Domestic Relations Financial Affidavit
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4DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
1. AFFIANT’S NAME:
Age
Affiant’s Social Security No. (last 4 digits)
Spouse’s Name:
Age
Date of Marriage:
Date of Separation:
Names and birth dates of children of this marriage:
Name
Date of Birth
Resides With
Names and birth dates of children of prior marriage/relationship residing with Affiant:
Name
Date of Birth
2. SUMMARY OF AFFIANT’S INCOME AND NEEDS
Note:
Summary data for 2(a), (b), (c) calculates automatically – begin with next section;
Enter data for 2(d) and 2(e) manually
0.00
(a) Gross monthly income (from Item 3A)
$
(b) Net monthly income (from Item 3C)
$
0.00
(c) Average monthly expenses (Item 5A)
$
0.00
Monthly payments to creditors (Item 5B)
+
0.00
Total monthly expenses and payments to creditors (Item 5C)
$
(d) Amount of spousal/ child support needed by Affiant
$
(e) Amount of child support indicated by Child Support Guidelines
$
3. A. AFFIANT’S GROSS MONTHLY INCOME
(All income must be entered based on monthly average regardless of date of receipt. Where
applicable, in come should be annualized.)
Salary
$
Bonuses, commissions, allowances, overtime, tips and similar payments
(based on past 12-month average or time of employment is less than 1 year)
ATTACH SHEET ITEMIZING THIS INCOME.
$
Business income from sources such as self employment, partnership, close
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