Florida Family Law Rules of Procedure Form 12.902(C) Family Law Financial Affidavit (10/11)

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INSTRUCTIONS FOR FLORIDA FAMILY LAW Rule OF Process FORM 12.902(c), FAMILY LAW FINANCIAL Affirmation (LONG Class)(09/12)

When should this form be used?

This grade should exist used when yous are involved in a family law case which requires a financial affidavit and your private gross income is $50,000 OR More per year unless:

1. You are filing a simplified dissolution of union under rule 12.105 and both parties have waived the filing of financial affidavits;

2. y'all accept no minor children, no support problems, and have filed a written settlement agreement disposing of all financial problems; or

3. the courtroom lacks jurisdiction to make up one's mind whatever financial issues.

This course should be typed or printed in black ink. After completing this form, y'all should sign the form before a notary public or deputy clerk . You should then file the original with the clerk of the circuit courtroom in the county where the petition was filed and go on a copy for your records.

What should I do next?

A copy of this form must be served on the other party in your instance within 45 days of being served with the petition, if it is non served on him or her with your initial papers. Service must exist in accordance with Florida Rule of Judicial Administration 2.516.

Where can I look for more data?

Earlier proceeding, you should read "Full general Information for Self-Represented Litigants" institute at the offset of these forms. The words that are in "assuming underline" in these instructions are defined there. For further data, encounter Florida Family Law Rule of Procedure 12.285.

Special notes...

If you want to keep your address confidential considering you lot are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence practice non enter the address, phone, and fax information at the lesser of this course. Instead, file Request for Confidential Filing of Address, Florida Supreme Courtroom Approved Family Police Form 12.980(h).

The affirmation must exist completed using monthly income and expense amounts. If you lot are paid or your bills are due on a schedule which is not monthly, you lot must convert those amounts. Hints are provided below for making these conversions.

Instructions for Florida Family Police force Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (09/12)

Hourly - If you are paid by the hour, you may convert your income to monthly equally follows: Hourly amount 10 Hours worked per week = Weekly amount Weekly amount x 52 Weeks per year = Yearly amount Yearly corporeality ÷ 12 Months per year = Monthly Amount Daily - If y'all are paid by the day, you may convert your income to monthly as follows: Daily amount x Days worked per week = Weekly amount Weekly amount 10 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Corporeality Weekly - If y'all are paid by the week, you may convert your income to monthly as follows: Weekly amount x 52 Weeks per yr = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Corporeality

Bi-weekly - If yous are paid every 2 weeks, yous may catechumen your income to monthly equally follows:

Bi-weekly corporeality 10 26 = Yearly amount Yearly amount ÷ 12 Months per twelvemonth = Monthly Amount

Semi-monthly - If you are paid twice per month, you may convert your income to monthly as follows:

Semi-monthly amount x 2 = Monthly Amount

Expenses may be converted in the same style.

Remember, a person who is NOT an chaser is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give y'all a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Grade 12.900(a), before he or she helps yous. A nonlawyer helping y'all make full out these forms also must put his or her proper name, address, and telephone number on the lesser of the terminal page of every course he or she helps you complete.

Instructions for Florida Family Police Rules of Procedure Grade 12.902(c), Family unit Law Financial Affidavit (Long Form) (09/12)

IN THE Excursion Courtroom OF THE JUDICIAL Circuit, IN AND FOR Canton, FLORIDA

,

Petitioner,

and

Case No.: Division:

,

Respondent.

FAMILY LAW FINANCIAL Affidavit (LONG FORM)

($50,000 or more Individual Gross Annual Income)

I, {full legal name} .div1 , being sworn, certify that the following information is truthful:

Section I. INCOME

1. My historic period is:

2. My occupation is:

3. I am currently [Check all that utilise]

   1. Unemployed

      Describe your efforts to observe employment, how before long yous expect to exist employed, and the pay y'all look to receive:

      

   2. Employed past: Accost: Metropolis, State, Zip code: Telephone Number: Pay rate: $ ( ) every week ( ) every other week ( ) twice a month

      ( ) monthly ( ) other:

      If yous are expecting to become unemployed or modify jobs soon, describe the change yous await and why and how it will bear upon your income:

      

      Check here if you currently have more than i task. List the information above for the second task(s) on a separate canvass and attach information technology to this affirmation.

   3. Retired. Date of retirement: Employer from whom retired: Address: City, State, Zip code: Phone Number:

LAST Year'Southward GROSS INCOME: Your Income Other Party'southward Income (if known)

YEAR $ $

Nowadays MONTHLY GROSS INCOME:

All amounts must be MONTHLY. Meet the instructions with this form to effigy out coin amounts for anything that is Non paid monthly. Attach more than paper, if needed. Items included under "other" should be listed separately with separate dollar amounts.

