11. _______Monthly rental income (gross receipts minus ordinary and necessary expenses
required to produce income) (□ Attach sheet itemizing such income and expense
items.)
12. _______ Monthly income from royalties, trusts, or estates
13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they
reduce personal living expenses
14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains)
15. _______ Any other income of a recurring nature (list source) _________________________
16. __________________________________________________________________________
17. $ _______ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1–16)
PRESENT MONTHLY DEDUCTIONS:
18. _______ Monthly federal, state, and local income tax (corrected for filing status and
allowable dependents and income tax liabilities)
a. Filing Status ____________
b. Number of dependents claimed _______
19. _______ Monthly FICA or self-employment taxes
20. _______ Monthly Medicare payments
21. _______ Monthly mandatory union dues
22. _______ Monthly mandatory retirement payments
23. _______ Monthly health insurance payments (including dental insurance), excluding portion
paid for any minor children of this relationship
24. _______ Monthly court-ordered child support actually paid for children from another
relationship
25. Monthly court-ordered alimony actually paid (Add 25a and 25b)
a. from this case: $ _______
b. from other case(s): _______
26. $_______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES
(Add lines 18 through 25).
27. $_______ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17)
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (ϭϬ/ϭϭ)