Family Law Financial Affidavit (Short Form) - Florida Circuit Court Page 7
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9B. LIABILITIES:
Nonmarital
DESCRIPTION OF ITEM(S). List a description of each separate debt
Current
(check correct
owed by you (and/or your spouse, if this is a petition for dissolution
Amount
column)
of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check
Owed
the line next to any debt(s) for which you believe you should be
responsible.
husband
wife
Mortgages on real estate: First mortgage on home
$
Second mortgage on home
Other mortgages
Auto loans
Charge/credit card accounts
Other
____Check here if additional pages are attached.
Total Debts (add next column)
$
C. CONTINGENT ASSETS AND LIABILITIES:
INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave,
bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax
liabilities, debts assumed by another), you must list them here.
Contingent Assets
Nonmarital
Possible
(check correct
Value
Check the line next to any contingent asset(s) which you are requesting the
column)
judge award to you.
husband
wife
$
Total Contingent Assets
$
Contingent Liabilities
Nonmarital
Possible
(check correct
Amount
column)
Check the line next to any contingent debt(s) for which you believe you
Owed
should be responsible.
husband
wife
$
Total Contingent Liabilities
$
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form)
(01/15)
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