1. $ Monthly gross salary or wages

2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments

3. Monthly business income from sources such as self-employment, partnerships, close corporations, and/or independent contracts (Gross receipts minus ordinary and necessary expenses required to produce income.)(Attach sheet itemizing such income and expenses.)

4. Monthly disability benefits/SSI

5. Monthly Workers' Compensation

6. Monthly Unemployment Bounty

7. Monthly alimony, retirement, or annuity payments

8. Monthly Social Security benefits

9. Monthly alimony really received (Add 9a and 9b) 9a. From this example: $

   9b. From other case(south):

10. Monthly involvement and dividends

11. Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income) (Attach sail itemizing such income and expense items.)

12. Monthly income from royalties, trusts, or estates

13. Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses (Adhere sheet itemizing each detail and amount.)

14. Monthly gains derived from dealing in property (non including nonrecurring gains) Whatever other income of a recurring nature (identify source)

xv.

xvi.

1. $ Full Present MONTHLY GROSS INCOME (Add lines 1 through xvi).

   PRESENT MONTHLY DEDUCTIONS:

   All amounts must exist MONTHLY. See the instructions with this form to figure out money amounts for annihilation that is NOT paid monthly.

2. $ Monthly federal, country, and local income tax (corrected for filing condition and allowable dependents and income tax liabilities)

   1. Filing Status

   2. Number of dependents claimed

19.

20.

Monthly FICA or self-employment taxes Monthly Medicare payments

1. Monthly mandatory union dues

2. Monthly mandatory retirement payments

3. Monthly wellness insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship

4. Monthly court-ordered child support actually paid for children from another relationship

5. Monthly court-ordered alimony actually paid (Add 25a and 25b) 25a. from this case: $

   25b. from other case(s):

6. $ Full DEDUCTIONS ALLOWABLE Nether SECTION 61.thirty, FLORIDA STATUTES

   (Add lines xviii through 25).

7. $ PRESENT NET MONTHLY INCOME

(Subtract line 26 from line 17).

SECTION II. AVERAGE MONTHLY EXPENSES

Proposed/Estimated Expenses. If this is a dissolution of marriage instance and your expenses as listed

below practice non reverberate what you lot actually pay currently, y'all should write "gauge" adjacent to each amount that is estimated.

HOUSEHOLD:

1. $ Monthly mortgage or rent payments

2. Monthly property taxes (if not included in mortgage)

3. Monthly insurance on residence (if not included in mortgage)

4. Monthly condominium maintenance fees and homeowner'south clan fees

5. Monthly electricity

6. Monthly water, garbage, and sewer

7. Monthly telephone

8. Monthly fuel oil or natural gas

9. Monthly repairs and maintenance

10. Monthly backyard intendance

11. Monthly pool maintenance

12. Monthly pest control

13. Monthly misc. household

14. Monthly food and dwelling house supplies

15. Monthly meals exterior home

16. Monthly cable t.v.

17. Monthly alarm service contract

18. Monthly service contracts on appliances

19. Monthly maid service Other:

20.

21.

22.

23.

24.

1. $ SUBTOTAL (add lines 1 through 24).

   Florida Family unit Law Rules of Procedure Form 12.902(c), Family Police Financial Affirmation (Long Form) (09/12)

   AUTOMOBILE:

2. $ Monthly gasoline and oil

3. Monthly repairs

4. Monthly auto tags and emission testing

5. Monthly insurance

6. Monthly payments (lease or financing)

7. Monthly rental/replacements

8. Monthly alternative transportation (bus, rail, car pool, etc.)

9. Monthly tolls and parking

10. Other:

11. $ SUBTOTAL (add lines 26 through 34)

    MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES:

12. $ Monthly nursery, babysitting, or solar day intendance

13. Monthly schoolhouse tuition

14. Monthly school supplies, books, and fees

15. Monthly afterwards school activities

16. Monthly luncheon coin

17. Monthly private lessons or tutoring

18. Monthly allowances

19. Monthly clothing and uniforms

20. Monthly entertainment (movies, parties, etc.)

21. Monthly health insurance

22. Monthly medical, dental, prescriptions (nonreimbursed only)

23. Monthly psychiatric/psychological/counselor

24. Monthly orthodontic

25. Monthly vitamins

26. Monthly dazzler parlor/barber shop

27. Monthly nonprescription medication

28. Monthly cosmetics, toiletries, and sundries

29. Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.)

30. Monthly camp or summertime activities

31. Monthly clubs (Boy/Girl Scouts, etc.)

32. Monthly time-sharing expenses

33. Monthly miscellaneous

34. $ SUBTOTAL (add together lines 36 through 57)

MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP

(other than court-ordered child support)

59. $

60.

