Fillable Family Law Financial Affidavit (Short Form) - Florida Circuit Court (Page 5 of 9) in pdf

Family Law Financial Affidavit (Short Form) - Florida Circuit Court Page 5

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SECTION II. AVERAGE MONTHLY EXPENSES

Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed

below do not reflect what you actually pay currently, you should write “estimate” next to each amount

that is estimated.

A. HOUSEHOLD:

Mortgage or rent

$ _______

E. OTHER EXPENSES NOT LISTED ABOVE

Property taxes

$_______

Clothing

$ _______

Utilities

$_______

Medical/Dental (uninsured)

$_______

Telephone

$ _______

Grooming

$ _______

Food

Entertainment

$_______

Meals outside home

$_______

Gifts

$_______

Maintenance/Repairs

$ _______

Religious organizations

$_______

Other: __________

$_______

Miscellaneous

$_______

Other: ______________

$ _______

B. AUTOMOBILE

____________________

$_______

Gasoline

$ _______

____________________

$_______

Repairs

$_______

____________________

$_______

Insurance

____________________

$_______

____________________

$_______

C. CHILD(REN)’S EXPENSES

Day care

$ _______

Lunch money

$_______

F. PAYMENTS TO CREDITORS

$ _______

Clothing

CREDITOR:

MONTHLY

Grooming

$_______

PAYMENT

Gifts for holidays

$ _______

____________________

$_______

Medical/Dental (uninsured)

$ _______

____________________

$_______

____________________

$_______

Other: ______________

$ _______

____________________

$_______

____________________

$_______

D. INSURANCE

____________________

$_______

Medical/Dental (if not listed on

____________________

$_______

lines 23 or 45)

$ _______

____________________

$_______

Child(ren)’s medical/dental

$ _______

____________________

$_______

Life

$ _______

____________________

$_______

Other:

$ _______

____________________

$_______

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 5

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