Domestic Relations Financial Affidavit - Superior Court Of Gwinnett County Page 3
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7Workers’ Compensation Benefits
Unemployment Benefits
Judgments from Personal Injury or Other Civil Cases
Gifts (cash or other gifts that can be converted to cash)
Prizes/Lottery Winnings
Child support from persons not in this case
Assets which are used for support of family
Fringe Benefits (if significantly reduce living expenses)
Any other income (do NOT include means-tested public assistance, such as
TANF or food stamps)
GROSS MONTHLY INCOME
B.
Affiant’s 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
4. ASSETS
(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion
under the appropriate spouse’s column and state the amount and the basis: pre-marital, gift,
inheritance, source of funds, etc.).
Description
Value
Wife’s Separate
Husband’s
Basis of the
Asset
Separate Asset
Claim
Cash
Investment
accounts
Certificates
(stocks/bonds)
Bank Accounts
(list each account):
_______________
_______________
Domestic Relations Financial Affidavit – Revised May 2016
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Provided by the Gwinnett Family Law Clinic
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