61.

62.

1. $ SUBTOTAL (add together lines 59 through 62)

   Florida Family Police force Rules of Process Form 12.902(c), Family unit Law Financial Affidavit (Long Grade) (09/12)

   MONTHLY INSURANCE:

2. $ Health insurance, excluding portion paid for whatever minor kid(ren) of this relationship

3. Life insurance

4. Dental insurance Other:

67.

68.

1. $ SUBTOTAL (add lines 64 through 68)

   OTHER MONTHLY EXPENSES NOT LISTED Above:

2. $ Monthly dry cleaning and laundry

3. Monthly vesture

4. Monthly medical, dental, and prescription (unreimbursed only)

5. Monthly psychiatric, psychological, or advisor (unreimbursed only)

6. Monthly not-prescription medications, cosmetics, toiletries, and sundries

7. Monthly preparation

8. Monthly gifts

9. Monthly pet expenses

10. Monthly gild dues and membership

11. Monthly sports and hobbies

12. Monthly entertainment

13. Monthly periodicals/books/tapes/CDs

14. Monthly vacations

15. Monthly religious organizations

16. Monthly bank charges/credit carte fees

17. Monthly education expenses

86.

Other: (include any usual and customary expenses not otherwise mentioned in the items listed above)

87.

88.

89.

xc. $ SUBTOTAL (add lines 70 through 89)

MONTHLY PAYMENTS TO CREDITORS: (only when payments are currently made by yous on outstanding balances). Listing only last iv digits of account numbers.

MONTHLY PAYMENT AND NAME OF CREDITOR(south):

91. $

92.

93.

94.

95.

96.

97.

98.

99.

100.

101.

102.

Florida Family unit Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (09/12)

103.

1. $ SUBTOTAL (add lines 91 through 103)

2. $ Full MONTHLY EXPENSES:

   

   (add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, Expenses)

   

   SUMMARY

   

3. $ Total Nowadays MONTHLY Cyberspace INCOME (from line 27 of Section I. INCOME)

   

4. $ TOTAL MONTHLY EXPENSES (from line 105 in a higher place)

   

5. $ SURPLUS (If line 106 is more than line 107, subtract line 107 from line 106. This is the amount of your surplus. Enter that amount hither.)

   

6. ($ )(Deficit) (If line 107 is more than line 106, subtract line 106 from line 107. This is the corporeality of your deficit. Enter that corporeality here.)

SECTION Iii. Avails AND LIABILITIES

1. Assets (This is where you list what you lot Own.) INSTRUCTIONS:

   Pace 1: In column A, list a description of each carve up particular endemic by yous (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if yous demand to list more than one of an particular.

   Pace 2: If this is a petition for dissolution of marriage, check the line in Cavalcade A adjacent to any detail that you are requesting the estimate laurels to you lot.

   STEP 3: In column B, write what you believe to be the electric current fair market value of all items listed. Step 4: Use cavalcade C only if this is a petition for dissolution of wedlock and yous believe an item is "nonmarital," meaning it belongs to only one of you and should not be divided. Y'all should

   indicate to whom y'all believe the item belongs. (Typically, you volition simply utilize Column C if property

   was owned past one spouse before the marriage. See the "General Information for Self-Represented Litigants" found at the beginning of these forms and section 61.075(ane), Florida Statutes, for

   definitions of "marital" and "nonmarital" avails and liabilities.)

   A ASSETS: Description OF ITEM(S) List ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Bank check the line next to whatever asset(s) which you are requesting the judge accolade to you lot.		B Current Fair Market Value	C Nonmarital (Check correct cavalcade)
   			hubby	wife
   	Cash (on manus)	$
   	Cash (in banks or credit unions)
   	Stocks/Bonds

   Florida Family Constabulary Rules of Procedure Form 12.902(c), Family Police force Financial Affidavit (Long Course) (09/12)

   	Notes (coin owed to y'all in writing)
   	Coin owed to y'all (non evidenced by a note)
   	Real estate: (Home)
   	(Other)
   	Business organisation interests
   	Automobiles
   	Boats
   	Other vehicles
   	Retirement plans (Turn a profit Sharing, Pension, IRA, 401(1000)s, etc.)
   	Article of furniture & furnishings in home
   	Furniture & furnishings elsewhere
   	Collectibles

   Florida Family Constabulary Rules of Procedure Form 12.902(c), Family Police force Financial Affidavit (Long Form) (09/12)

   	Jewelry
   	Life insurance (cash surrender value)
   	Sporting and entertainment (T.V., stereo, etc.) equipment
   	Other avails:
   Full Assets (add column B)		$

2. LIABILITIES/DEBTS (This is where you list what you OWE.) INSTRUCTIONS:

   Pace 1: In column A , list a clarification of each split up debt owed by y'all (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if yous need to list more one of an item.

