Domestic Relations Financial Affidavit - 2017
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5PLEASE FILL OUT, PRINT AND BRING THE DAY OF YOUR CONSULTATION ALONG WITH $100.00 CONSULTATION FEE.
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
FORM ONLY NEEDED FOR DIVORCES WITH CHILDREN
1. AFFIANT'S NAME: ______________________________________ Age: ________ _
Affiant's Social Security Number: _ ______ ___________________________________
Spouse’s Name: _________________________________ 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 affiant’s other children:
Name
Date of Birth
Resides With
____________________________________________________________________
______________________________________________________________________________
2. SUMMARY OF AFFIANT’S INCOME AND NEEDS
(a) Gross monthly income (from Item 3A)
(b) Net monthly income (from Item 3C)
(c) Average monthly expenses (Item 5A)
Monthly payments to creditors (Item 5B)
+
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. AFFIANT’S GROSS MONTHLY INCOME
A. (All income must be entered based on monthly average regardless of date of
receipt. Where applicable, income should be annualized.) Salary
Bonuses, commissions allowances, overtime, tips and similar payments (based
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