Form #4 - Financial Affidavit - Pitt County General Court Of Justice Page 5
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6Form #4
Part 3
Debts
Creditor
Balance due on
Monthly
Current
Monthly
DOS
Payment
Balance due
Payment
GRAND TOTALS
FOR PART 3:
Part 4
Summary
Plaintiff’s or
Defendant’s Contentions:
Current monthly net income after all deductions:
Minus regular recurring fixed monthly expense (Part 1):
-
Minus individual monthly expenses (Part 2):
-
Minus debts (Part 3):
-
Equals Net Disposable Income:
=
Verification
I certify that aforementioned is true, complete and accurate to the best of my ability.
_________________________________
Affiant
____________________ County, North Carolina
I certify that ____________________________ personally appeared before me this day, and acknowledged
to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the
capacity indicated.
Date: ______________________
_________________________
(Signature)
______________________, Notary Public
(Notary’s printed name)
My Commission Expires: ________________
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Pitt County Family Court Domestic Forms, 2017
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