   STEP 2: If this is a petition for dissolution of marriage, check the line in Column A adjacent to whatever debt(s) for which yous believe y'all should be responsible.

   Pace 3: In column B , write what you believe to be the electric current amount owed for all items listed. STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an particular is "nonmarital," pregnant the debt belongs to only one of you and should not be divided. Yous

   should signal to whom you believe the debt belongs. (Typically, you volition merely utilise Column C if the

   debt was owed by i spouse before the spousal relationship. See the "General Information for Cocky- Represented Litigants" constitute at the beginning of these forms and department 61.075(1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.)

   Florida Family Police force Rules of Procedure Form 12.902(c), Family unit Police Financial Affidavit (Long Form) (09/12)

   A LIABILITIES: Description OF ITEM(S) LIST Simply LAST Four DIGITS OF ACCOUNT NUMBERS. Check the line side by side to whatsoever debt(south) for which you believe you should be responsible.		B Current Amount Owed	C Nonmarital (Check correct column)
   			married man	wife
   	Mortgages on real manor: Showtime mortgage on abode	$
   	2d mortgage on abode
   	Other mortgages
   	Charge/credit card accounts
   	Auto loan
   	Auto loan
   	Bank/Credit Union loans
   	Money y'all owe (not evidenced by a note)
   	Judgments
   	Other:
   Full Debts (add column B)		$

   Florida Family Law Rules of Procedure Form 12.902(c), Family Police force Fiscal Affirmation (Long Course) (09/12)

3. Internet WORTH (excluding contingent avails and liabilities)

   $ Full Assets (enter total of Column B in Asset Table; Section A)

   $ Full Liabilities (enter total of Column B in Liabilities Table; Department B)

   $ Full Cyberspace WORTH (Total Assets minus Total Liabilities)

   (excluding contingent avails and liabilities)

4. CONTINGENT ASSETS AND LIABILITIES INSTRUCTIONS:

   If you take any POSSIBLE assets (income potential, accrued vacation or ill leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent revenue enhancement liabilities, debts assumed by another), you must list them here.

   A Contingent Avails Check the line next to whatsoever contingent asset(southward) which yous are requesting the judge accolade to you.		B Possible Value	C Nonmarital (Bank check correct cavalcade)
   			husband	wife
   		$
   Total Contingent Avails		$

   A Contingent Liabilities Check the line next to whatever contingent debt(s) for which you believe you should exist responsible.		B Possible Corporeality Owed	C Nonmarital (Check right cavalcade)
   			husband	wife
   		$
   Full Contingent Liabilities		$

5. CHILD Support GUIDELINES WORKSHEET. Florida Family unit Police Rules of Procedure Course 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or modify child back up. This requirement cannot be waived by the parties.

Florida Family unit Constabulary Rules of Process Course 12.902(c), Family Constabulary Financial Affidavit (Long Class) (09/12)

[Check one only]

A Child Support Guidelines Worksheet IS or WILL Exist filed in this case. This case involves the establishment or modification of child back up.

A Child Support Guidelines Worksheet IS Not being filed in this case. The establishment or modification of kid support is not an upshot in this case.

I certify that a copy of this financial affidavit was [check all used]: ( ) e-mailed ( ) mailed, ( ) faxed ( ) hand delivered to the person(s) listed beneath on {date} .div1 .

Other political party or his/her attorney:

Name: Address: City, State, Zip: Fax Number: E-mail Address(es):

I empathise that I am swearing or affirming under oath to the truthfulness of the claims made in this affirmation and that the penalisation for knowingly making a false statement includes fines and/or imprisonment.

Dated:

Signature of Party

Printed Name: Address: Metropolis, State, Null: Fax Number: Electronic mail Accost(es):

STATE OF FLORIDA

COUNTY OF

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

Personally known

Produced identification

[Print, type, or postage stamp commissioned proper name of notary or deputy clerk]

Type of identification produced

IF A NONLAWYER HELPED Y'all Fill OUT THIS FORM, HE/SHE MUST Fill up IN THE BLANKS Below:

[fill in all blanks] This form was prepared for the: {cull only one } .div1 ( ) Petitioner ( ) Respondent This class was completed with the assistance of:

{name of individual} .div1 ,

{name of business concern} .div1 _,

{accost} .div1 ,

{city} .div1 ,{state} .div1 _ , {telephone number} .div1 .

