Family Law Financial Affidavit (Long Form) - Florida Circuit Court Page 6
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13AUTOMOBILE:
26. $______ Monthly gasoline and oil
27. _______ Monthly repairs
28. _______ Monthly auto tags and emission testing
29. _______ Monthly insurance
30. _______ Monthly payments (lease or financing)
31. _______ Monthly rental/replacements
32. _______ Monthly alternative transportation (bus, rail, car pool, etc.)
33. _______ Monthly tolls and parking
34. _______ Other: _________________________________________________
35. $_______ SUBTOTAL (add lines 26 through 34)
MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES:
36. $______ Monthly nursery, babysitting, or day care
37. _______ Monthly school tuition
38. _______ Monthly school supplies, books, and fees
39. _______ Monthly after school activities
40. _______ Monthly lunch money
41. _______ Monthly private lessons or tutoring
42. _______ Monthly allowances
43. _______ Monthly clothing and uniforms
44. _______ Monthly entertainment (movies, parties, etc.)
45. _______ Monthly health insurance
46. _______ Monthly medical, dental, prescriptions (nonreimbursed only)
47. _______ Monthly psychiatric/psychological/counselor
48. _______ Monthly orthodontic
49. _______ Monthly vitamins
50. _______ Monthly beauty parlor/barber shop
51. _______ Monthly nonprescription medication
52. _______ Monthly cosmetics, toiletries, and sundries
53. _______ Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.)
54. _______ Monthly camp or summer activities
55. _______ Monthly clubs (Boy/Girl Scouts, etc.)
56. _______ Monthly time-sharing expenses
57. _______ Monthly miscellaneous
58. $_______ SUBTOTAL (add lines 36 through 57)
MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP
(other than court-ordered child support)
59. $________________________________________________________________________________
60. __________________________________________________________________________________
61. __________________________________________________________________________________
62. __________________________________________________________________________________
63. $_______ SUBTOTAL (add lines 59 through 62)
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
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