GA Financial Affidavit

Joseph McClelland — Sat, 21 May 2011 11:32:30 +0000

GA Financial Affidavit is a post from: Atlanta wrongful death law firms motorcycle laws car accidents

GEORGIA DIVORCE LAWYER

Monticello Lawyer

Superior Court of ________County, Georgia

)
______________________,

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

Defendant )
)

DOMESTIC RELATIONS FINANCIAL AFFIDAVIT

1. AFFIANTâ€™S NAME:_______________ Age _________

Spouseâ€™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 affiantâ€™s other children:

Name Date of Birth Resides with

________________________________________________________

2. SUMMARY OF AFFIANTâ€™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. AFFIANTâ€™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 $ ______________

Workersâ€™ 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. Affiantâ€™s Net Monthly Income from employment
(deducting only state and federal taxes and FICA)$ ____________

Affiantâ€™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 spouseâ€™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
$____________
______________
______________
______________

CDâ€™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 $__________

$__________

CHILDRENâ€™S EXPENSES AFFIANTâ€™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) $__________
Affiantâ€™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)â€™s portion: $__________ $__________
Dental
Child(ren)â€™s portion: $__________ $__________
Vision
Child(ren)â€™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________.

_____________________________________

Affiantâ€™s Signature

_____________________________________
Notary Public Affiant

Attorney

Joseph P. McClelland, LLC» spalding lawyer

GA Financial Affidavit