Fillable Family Law Financial Affidavit (Short Form) - Florida Circuit Court (Page 3 of 9) in pdf

Family Law Financial Affidavit (Short Form) - Florida Circuit Court Page 3

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IN THE CIRCUIT COURT OF THE

JUDICIAL CIRCUIT,

IN AND FOR

COUNTY, FLORIDA

Case No.: ______________________

Division: _______________________

Petitioner,

and

Respondent.

FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)

(Under $50,000 Individual Gross Annual Income)

I, {full legal name}

, being sworn, certify that the following

information is true:

My Occupation:

Employed by: ___________________________

Business Address: ________________________________________________________________

Pay rate: $

( ) every week ( ) every other week ( ) twice a month ( ) monthly

( ) other: ____________

___ Check here if unemployed and explain on a separate sheet your efforts to find employment.

SECTION I. PRESENT MONTHLY GROSS INCOME:

All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for

anything that is NOT paid monthly. Attach more paper, if needed. Items included under “other” should

be listed separately with separate dollar amounts.

1. $______ Monthly gross salary or wages

______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments

3. _______Monthly business income from sources such as self-employment, partnerships, close

corporations, and/or independent contracts (gross receipts minus ordinary and necessary

expenses required to produce income) (Attach sheet itemizing such income and expenses.)

4. _______Monthly disability benefits/SSI

5. _______Monthly Workers’ Compensation

6. _______Monthly Unemployment Compensation

7. _______Monthly pension, retirement, or annuity payments

8. _______Monthly Social Security benefits

9. ______ Monthly alimony actually received (Add 9a and 9b)

9a. From this case: $ _______

9b. From other case(s): _______

10. _______ Monthly interest and dividends

11. _______Monthly rental income (gross receipts minus ordinary and necessary expenses

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

Family Law Financial Affidavit (Short Form) - Florida Circuit Court Page 3

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