Financial Affidavit Short Form
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4IN THE CIRCUIT COURT OF THE 11TH JUDICIAL CIRCUIT
IN AND FOR MIAMI-DADE COUNTY, FLORIDA
_________________,
Family Division
Petitioner,
CASE NO: _________________
and
Judge........: _________________
_________________,
Respondent.
_______________________________/
FINANCIAL AFFIDAVIT
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
BEFORE ME, this day personally appeared _________________, who being duly sworn, deposes and says that the
following information is true and correct according to his/her best knowledge and belief:
EMPLOYMENT AND INCOME
OCCUPATION:
EMPLOYED BY:
ADDRESS:
PAY PERIOD:
RATE OF PAY:
Present gross income
$
____Imputed minimum wage
Allowable Deductions
1) Taxes
$
2) Personal Medical Deductions
$
3) Child support for other children
$
4) Alimony from prior dissolutions
$
Total Net Monthly Income
$
A. Housing Expenses
Mortgage or rent
Cable/Satellite
Property taxes
Internet service
Association fees
Telephone
Maintenance/Repairs
Water and Sewers
Insurance
Pest Control
Landscaping
Misc.
Electricity (Power)
Total Housing Expenses–>
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