Family Law Financial Affidavit (Short Form) (Page 4 of 9) in pdf

Family Law Financial Affidavit (Short Form) Page 4

required to produce income) (Attach sheet itemizing such income and expense items.)

12. _______ Monthly income from royalties, trusts, or estates

13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they

reduce personal living expenses

14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains)

15. _______ Any other income of a recurring nature (list source) _________________________

16. __________________________________________________________________________

17. $ _______ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1–16)

PRESENT MONTHLY DEDUCTIONS:

18. $______Monthly federal, state, and local income tax (corrected for filing status and allowable

dependents and income tax liabilities)

Filing Status ____________

Number of dependents claimed _______

19. _______ Monthly FICA or self-employment taxes

20. _______ Monthly Medicare payments

21. _______ Monthly mandatory union dues

22. _______ Monthly mandatory retirement payments

23. _______ Monthly health insurance payments (including dental insurance), excluding portion

paid for any minor children of this relationship

24. _______ Monthly court-ordered child support actually paid for children from another

relationship

25. _______Monthly court-ordered alimony actually paid (Add 25a and 25b)

25a. from this case:

$ _______

25b. from other case(s):$ _______

26. $_______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES

(Add lines 18 through 25).

27. $_______ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17)

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form)(01/15)

Family Law Financial Affidavit (Short Form) Page 4