Florida Family unit Law Rules of Procedure Form 12.902(c), Family unit Police force Financial Affidavit (Long Grade) (09/12)

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INSTRUCTIONS FOR FLORIDA Family LAW RULE OF Process FORM 12.902(c), Family unit Police force FINANCIAL Affidavit (LONG Class)(09/12) When should this form be used? This grade should exist used when you are involved in a family unit law case which requires a financial affidavit and your individual gross income is $l,000 OR MORE per year unless: (1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have waived the filing of fiscal affidavits; (two) y'all have no minor children, no support issues, and accept filed a written settlement agreement disposing of all fiscal issues; or (3) the court lacks jurisdiction to decide any financial issues. This grade should exist typed or printed in black ink. After completing this form, you should sign the form earlier a notary public or deputy clerk. Yous should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this grade must be served on the other party in your example within 45 days of being served with the petition, if it is non served on him or her with your initial papers. Service must be in accord with Florida Rule of Judicial Administration 2.516. Where tin can I look for more information? Earlier proceeding, you should read �General Data for Self-Represented Litigants� found at the beginning of these forms. The words that are in �bold underline� in these instructions are defined there. For further information, see Florida Family unit Law Rule of Process 12.285. Special notes... If you want to proceed your address confidential because you are the victim of sexual bombardment, aggravated child abuse, aggravated stalking, harassment, aggravated bombardment, or domestic violence do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family unit Constabulary Form 12.980(h). The affirmation must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is non monthly, you must convert those amounts. Hints are provided below for making these conversions. Hourly - If you are paid by the hour, yous may convert your income to monthly as follows: Hourly amount x Hours worked per calendar week = Weekly corporeality Weekly amount x 52 Weeks per year = Yearly corporeality Yearly amount � 12 Months per year = Monthly Corporeality Daily - If yous are paid by the mean solar day, you may convert your income to monthly as follows: Daily amount x Days worked per week = Weekly amount Weekly amount ten 52 Weeks per yr = Yearly amount Yearly corporeality � 12 Months per year = Monthly Amount Weekly - If y'all are paid by the week, you lot may convert your income to monthly as follows: Weekly amount x 52 Weeks per twelvemonth = Yearly amount Yearly amount � 12 Months per yr = Monthly Amount Bi-weekly - If you are paid every ii weeks, y'all may convert your income to monthly as follows: Bi-weekly amount x 26 = Yearly amount Yearly corporeality � 12 Months per year = Monthly Amount Semi-monthly - If you lot are paid twice per month, you may convert your income to monthly as follows: Semi-monthly corporeality x 2 = Monthly Corporeality Expenses may exist converted in the same way. Call up, a person who is Not an attorney is chosen a nonlawyer. If a nonlawyer helps you fill out these forms, that person must requite you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), earlier he or she helps yous. A nonlawyer helping you fill out these forms besides must put his or her name, address, and phone number on the bottom of the final page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. Family Law FINANCIAL Affidavit (LONG Course) ($50,000 or more Individual Gross Almanac Income) I, {full legal name} , beingness sworn, certify that the following information is truthful: Department I. INCOME 1. My historic period is: ___________________ 2. My occupation is: ________________________________________________________________ iii. I am currently [Cheque all that apply] a. ____ Unemployed Describe your efforts to detect employment, how soon you lot expect to be employed, and the pay you wait to receive: __________________________________________________________ ____________________________________________________________________________ b. ____ Employed by: ____________________________________________________________ Address: ____________________________________________________________________ Metropolis, State, Cipher lawmaking: ________________________________ Telephone Number: _________ Pay rate: $ ______ ( ) every calendar week ( ) every other week ( ) twice a month ( ) monthly ( ) other: ________________________________________________________ If y'all are expecting to get unemployed or alter jobs soon, describe the change you expect and why and how information technology will bear upon your income: _________________________________ ___________________________________________________________________________ ____ Check here if you currently have more than one job. List the information higher up for the 2nd task(s) on a divide canvass and attach information technology to this affirmation. c. _____ Retired. Engagement of retirement: _______________________________________________ Employer from whom retired: ___________________________________________________ Accost: _____________________________________________________________________ City, State, Null code: _______________________________ Telephone Number: __________ Concluding YEAR�S GROSS INCOME: Your Income Other Political party�southward Income (if known) YEAR_____ $ _______ $ _______ PRESENT MONTHLY GROSS INCOME: All amounts must be MONTHLY. See the instructions with this form to figure out coin amounts for anything that is NOT paid monthly. Attach more paper, if needed. Items included under �other� should exist listed separately with dissever dollar amounts. 