Domestic Relations Financial Affidavit - Georgia Superior Court (Page 3 of 6) in pdf

Domestic Relations Financial Affidavit - Georgia Superior Court Page 3

B. Affiant’s Net Monthly Income from employment

(deducting only state and federal taxes and FICA)

$ _______________

Affiant’s pay period (i.e., weekly, monthly, etc.) ___________________

Number of exemptions claimed ____________

4. ASSETS

(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion under the

appropriate spouse’s column and state the amount and the basis: pre-marital, gift, inheritance, source of

funds, etc.).

Description

Value

Separate Asset

Basis of the

of the Husband

of the Wife

Claim

Cash

$____________ ______________ ______________ ____________________

Stocks, bonds

$____________ ______________ ______________ ____________________

CD’s/Money Market

$____________ ______________ ______________ ____________________

Accounts

Bank Accounts

(list each account):

_______________

$____________ ______________ ______________ ____________________

_______________

$____________ ______________ ______________ ____________________

_______________

$____________ ______________ ______________ ____________________

Retirement Pensions,

401K, IRA, or

$____________ ______________ ______________ ____________________

Profit Sharing

Money owed you:

$____________ ______________ ______________ ____________________

Tax Refund

owed you:

$____________ ______________ ______________ ____________________

Real Estate:

home:

$ ___________

_____________ _____________ ____________________

debt owed:

$ ___________

other:

$____________

______________ ______________ ____________________

debt owed:

$ ____________

Automobiles/Vehicles:

Vehicle 1:

$____________

______________ ______________ ____________________

debt owed:

$ ___________

Domestic Relations Financial Affidavit - Georgia Superior Court Page 3

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