Family Law Financial Affidavit Page 2
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8SECTION I. AVERAGE MONTHLY INCOME
PRESENT MONTHLY GROSS INCOME
All amounts must be MONTHLY. Attach more paper if needed. Items included
* Explanations
under "other" should be listed separately with separate dollar amounts
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Monthly GROSS salary or wages
W-2/OTHER INCOME : If you provide us with your
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Monthly bonuses,commissions,allowances,OT, tips & similar pymnts
most current pay stub, Disability statement, Social
Monthly business income from sources such as self-employment,
Security income statement, or other
documentation of your regular ongoing pay, we
partnerships,close corporation, and/or independent contracts (gross receipts
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can calculate your average monthly income for
minus ordinary and necessary expenses required to produce income
you.
(œ Attach sheet itemizing such income and expenses)
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Monthly disability benefits/SSI
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Monthly Workers' Compensation
IF SELF EMPLOYED : Please provide a complete
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Monthly Unemployment Compensation
list of all income in the last 12 months, along with
a complete list of expenses and we can calculate
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Monthly Pension, retirement, or annuity payments
your average monthly income for you.
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Monthly Social Security benefits
Monthly Alimony actually received (total of 9a. And 9b.)
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9a. From this case
$ ____________
9b. From other case
$ ____________
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Monthly interest and dividends
Please provide total monthly rental income and a
Monthly rental income (gross receipts less ordinary and necessary
detailed list of all expenses associated with this
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property (please specify if an expense is weekly,
expenses required to produce income). (œ Attach itemization of income and expense )
monthly or annual)
Monthly reimbursed expenses and in-kind payments to the extent
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they reduce personal living expenses. (Attach sheet itemizing each item and amount)
Monthly gains derived from dealing in property (not including non-
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recurring gains) Any other income of a recurring nature (identify source):
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Additional Income
MONTHLY DEDUCTIONS
* Explanations
All Amounts must be MONTHLY
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Monthly Mandatory Union Dues
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Monthly Mandatory Retirement Payments
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Monthly health insurance payments (including dental insurance),
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excluding portion paid for any minor children of THIS relationship
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Monthly court-ordered child support actually paid for children from
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another relationship
Monthly court-ordered alimony actually paid
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26a.
26b.
Page 2 of 8
Florida Family Law Rules of Procedure Form 12.902(c) Family Law Financial Affidavit
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