GA Financial Affidavit

admin — Sun, 06 Sep 2009 03:31:31 +0000

GEORGIA DIVORCE LAWYER

Monticello Lawyer

Superior Court of ________County, Georgia

)
______________________,

Plaintiff )
)
vs. ) Civil Action No. ___________
)
______________________, )

Defendant )
)

DOMESTIC RELATIONS FINANCIAL AFFIDAVIT

1. AFFIANT’S NAME:_______________ Age _________

Spouse’s Name: __________________ Age _________

Date of Marriage: _____________________

Date of Separation __________________

Names and birth dates of children for whom support is to be determined in this action:

Name Date of Birth Resides with

________________________________________________________

Names and birth dates of affiant’s other children:

Name Date of Birth Resides with

________________________________________________________

2. SUMMARY OF AFFIANT’S INCOME AND NEEDS

(a) Gross monthly income (from item 3A) $ ______________

(b) Net monthly income (from item 3B) ______________

Monthly payments to creditors + ______________

Total monthly expenses and payments
to creditors (item 5C) _______________

3. A. AFFIANT’S GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A)
(All income must be entered based on monthly average regardless of date of receipt.)

Salary or Wages $ ______________
ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS

Commissions, Fees, Tips $ ______________

Income from self-employment, partnership, close corporations,
and independent contracts (gross receipts minus ordinary
and necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ______________

Rental Income (gross receipts minus ordinary and
necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ______________

Bonuses $ ______________

Overtime Payments $ ______________

Severance Pay $ ______________

Recurring Income from Pensions or

Retirement Plans $ ______________

Interest and Dividends $ ______________

Trust Income $ ______________

Income from Annuities $ ______________

Capital Gains $ ______________

Social Security Disability or

Retirement Benefits $ ______________

Workers’ Compensation Benefits $ ______________

Unemployment Benefits $ ______________

Judgments from Personal Injury or

Other Civil Cases $ ______________

Gifts (cash or other gifts that

can be converted to cash) $ ______________

Prizes/Lottery Winnings $ ______________

Alimony and maintenance

from persons not in this case $ ______________

Assets which are used for support of family $ ______________

Fringe Benefits

(if significantly reduce living expenses) $ ______________

Any other income (do NOT include means-tested
Public assistance, such as TANF or food stamps) $ _____________

GROSS MONTHLY INCOME $ ______________
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
of the Husband Separate Asset
of the Wife Basis of the
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: $____________

$ ___________ ______________ ______________ ____________________
Vehicle 2:

debt owed: $____________

$____________ ______________ ______________ ____________________

Life Insurance
(net cash value):

$____________

______________

____________________

Furniture/furnishings:
$____________
______________
______________
____________________

Jewelry:
$____________
______________
______________
____________________

Collectibles:
$____________
______________
______________
____________________

Other Assets:
$____________
______________
______________
____________________

_______________
$____________
______________
______________
____________________

Total Assets:
$____________
______________
______________
____________________

5. A. AVERAGE MONTHLY EXPENSES

HOUSEHOLD
Mortgage or rent payments $ __________ Cable TV $ __________

Property taxes
$ __________
Misc. household and grocery
Items

$ __________

Homeowner/Renter Insurance
$ __________
Meals outside the home
$ __________

Electricity
$ __________
Other
$ __________

Water
$ __________
AUTOMOBILE

Garbage and Sewer
$ __________ Gasoline and oil $ __________

Telephone:
residential line:

cellular telephone:

$ __________

$ __________ Repairs

Auto tags and license

Insurance $ __________

$ __________

Gas
$ __________
OTHER VEHICLES
(boats, trailers, RVs, etc.)

Repairs and maintenance:
$ __________ Gasoline and oil $__________

Lawn Care
$ __________ Repairs $__________

Pest Control
$ __________ Tags and license

Insurance $__________

$__________

CHILDREN’S EXPENSES AFFIANT’S OTHER EXPENSES

Child care (total monthly cost)
$__________
Dry cleaning/laundry
$__________

School tuition
$__________
Clothing
$__________

Tutoring
$__________
Medical, dental, prescription
(out of pocket/uncovered expenses)

$__________
Private lessons (e.g., music, dance) $__________
Affiant’s gifts (special holidays)
$__________

School supplies/expenses
$__________
Entertainment
$__________

Lunch Money
$__________
Recreational Expenses (e.g., fitness)
$__________

Other Educational Expenses (list)

Vacations
$__________

____________________
$__________
Travel Expenses for Visitation
$__________

____________________
$__________
Publications
$__________

Allowance
$__________
Dues, clubs
$__________

Clothing
$__________
Religious and charities
$__________

Diapers
$__________
Pet expenses
$__________

Medical, dental, prescription
(out of pocket/uncovered expenses)

$__________
Alimony paid to former spouse
$__________

Grooming, hygiene
$__________ Child support paid for other children
$__________

Gifts from children to others
$__________
Date of initial order:
__________

Entertainment
$__________
Other (attach sheet)
$__________

Activities (including extra-curricular,
school, religious, cultural, etc.)
$__________

Summer Camps
$__________

OTHER INSURANCE
Health
Child(ren)’s portion: $__________ $__________
Dental
Child(ren)’s portion: $__________ $__________
Vision
Child(ren)’s portion: $__________ $__________
Life
Relationship of Beneficiary: $__________
____________
Disability $__________

Other (specify):
$__________
TOTAL ABOVE EXPENSES $ _______________________

B. PAYMENTS TO CREDITORS
(please check one)
To Whom: Balance Due Monthly Payment Joint Plaintiff Defendant

TOTAL MONTHLY PAYMENTS TO CREDITORS: $ ___________________

C. TOTAL MONTHLY EXPENSES: $ ______________________

This ______________________ day of ___________, 20________.

_____________________________________

Affiant’s Signature

_____________________________________
Notary Public Affiant

McClelland Law Firm » divorce

GA Financial Affidavit