Family Law Financial Affidavit (Short Form) Page 6

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A. ASSETS:
Nonmarital
DESCRIPTION OF ITEM(S). List a description of each separate item
Current
(Check correct
owned by you (and/or your spouse, if this is a petition for dissolution
Fair
of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check
column)
Market
the box next to any asset(s) which you are requesting the judge
Value
award to you.
husband wife
Cash (on hand)
$
Cash (in banks or credit unions)
Stocks, Bonds, Notes
Real estate: (Home)
(Other)
Automobiles
Other personal property
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Other
Check here if additional pages are attached.
Total Assets (add next column)
$
B. LIABILITIES:
Nonmarital
DESCRIPTION OF ITEM(S). List a description of each separate debt
Current
(check correct
owed by you (and/or your spouse, if this is a petition for dissolution
Amount
column)
of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check
Owed
the box next to any debt(s) for which you believe you should be
responsible.
husband wife
Mortgages on real estate: First mortgage on home
$
Second mortgage on home
Other mortgages
Auto loans
Charge/credit card accounts
Other
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (10/11)

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