Family Law Financial Affidavit Long Form Florida Legal Form

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)(09/12)

When should this form be used?

This form should be used when you are involved in a family law case which requires a financial affidavit and your individual gross income is $50,000 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 financial affidavits;
(2) you have no minor children, no support issues, and have filed a written settlement agreement disposing of all financial issues; or
(3) the court lacks jurisdiction to determine any financial issues.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should 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 form must be served on the other party in your case within 45 days of being served with the petition, if it is not served on him or her with your initial papers. Service must be in accordance with Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information 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 Law Rule of Procedure 12.285.

Special notes…

If you want to keep your address confidential because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, 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 Law Form 12.980(h).

The affidavit must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided below for making these conversions. The on line form will convert salaries to monthly amounts.

Hourly – If you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount x Hours worked per week = Weekly amount
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Daily – If you 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 x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Weekly – If you are paid by the week, you may convert your income to monthly as follows:
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weekly – If you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount x 26 = Yearly amount
Yearly amount ÷ 12 Months per year = 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 manner.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

NOTE: You can’t save and return to this form on line. Be sure to have your state and federal income tax information, a current pay stub, utility bills, insurance, mortgage or rent information, information on child support and alimony, credit card debt and payments, car payments, unemployment and any other income and debt information. You can save the form if it is incomplete, but if you return to the form on line, you will have to re-enter your information.

Your full legal name:

I am the:

petitioner

respondent

Other Party’s legal name:

Your Information

Address:
City, state, zip:

Phone (area code and number):
Fax (area code and number):
Email(s):
Age:

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No:
(If you don’t have this information yet, leave it blank)
Division:
(If you don’t have this information yet, leave it blank)

Petitioner,
and
Respondent.

My Occupation:

I am:
Unemployed
Describe your efforts to find employment, how soon you expect to be employed, and the pay you expect to receive:

Employed by:

Business Address:
City, State Zip Code:
Phone:

Employment Information
If you are employed but have a different pay period than the choices given below, or your pay varies (if you have more than one job, for example) estimate your average gross pay as closely as possible and convert it to a monthly pay amount. Enter it here as monthly. If you are self-employed, unemployed, retired, on disability, etc, leave this at 0.

Pay rate $

Pay Rate: Numbers only

Your Gross Monthly pay is $
If this doesn’t seem right, please double-check your entry, or calculate your monthly gross wages manually and enter it above as “Monthly”.

If you are expecting to become unemployed or change jobs soon, describe the change you expect and why and how it will affect your income:

Check here if you currently have more than one job. List the information above for the second job(s) on a separate sheet and attach it to this affidavit.

Check here if you are retired.
Date of retirement:
Employer from whom retired:
Address:
City, State Zip:
Phone:

LAST YEAR’S GROSS INCOME:

YEAR Your Income:

Other Party’s Income (if known)

SECTION I. PRESENT MONTHLY GROSS INCOME
Attach extra sheets to your printed form, if needed to cover extra items and
descriptions. Items included under “other” should be listed separately with
separate dollar amounts. Where you calculate amounts, make sure and use MONTHLY
amounts for all the following sections, unless otherwise noted.
The on-line form makes conversions between other pay periods to monthly, as far as
possible.

1. Monthly gross salary or wages	1. $ 0
2. Monthly bonuses, commission, allowances, overtime, tips and similar payments	2. $
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.)	3. $
4. Monthly disability benefits/SSI received	4. $
5. Monthly Workers’ Compensation received	5. $
6. Monthly Unemployment Compensation received	6. $
7. Monthly pension, retirement, or annuity payments received	7. $
8. Monthly Social Security Benefits received	8. $
9. Monthly Alimony payment actually received 9a. From this case: $ 9b. From other case(s): $	9. $ 0
10. Monthly interest and dividends received	10. $
11. Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income) (Attach sheet itemizing such income and expense items.)	11. $
12. Monthly income from royalties, trusts, or estates	12. $
13. Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses	13. $
14. Monthly gains derived from dealing in property (not including nonrecurring gains)	14. $ Numbers only
15. Any other income of a recurring nature (list source)	15. $
16. Any other income of a recurring nature (list source)	16. $
17. PRESENT MONTHLY GROSS INCOME TOTAL:	17. $ 0.00

SECTION I. PRESENT MONTHLY DEDUCTIONS

18. Federal, state and local income tax (corrected for filing status and allowable dependents and income tax liabilities) Add up your adjusted tax totals from your current IRS, State and local returns. Do not convert to monthly $ a. Filing Status b. Number of dependents claimed	18. $ 0.00 /month
19. FICA or self-employment taxes Amount listed on your most recent pay stub:	19. $ 0 /month
20. Medicare payments Amount listed on your most recent pay stub:	20. $ /month
21. Mandatory union dues Amount listed on your most recent pay stub:	21. $ /month
22. Mandatory retirement payments Amount listed on your most recent pay stub:	22. $ /month
23. Employer health insurance payments, including dental insurance. Exclude portion paid for any minor children of this relationship, or insurance not provided by your employer. Amount listed on your most recent pay stub:	23. $ /month
24. Monthly court-ordered child support actually paid for children from another relationship	24. $ /month
25. Monthly court-ordered alimony actually paid 25a. From this case: $ /month 25b. From other case(s): $ /month	25. $ 0 /month
26. TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES (Add lines 18 through 25):	26. $
PRESENT NET MONTHLY INCOME :	26. $

