Family Law Financial Affidavit (Long Form) - Florida Circuit Court Page 8
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13103.______________________________________________________________________________
104. $_______ SUBTOTAL (add lines 91 through 103)
105. $_______TOTAL MONTHLY EXPENSES:
(add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, Expenses)
SUMMARY
106. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)
107. $_______ TOTAL MONTHLY EXPENSES (from line 105 above)
108. $_______ SURPLUS (If line 106 is more than line 107, subtract line 107 from line 106. This is the
amount of your surplus. Enter that amount here.)
109. ($______)(DEFICIT) (If line 107 is more than line 106, subtract line 106 from line 107. This is
the amount of your deficit. Enter that amount here.)
SECTION III. ASSETS AND LIABILITIES
A. ASSETS (This is where you list what you OWN.)
INSTRUCTIONS:
STEP 1: In column A, list a description of each separate item owned by you (and/or your spouse, if
this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than
one of an item.
STEP 2: If this is a petition for dissolution of marriage, check the line in Column A next to any item
that you are requesting the judge award to you.
STEP 3: In column B, write what you believe to be the current fair market value of all items listed.
STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
is “nonmarital,” meaning it belongs to only one of you and should not be divided. You should
indicate to whom you believe the item belongs. (Typically, you will only use Column C if property
was owned by one spouse before the marriage. See the “General Information for Self-Represented
Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for
definitions of “marital” and “nonmarital” assets and liabilities.)
A
C
B
ASSETS: DESCRIPTION OF ITEM(S)
Nonmarital
Current
Fair
(Check correct
LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Market
column)
Value
Check the line next to any asset(s) which you are requesting the judge award
to you.
husband wife
$
Cash (on hand)
Cash (in banks or credit unions)
Stocks/Bonds
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
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