NOT A CERTIFIED COPY
`
`a.
`
`
`b.
`
`c.
`
`d.
`
`e.
`
`
`
`f.
`
`
`
`
`
`__N/A__ All deeds to real estate in which I presently own or owned an interest
`within the past 3 years. All promissory notes or other documents evidencing
`money owed to me or my spouse at any time within the last 24 months. All
`leases, whether in my name individually, in my name jointly with any other
`person or entity, in my name as trustee or guardian for a party or a minor or adult
`dependent child of both parties, or in someone else’s name on my behalf wherein
`either party (A) is receiving or has received payments at any time within the last 3
`years, or (B) owns or owned an interest. The following are produced:
`GRAYROBINSON
`
`ÊÊÊ
`ÊÊOneÊBocaÊPlace,Ê2255ÊGladesÊRoad,ÊSuiteÊ301E,ÊBocaÊRaton,ÊFloridaÊÊ33431ÊÊ|ÊÊTÊ561.368.3808ÊÊ|ÊÊFÊ561.368.4008Ê
`
`
`
`Ê
`
`

`

`DocuSign Envelope ID: 7DCF950C-7AEE-4919-968D-E67D634EFDEA
`
`Barker and Azoulay
`Case No. 2021DR009447
`Certificate of Compliance with
`Mandatory Disclosure
`Page 3 of 4
`
`g.
`
`_X___ All periodic statements for the last 12 months for all checking accounts
`and for the last year for all savings accounts, money market funds, certificates of
`deposit, etc., whether in my name individually, in my name jointly with any other
`person or entity, in my name as trustee or guardian for a party or a minor or adult
`dependent child of both parties, or in someone else’s name on my behalf; and for
`all accounts that have check-writing privileges, copies of canceled checks and
`registers, whether written or electronically maintained. The following are
`produced:
`Ally Bank Combined Statements for the period of December 2022
`•
`through March 2023 are attached hereto related to accounts ending in:
`3372; 6752; 4300; 7820; 0807; 6665; 4064; and 5072.
`Bank of America Account Ending No. 4522 statements for the period
`•
`of November 2022 through January 2023 are attached. Statement for the
`period of February 2023 is nonexistent due to inactivity.
`Capital One Account ending No. 2525 statements for the period of
`•
`November 2022 through February 2023.
`•
`PNC Account ending No. 0732 statements for the period of
`November 2022 through February 2023 are attached hereto.
`Chase Account ending No. 9792 for the period of January 1, 2022
`
`through February 28, 2023
`_N/A ___ All brokerage account statements for the last 12 months, in either
`party’s name individually or jointly with any person or entity, or as a trustee or
`guardian for a party or a minor or adult dependent child of both parties, or in
`someone else’s name on my behalf; and for all accounts that have check-writing
`privileges, copies of canceled checks and registers, whether written or
`electronically maintained. The following are produced:
`
`NOT A CERTIFIED COPY
`
`h.
`
`
`i.
`
`
`
`j.
`
`__X__ Most recent statement and statements for the past 12 months for any
`pension, profit sharing, deferred compensation, or retirement plan (for example,
`IRA, 401(k), 403(b), SEP, KEOGH, etc.) and summary plan description for any
`such plan in which I am a participant or an alternate payee receiving payments.
`The following are produced:
`Vanguard Roth IRA Account ending No. 2028 statements for the
`•
`period at November 2022 through February 2023 are attached hereto.
`•
`Vanguard Traditional IRA Account ending No. 2792 statements for
`the period at November 2022 through February 2023 are attached hereto.
`•
`Vanguard Account ending No. 3984 statements for the period at
`November 2022 through February 2023 are attached hereto.
`•
`TD Ameritrade Account ending No. 0342 statements for the period at
`November 2022 through February 2023 are attached hereto.
`__N/A__ Most recent statement and statements for the past 12 months for any
`virtual currency transactions in which either party participated within the last 12
`months or holds an interest in, either individually, jointly with any other person or
`entity, as trustee or guardian for a party or minor or adult dependent child of both
`parties, or in someone else’s name on my behalf, and a listing of all current
`holdings of virtual currency. The following are produced:
`GRAYROBINSON
`
`ÊÊÊ
`ÊÊOneÊBocaÊPlace,Ê2255ÊGladesÊRoad,ÊSuiteÊ301E,ÊBocaÊRaton,ÊFloridaÊÊ33431ÊÊ|ÊÊTÊ561.368.3808ÊÊ|ÊÊFÊ561.368.4008Ê
`
`
`
`Ê
`
`

