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E. OTHER EXPENSES NOT LISTED ABOVE
SECTION II. AVERAGE MONTHLY EXPENSES
A. HOUSEHOLD:
Clothing
$ _______
Mortgage or rent
$ _______
Medical/Dental (uninsured) $_______
Property taxes
$_______
Grooming
$ _______
Utilities
$_______
Entertainment
$_______
Telephone
$ _______
Gifts
$_______
Food
$ _______
Religious organizations
$_______
Meals outside home
$_______
Miscellaneous
$_______
Maintenance/Repairs
$ _______
Other: ______________ $ _______
Other: __________
$_______
____________________ $_______
____________________ $_______
B. AUTOMOBILE
____________________ $_______
Gasoline
$ _______
____________________ $_______
Repairs
$_______
____________________ $_______
Insurance
$_______
C. CHILD(REN)’S EXPENSES
F. PAYMENTS TO CREDITORS
Day care
$ _______
CREDITOR:
MONTHLY
Lunch money
$_______
PAYMENT
Clothing
$ _______
Grooming
$_______
____________________ $_______
Gifts for holidays
$ _______
____________________ $_______
____________________ $_______
Medical/Dental (uninsured) $ _______
____________________ $_______
Other:
$_______
____________________ $_______
D. INSURANCE
____________________ $_______
Medical/Dental
$ _______
____________________ $_______
Child(ren)’s medical/dental $ _______
____________________ $_______
Life
$ _______
____________________ $_______
Other:
$ _______
____________________ $_______
____________________ $_______
28. $_______ TOTAL MONTHLY EXPENSES (add ALL monthly amounts in A through F above)
SUMMARY
29. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)
30. $_______ TOTAL MONTHLY EXPENSES (from line 28 above)
31. $_______ SURPLUS (If line 29 is more than line 30, subtract line 30 from line 29. This is the
amount of your surplus. Enter that amount here.)
32. $_______ (DEFICIT) (If line 30 is more than line 29, subtract line 29 from line 30. This is the
amount of your deficit. Enter that amount here.)
SECTION III. ASSETS AND LIABILITIES
Use the nonmarital column 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(s) or debt belongs. (Typically, you
will only use this column if property/debt was owned/owed 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.)
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (10/11)

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