Domestic Relations Financial Affidavit Page 2
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13__________________________________________________________________________
__________________________________________________________________________
____________________________________________________________________
2.
EMPLOYMENT AND INCOME
Occupation:
________________________________________________________
Employed By: ________________________________________________________
Number of exemptions claimed: __________________________________________
Pay period (ie, weekly, monthly, etc.) _____________________________________
If you are employed, but expecting soon to become unemployed or change jobs, describe the
change you expect and why and how it will affect your income. If currently unemployed, describe
your efforts to find employment, how soon you expect to be employed, and the pay you expect to
receive:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________
EXCEPT IN PROCEEDINGS FOR ADOPTION, ENFORCEMENT, CONTEMPT, AND
INJUNCTIONS FOR DOMESTIC OR REPEAT VIOLENCE, ALL OF THE FOLLOWING
MUST BE ATTACHED TO THE COPY OF THIS FINANCIAL AFFIDAVIT SERVED ON THE
OPPOSING PARTY. THE ATTACHMENTS SHALL NOT BE FILED WITH THE COURT:
Your three (3) most recent pay stubs, your three (3) most recent Federal and State tax returns, and
the most recent W-2 forms. If last year’s Federal income tax return has not yet been filed, attach
W-2s, 1099s, K-1s, and any other document to be attached to your tax return. If the attachments are
not made to the copy served on the opposing party, an explanation is required.
3.
SUMMARY OF YOUR INCOME AND NEEDS
(a)
Gross monthly income (from Item 4A)
$ ____________
(b)
Total income taxes paid on above income
(Incl. Fed., State and FICA)
$ ____________
(c)
Net monthly income (from Item 4C)
$ ____________
(d)
Expenses
Average monthly expenses (Item 5A)
$ ____________
Monthly payments to creditors (Item 5B)
$ ____________
TOTAL monthly expenses and payments to
creditors (Item 5C)
$ ____________
Domestic Relations Financial Affidavit
Fulton County Family Division
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