`

`DocuSign Envelope ID: 7DCF950C-7AEE-4919-968D-E67D634EFDEA
`
`Barker and Azoulay
`Case No. 2021DR009447
`Certificate of Compliance with
`Mandatory Disclosure
`Page 4 of 4
`
`
`
`_X___ The declaration page, the last periodic statement, statements for the past
`12 months and the certificate for any group insurance for all life insurance
`policies insuring my life or the life of my spouse. The following are produced:
`Copy of MassMutual Term Life Insurance Policy for the period of
`•
`2022 is attached hereto.
`•
`Copy of MassMutual Term Whole Insurance Policy for the period of
`2022 is attached hereto.
`
`_N/A___ All health and dental insurance cards covering either me or my spouse
`and/or our dependent child(ren). The following are produced:
`
`k.
`
`
`l.
`
`
`
`NOT A CERTIFIED COPY
`
`n.
`
`m. _N/A___ Corporate, partnership, and trust tax returns for the last 3 tax years, in
`which I have an ownership or interest. The following are produced:
`
`__X__ All credit card and charge account statements and other records showing
`my (our) indebtedness as of the date of the filing of this action and for the prior
`24 months preceding compliance with these disclosure requirements for initial or
`supplemental proceedings. All promissory notes on which I presently owe or
`owned within the past 24 months, whether paid or not. All lease agreements I
`presently owe, either in my name individually, jointly with any other person or
`entity, in my name as trustee or guardian for a party or a minor or adult
`dependent child of both parties, or in someone else’s name on my behalf. The
`following are produced:
`a. Venmo Transaction History from November 2022 through March 2023 is
`attached hereto.
`b. Zelle Transaction Activity from November 2022 through March 2023 is
`attached hereto.
`c. American Express Account ending No. 2005 statements for the period of
`December 2022 through February 2023 are attached hereto.
`d. American Express Account ending No. 2007 statements for the period of
`December 2022 through February 2023 are attached hereto.
`e. American Express Account ending No. 2009 statements for the period of
`December 2022 through February 2023 are attached hereto.
`f. Bank of America Account ending No. 5353 statements for the period of
`December 2022 through March 2023 are attached hereto.
`g. Chase Account ending No. 3329 statements for the period of December
`2022 through March 2023 are attached hereto.
`h. Chase Account ending No. 9747 statement for the period of December
`2022 is attached hereto. No statements exists for November 2022 nor
`January through March 2023 due to inactivity.
`i. Chase Account ending No. 8174 statements for the period of December
`2022 through February 2023 are attached hereto.
`j. Brookfield Infrastructure Partner Stock Purchases/Sales (TD Ameritrade
`Account)
`k. Energy Transfer Stock Purchases/Sales (TD Ameritrade Account)
`
`GRAYROBINSON
`
`ÊÊÊ
`ÊÊOneÊBocaÊPlace,Ê2255ÊGladesÊRoad,ÊSuiteÊ301E,ÊBocaÊRaton,ÊFloridaÊÊ33431ÊÊ|ÊÊTÊ561.368.3808ÊÊ|ÊÊFÊ561.368.4008Ê
`
`
`
`Ê
`
`

`

`DocuSign Envelope ID: 7DCF950C-7AEE-4919-968D-E67D634EFDEA
`
`Barker and Azoulay
`Case No. 2021DR009447
`Certificate of Compliance with
`Mandatory Disclosure
`Page 5 of 4
`
`_N/A_All premarital and marital agreements between the parties to this case,
`o.
`and all affidavits and declaration of non-paternity or judgments of disestablishment of
`paternity for any minor or dependent children born or conceived during the marriage.
`The following are produced:
`_N/A_If a modification proceeding, all written agreements entered into
`p.
`between the parties at any time since the order to be modified was entered. The
`following are produced:
`_N/A_All documents relating to claims for an unequal distribution of marital
`property, enhancement or appreciation in nonmarital property, or nonmarital
`status of an asset or debt. The following are produced:
`_N/A_Any court order directing that I pay or receive spousal support
`(alimony) or child support. The following are produced:
`Under penalties of perjury, I declare that I have read this doram^tuWHfofeyfacts stated
`in it are true.
`_ .
`3/23/2023
`
`q.
`
`r.
`
`,
`
`(tarrMvu Mir
`
`Dated:__
`
`NOT A CERTIFIED COPY
`
`WE HEREBY CERTIFY that on this 23rd day of March 2023, a true and correct copy of
`the foregoing was filed with the Clerk of Court with notice furnished via E-Service to Philip
`Schwartz, Esq., at 2000 Glades Road, Suite 208, Boca Raton, Florida 33431
`eservice@schwartz-white.com.
`
`GRAY|ROBINSON, P.A.
`
`/s/
`By:
`STACEY D. MULLINS, ESQ.
`FL Bar No. 937193
`Stacev.Mullins@qray-robinson.com
`Daniela.Nuvoloso@qray-robinson.com
`2255 Glades Road, Suite 301E
`Boca Raton, FL 33431
`Telephone: 561-368-3808
`
`GRAYROBINSON
`
`One Boca Place, 2255 Glades Road, Suite 301E, Boca Raton, Florida 33431 | T 561.368.3808 | F 561.368.4008
`
`