1. $______ Monthly gross salary or wages 2. _______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 3. _______ Monthly business income from sources such as self-employment, partnerships, close corporations, and/or contained contracts (Gross receipts minus ordinary and necessary expenses required to produce income.)(Attach sheet itemizing such income and expenses.) 4. _______ Monthly inability benefits/SSI 5. _______ Monthly Workers� Compensation 6. _______ Monthly Unemployment Compensation 7. _______ Monthly pension, retirement, or annuity payments viii. _______ Monthly Social Security benefits 9. _______ Monthly pension really received (Add 9a and 9b) 9a. From this example: $________ 9b. From other case(due south): ________ ten. _______ Monthly interest and dividends 11. _______ Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income) (Attach sheet itemizing such income and expense items.) 12. _______ Monthly income from royalties, trusts, or estates 13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses (Attach sheet itemizing each item and corporeality.) fourteen. _______ Monthly gains derived from dealing in belongings (not including nonrecurring gains) Any other income of a recurring nature (identify source) 15. _______________________________________________________________________________ 16. _______________________________________________________________________________ 17. $_________ TOTAL PRESENT MONTHLY GROSS INCOME (Add together lines 1 through 16). PRESENT MONTHLY DEDUCTIONS: All amounts must exist MONTHLY. See the instructions with this form to figure out money amounts for anything that is Not paid monthly. 18. $_______ Monthly federal, country, and local income tax (corrected for filing status and commanded dependents and income tax liabilities) a. Filing Condition b. Number of dependents claimed nineteen. _______ Monthly FICA or self-employment taxes 20. _______ Monthly Medicare payments 21. _______ Monthly mandatory union ante 22. _______ Monthly mandatory retirement payments 23. _______ Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship 24. _______ Monthly court-ordered child support really paid for children from another relationship 25. _______ Monthly court-ordered pension actually paid (Add together 25a and 25b) 25a. from this case: $ _________ 25b. from other case(s): _________ 26. $______ TOTAL DEDUCTIONS Commanded Nether Department 61.30, FLORIDA STATUTES (Add together lines 18 through 25). 27. $______ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17). Section II. AVERAGE MONTHLY EXPENSES Proposed/Estimated Expenses. If this is a dissolution of union example and your expenses every bit listed below do not reflect what you lot actually pay currently, yous should write �judge� side by side to each amount that is estimated. HOUSEHOLD: 1. $______ Monthly mortgage or rent payments 2. _______ Monthly property taxes (if not included in mortgage) three. _______ Monthly insurance on residence (if non included in mortgage) 4. _______ Monthly condominium maintenance fees and homeowner�s association fees 5. _______ Monthly electricity half dozen. _______ Monthly water, garbage, and sewer 7. _______ Monthly telephone eight. _______ Monthly fuel oil or natural gas 9. _______ Monthly repairs and maintenance 10. _______ Monthly backyard care eleven. _______ Monthly pool maintenance 12. _______ Monthly pest command 13. _______ Monthly misc. household 14. _______ Monthly food and dwelling supplies 15. _______ Monthly meals outside dwelling house 16. _______ Monthly cablevision t.v. 17. _______ Monthly alarm service contract eighteen. _______ Monthly service contracts on appliances nineteen. _______ Monthly maid service Other: 20. __________________________________________________________________________________ 21. __________________________________________________________________________________ 22. __________________________________________________________________________________ 23. __________________________________________________________________________________ 24. __________________________________________________________________________________ 25. $_______ SUBTOTAL (add lines 1 through 24). Automobile: 26. $______ Monthly gasoline and oil 27. _______ Monthly repairs 28. _______ Monthly machine tags and emission testing 29. _______ Monthly insurance 30. _______ Monthly payments (lease or financing) 31. _______ Monthly rental/replacements 32. _______ Monthly alternative transportation (bus, rail, machine pool, etc.) 33. _______ Monthly tolls and parking 34. _______ Other: _________________________________________________ 35. $_______ SUBTOTAL (add together lines 26 through 34) MONTHLY EXPENSES FOR CHILDREN Common TO BOTH PARTIES: 36. $______ Monthly nursery, babysitting, or day intendance 37. _______ Monthly schoolhouse tuition 38. _______ Monthly school supplies, books, and fees 39. _______ Monthly after school activities forty. _______ Monthly luncheon money 41. _______ Monthly private lessons or tutoring 42. _______ Monthly allowances 43. _______ Monthly clothing and uniforms 44. _______ Monthly entertainment (movies, parties, etc.) 45. _______ Monthly health insurance 46. _______ Monthly medical, dental, prescriptions (nonreimbursed only) 47. _______ Monthly psychiatric/psychological/counselor 48. _______ Monthly orthodontic 49. _______ Monthly vitamins 50. _______ Monthly beauty parlor/barber shop 51. _______ Monthly nonprescription medication 52. _______ Monthly cosmetics, toiletries, and sundries 53. _______ Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.) 