Domestic Relations Financial Affidavit Page 2
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4corporations and/or independent contracts (gross receipts minus ordinary
and necessary expenses required to produce income)
ATTACH SHEET ITEMIZING THIS INCOME.
$
Disability/unemployment/workers’ compensation
$
Pension, retirement or annuity payments
$
Social Security benefits
$
Other public benefits (specify)
$
Spousal or child support from prior marriage
$
Interest and dividends
$
Rental income (gross receipts minus ordinary and necessary expenses
required to produce income) ATTACH SHEET ITEMIZING THIS INCOME. $
Income royalties, trusts or estates
$
Gains derived from dealing in property (not including non-recurring gains)
$
Other income of a recurring nature (specify source)
$
0.00
GROSS MONTHLY INCOME
$
B. List and describe all benefits of employment, e.g., automobile and /or
auto allowance, insurance (auto, life, disability, etc.), deferred compensation,
employer contribution to retirement or stock, club memberships and reimbursed
expenses (to the extent they reduce personal living expenses) ATTACH SHEET,
IF NECESSARY.
C. Net monthly income from employment (deducting only state and federal
taxes and FICA)
$
Affiant’s pay period (i.e. weekly, monthly, etc.)
Number of exemptions claimed
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