Motion For Installment Payments - Chancery Court, Davidson County, Nashville, Tennessee Page 2
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1
2Chancery Court
A
I
FFIDAVIT OF
NCOME
Davidson County
Case Number
Nashville, Tennessee
P
AND
ROPERTY
_____________________________________________ vs. _______________________________________________
Comes now the Defendant(s) and, subject to the penalty of perjury, makes oath and says that the following facts are true and that there
is NO OTHER source of income or property other than that described below:
7. List all land/house/real estate/property you own:
1. Full name:
DESCRIBE
VALUE
Address:
$
Phone #
$
Soc. Sec. No.
$
Employer:
$
Phone #
8. List all personal property/cars/trucks/
2. List all dependents:
furniture/stocks/bonds/tools/equipment you own and its total
Name
Age
Relationship
value:
DESCRIBE
VALUE
Cars
$
Trucks
$
Other
$
$
3. List all income from any source:
$
per/wk /mo ,
$
$
from
:
per/wk /mo ,
9.
List all assets/property sold or transferred in the last six
$
months:
from
:
per/wk /mo ,
DESCRIBE
VALUE
$
$
from
:
$
$
I receive CHILD SUPPORT in the sum of
$
$
per
.
$
4. List all bank accounts:
10. The last income tax I filed was for
and it reflected
ACCOUNT
BANK/SOURCE
BALANCE
an income of $
and I attach a copy hereto or will
Checking
$
file the same within seven days.
Savings
$
Other:
$
LIST ALL PROPERTY YOU CLAIM TO BE EXEMPT
Other:
$
PURSUANT TO LAW:
5. List all debts:
All clothing for myself and my family; all receptacles for said
CREDITOR/ADDRESS
BALANCE
clothing; family portraits; family Bible; school books; and
$
$
$
$
$
6. List all monthly household expenses:
Rent/Mortgage:
$
VERIFICATION AND OATH:
Comes now the
Utilities:
$
Petitioner(s) / Defendant(s) and makes oath, subject to the
Health Insurance:
$
penalty of perjury, that the information in this Motion for
Transportation Cost:
$
Installment Payment is true to the best of Petitioner's
Food:
$
knowledge, information and belief.
Clothing:
$
Defendant(s)
Other:
$
$
$
Sworn to and subscribed before me
$
on ____________________
TOTAL
$
Clerk/Deputy Clerk/Notary Public
Commission Expires:
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