Domestic Relations Financial Affidavit Page 3
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134.
YOUR MONTHLY INCOME
A. Gross Income
(All income whether earned or unearned, from any source, must be entered based
on monthly average regardless of date of receipt.
Salary or Wages
$ ____________
Bonuses, Commissions, Allowances, Fees,
Overtime, Tips and similar payments (based
on past 12-month average or time of employment
if less than 1 year)
$ ____________
Income from sources such as self-
employment, partnership, close corporations
and independent contracts (gross receipts minus
ordinary and necessary expenses required to
produce income) ATTACH SHEET ITEMIZING
YOUR CALCULATIONS.
$ ______________
Severance Pay
$ ______________
Disability/Unemployment/Worker's Compensation
$ ______________
Recurring Income from Pension and Retirement Plans
or Annuity payments
$ ______________
Social Security benefits
$ ______________
Other public benefits (do NOT include means-tested
public assistance such as TANF or food stamps)
$ ______________
$ ______________
Spousal or child support from people not in this case
$ ______________
Interest and Dividends
$ ______________
Rental income (gross receipts minus ordinary and
necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ______________
Reimbursed expenses and In kind payments to the extent
they reduce personal living expenses
$ ______________
Fringe Benefits (if significantly reduce living expenses)
$ ______________
Income from Royalties, Trusts or Estates
$ ______________
Capital Gains or Gains derived from dealing in property
(not including non-recurring gains)
$ ______________
Prizes/Lottery Winnings
$ ______________
Gifts (cash or other liquid assets or which can be
converted to cash)
$ ______________
Judgments from Personal Injury or other civil cases
where cash is received on a recurring basis
$ ______________
Assets used for support of family
$ ______________
Other income of a recurring nature (specify source)
$ ______________
Gross Monthly Income
$ ______________
Domestic Relations Financial Affidavit
Fulton County Family Division
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