54. _______ Monthly military camp or summer activities 55. _______ Monthly clubs (Boy/Girl Scouts, etc.) 56. _______ Monthly fourth dimension-sharing expenses 57. _______ Monthly miscellaneous 58. $_______ SUBTOTAL (add lines 36 through 57) MONTHLY EXPENSES FOR Child(REN) FROM ANOTHER RELATIONSHIP (other than court-ordered child support) 59. $________________________________________________________________________________ threescore. __________________________________________________________________________________ 61. __________________________________________________________________________________ 62. __________________________________________________________________________________ 63. $_______ SUBTOTAL (add lines 59 through 62) MONTHLY INSURANCE: 64. $______ Health insurance, excluding portion paid for whatsoever modest child(ren) of this relationship 65. _______ Life insurance 66. _______ Dental insurance Other: 67. __________________________________________________________________________________ 68. __________________________________________________________________________________ 69. $_______ SUBTOTAL (add together lines 64 through 68) OTHER MONTHLY EXPENSES Not LISTED ABOVE: lxx. $______ Monthly dry cleaning and laundry 71. _______ Monthly clothing 72. _______ Monthly medical, dental, and prescription (unreimbursed merely) 73. _______ Monthly psychiatric, psychological, or counselor (unreimbursed merely) 74. _______ Monthly not-prescription medications, cosmetics, toiletries, and sundries 75. _______ Monthly grooming 76. _______ Monthly gifts 77. _______ Monthly pet expenses 78. _______ Monthly club dues and membership 79. _______ Monthly sports and hobbies lxxx. _______ Monthly entertainment 81. _______ Monthly periodicals/books/tapes/CDs 82. _______ Monthly vacations 83. _______ Monthly religious organizations 84. _______ Monthly bank charges/credit card fees 85. _______ Monthly education expenses 86. ______ Other: (include whatsoever usual and customary expenses non otherwise mentioned in the items listed above)______________________________________________________________ 87. __________________________________________________________________________________ 88. __________________________________________________________________________________ 89. __________________________________________________________________________________ 90. $_______ SUBTOTAL (add lines 70 through 89) MONTHLY PAYMENTS TO CREDITORS: (only when payments are currently made past you on outstanding balances). List only last 4 digits of business relationship numbers. MONTHLY PAYMENT AND Proper name OF CREDITOR(due south): 91. $_________________________________________________________________________________ 92. __________________________________________________________________________________ 93. __________________________________________________________________________________ 94. __________________________________________________________________________________ 95. __________________________________________________________________________________ 96. __________________________________________________________________________________ 97. __________________________________________________________________________________ 98. __________________________________________________________________________________ 99. __________________________________________________________________________________ 100. ______________________________________________________________________________ 101. ______________________________________________________________________________ 102. ______________________________________________________________________________ 103. ______________________________________________________________________________ 104. $_______ SUBTOTAL (add lines 91 through 103) 105. $_______TOTAL MONTHLY EXPENSES: (add together lines 25, 35, 58, 63, 69, ninety, and 104 of Department II, Expenses) SUMMARY 106. $_______ TOTAL PRESENT MONTHLY Cyberspace INCOME (from line 27 of Section I. INCOME) 107. $_______ TOTAL MONTHLY EXPENSES (from line 105 in a higher place) 108. $_______ SURPLUS (If line 106 is more than line 107, subtract line 107 from line 106. This is the amount of your surplus. Enter that amount here.) 109. ($______)(Arrears) (If line 107 is more than line 106, decrease line 106 from line 107. This is the corporeality of your deficit. Enter that corporeality here.) Section 3. ASSETS AND LIABILITIES A. ASSETS (This is where you listing what you OWN.) INSTRUCTIONS: STEP 1: In column A, list a description of each divide detail owned by you (and/or your spouse, if this is a petition for dissolution of spousal relationship). Blank spaces are provided if you need to list more than i of an item. Pace 2: If this is a petition for dissolution of matrimony, check the line in Column A next to any particular that you are requesting the judge award to you. STEP 3: In cavalcade B, write what you believe to be the current fair market value of all items listed. STEP 4: Use column C only if this is a petition for dissolution of union and you believe an item is �nonmarital,� meaning it belongs to only i of you and should not exist divided. You lot should signal to whom you believe the item belongs. (Typically, you lot volition just utilize Cavalcade C if property was owned by i spouse before the marriage. Run across the �General Data for Cocky-Represented Litigants� found at the showtime of these forms and section 61.075(1), Florida Statutes, for definitions of �marital� and �nonmarital� assets and liabilities.) A ASSETS: DESCRIPTION OF Particular(S) List ONLY LAST Four DIGITS OF ACCOUNT NUMBERS. Check the line next to whatsoever asset(s) which you