Domestic Relations Financial Affidavit - Pataula Judicial Circuit Page 2
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92.
SUMMARY OF AFFIANT’S INCOME AND NEEDS
a.
Gross monthly income (item 3A)
$
b.
Net monthly income (item 3B)
$
c.
Average monthly expenses (item 5A)
$
d.
Monthly payment to creditors (item 5B)
+ $
Total of (c.) and (d.) above:
$
3.
A.
Affiant’s Gross Monthly Income (complete this section or attach Child
Support Schedule A) (All income must be entered based on monthly average
regardless of date of receipt.)
$
Salary or Wages (attach copies of 2 most recent
wage statement)
Commissions, Fees, Tips
$
Income from self-employment, partnerships, close
$
corporations and independent contracts (gross receipts
minus ordinary and necessary expenses required to
produce income). Attach sheet itemizing your
calculations.
Rental Income (gross receipts minus ordinary and
$
necessary expenses required to produce income).
Attach sheet itemizing your calculations.
Bonuses
$
Overtime Payments
$
Severance Pay
$
Recurring Income from Pensions or Retirement Plans
$
Interest and Dividends
$
Trust Income
$
Income from Annuities
$
Capital Gains
$
Social Security Disability or Retirement Benefits
$
Pataula Judicial Circuit
Domestic Relations Financial Affidavit - Revised 2016
Page 2 of 9
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