are requesting the judge award to you. B Current Fair Market Value C Nonmarital (Check correct column) hubby wife Cash (on paw) $ Cash (in banks or credit unions) Stocks/Bonds Notes (coin owed to you in writing) Money owed to y'all (non evidenced by a note) Real manor: (Home) (Other) Business interests Automobiles Boats Other vehicles Retirement plans (Profit Sharing, Alimony, IRA, 401(k)s, etc.) Article of furniture & effects in home Furniture & effects elsewhere Collectibles Jewelry Life insurance (cash give up value) Sporting and entertainment (T.5., stereo, etc.) equipment Other assets: Total Assets (add together column B) $ B. LIABILITIES/DEBTS (This is where you listing what you lot OWE.) INSTRUCTIONS: STEP 1: In column A, listing a clarification of each split debt owed by you lot (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of an item. Footstep 2: If this is a petition for dissolution of marriage, check the line in Column A next to any debt(south) for which you believe you should exist responsible. Stride 3: In column B, write what you believe to be the current amount owed for all items listed. STEP iv: Use cavalcade C only if this is a petition for dissolution of wedlock and yous believe an particular is �nonmarital,� meaning the debt belongs to only 1 of you and should non be divided. Y'all should point to whom you believe the debt belongs. (Typically, you volition merely employ Column C if the debt was owed by 1 spouse before the marriage. See the �General Information for Self-Represented Litigants� plant at the starting time of these forms and section 61.075(1), Florida Statutes, for definitions of �marital� and �nonmarital� avails and liabilities.) A LIABILITIES: DESCRIPTION OF ITEM(S) LIST Simply Last FOUR DIGITS OF ACCOUNT NUMBERS. Check the line next to any debt(southward) for which you believe yous should be responsible. B Electric current Corporeality Owed C Nonmarital (Cheque correct column) married man married woman Mortgages on existent manor: Beginning mortgage on home $ Second mortgage on habitation Other mortgages Charge/credit card accounts Automobile loan Car loan Banking concern/Credit Union loans Money you owe (not evidenced by a note) Judgments Other: Full Debts (add together column B) $ C. Internet WORTH (excluding contingent assets and liabilities) $_______Total Assets (enter full of Column B in Asset Table; Section A) $_______Total Liabilities (enter total of Column B in Liabilities Table; Department B) $_______TOTAL NET WORTH (Total Assets minus Full Liabilities) (excluding contingent avails and liabilities) D. CONTINGENT ASSETS AND LIABILITIES INSTRUCTIONS: If you accept any POSSIBLE assets (income potential, accrued vacation or ill leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent taxation liabilities, debts assumed by another), you must list them here. A Contingent Assets Bank check the line next to whatsoever contingent asset(southward) which you are requesting the judge award to you. B Possible Value C Nonmarital (Check correct column) husband wife $ Full Contingent Assets $ A Contingent Liabilities Check the line next to whatsoever contingent debt(southward) for which yous believe you should be responsible. B Possible Amount Owed C Nonmarital (Check correct cavalcade) married man wife $ Full Contingent Liabilities $ Due east. CHILD SUPPORT GUIDELINES WORKSHEET. Florida Family Law Rules of Process Grade 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or alter kid back up. This requirement cannot be waived by the parties. [Check one only] ____A Child Support Guidelines Worksheet IS or WILL BE filed in this example. This case involves the institution or modification of child back up. ____A Child Back up Guidelines Worksheet IS NOT beingness filed in this case. The establishment or modification of kid support is not an consequence in this case. I certify that a copy of this fiscal affidavit was [check all used]: ( ) e-mailed ( ) mailed, ( ) faxed ( ) hand delivered to the person(s) listed below on {engagement} ____________________. Other party or his/her attorney: Name: _____________________________ Address: ____________________________ City, Country, Zip: _______________________ Fax Number: _________________________ Electronic mail Address(es): _____________________ I empathise that I am swearing or affirming under oath to the truthfulness of the claims fabricated in this affidavit and that the punishment for knowingly making a faux statement includes fines and/or imprisonment. Dated: ______________________ __________________________________________ Signature of Party Printed Name: ______________________________ Address: ___________________________________ Metropolis, State, Zero: ______________________________ Fax Number: ________________________________ Electronic mail Address(es): ____________________________ STATE OF FLORIDA County OF Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, blazon, or stamp commissioned proper name of notary or deputy clerk] __ Personally known __ Produced identification Blazon of identification produced IF A NONLAWYER HELPED You lot Fill OUT THIS Form, HE/SHE MUST Fill up IN THE BLANKS BELOW: [fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent This class was completed with the aid of: {name of individual} ___________________________________________________________, {name of concern} _______________________________________________________________, {accost} ___________________________, {urban center} ____,{state} _, {telephone number} ______________________.

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Source: https://e-database.org/florida-family-law-financial-affidavit-long-form

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