SECTION II. AVERAGE MONTHLY EXPENSES

A. HOUSEHOLD:
Mortgage or rent	$
Property taxes	$
House Insurance (if not included in mortgage)	$
Condominium or Homeowner’s Association Fees	$
Electricity	$
Water, garbage and sewer	$
Telephone	$
Fuel Oil or natural gas	$
Maintenance/Repairs	$
Lawn care	$
Pool Maintenance	$
Pest control	$
Misc. Household	$
Food	$
Meals outside home	$
Cable or Satellite t.v.	$
Alarm service	$
Service contracts on appliances	$
Maid service	$
Other	$
	$
	$
	$
	$
SUBTOTAL	$0.00

B. AUTOMOBILE:
Gas	$
Repairs	$
Auto tags and emission testing	$
Insurance	$
Car payments (lease or financing)	$
Car rental/replacement	$
Alternative transportation (bus, rail, car pool, etc)	$
Tolls and parking	$
Other:	$
SUBTOTAL	$0.00

C. CHILD(REN)’S EXPENSES:
Day Care	$
School tuition	$
School supplies, books and fees	$
After school activities	$
Lunch Money	$
Private lessons or tutoring	$
Allowances	$
Clothing and uniforms	$
Entertainment	$
Health Insurance	$
Medical, dental, prescriptions (nonreimbursed only)	$
Psychiatric/psychological/counselor	$
Orthodontic	$
Vitamins	$
Beauty Shop/Barber Shop	$
Nonprescription medication	$
Cosmetics, toiletries, and sundries	$
Gifts from child(ren) to others (other children, relatives, teachers, etc.)	$
Camp or Summer Activities	$
Clubs (Boy/Girl Scouts, etc.)	$
Access expenses (for nonresidential parent)	$
Miscellaneous	$
SUBTOTAL	$0.00

MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP:(other than court ordered child support)
	$
	$
	$
	$
SUBTOTAL	$0.00

INSURANCE:
Health insurance, excluding portion paid for any minor child(ren) of the relationship and paycheck deductions	$
Life	$
Dental	$
Other	$
Other	$
SUBTOTAL	$0.00

E. OTHER EXPENSES NOT LISTED ABOVE:

Dry Cleaning and Laundry

Clothing

Medical/Dental (uninsured)

Psychiatric, psychological or counselor

Non-prescription medications, cosmetics toiletries and sundries

Grooming

Gifts

Pet expenses

Entertainment

Club dues and membership

Sports and hobbies

Periodicals/books/tapes/CDs

Vacations

Religious Organizations

Bank charges/credit card fees

Education expenses

Other

SUBTOTAL

$0.00

F. PAYMENTS TO CREDITORS:

Creditor

Monthly
Payment

10.

11.

12.

13.

SUBTOTAL

$0.00

TOTAL MONTHLY EXPENSES

28. $0.00

SUMMARY

29. TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)	29. $ 0
30. TOTAL MONTHLY EXPENSES (from line 28 above)	30. $ 0.00
31. SURPLUS (if line 29 is more than line 30, subtract line 30 from line 29. This is the amount of your surplus. Enter that amount here.)	31. $ 0
32. (DEFICIT) (if line 29 is less than line 30, subtract line 29 from line 30. This is the amount of your deficit. Enter that amount here.)	$ (0)

SECTION IV. CHILD SUPPORT GUIDELINES WORKSHEET
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot be waived by the parties.)

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

A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or modification of child support is not an issue in this case.

I certify that a copy of this document wasmailedfaxedemailedhand delivered
to the person(s) listed below on {date}.

Other party or his/her attorney:
Name:
Address:
City, State, Zip:
Fax Number:
E-mail Address(es):

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

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

full legal name of Non-Lawyer
Street:
City:
State:
Phone:

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Description of Items. List a description of each separate item owned by you (and/or your spouse, if this is a petition for dissolution of marriage). DO NOT LIST ACCOUNT NUMBERS. √ the box next to any asset(s) which you are requesting the judge award to you.	Current Fair Market Value	husband (Don’t check this column except for separate, non-marital items)	wife (Don’t check this column except for separate, non-marital items)
Cash (on hand)	$
Cash (in banks or credit unions)	$
	$
Stocks/Bonds	$
	$
	$
Notes (money owed to you in writing)	$
	$
	$
Money owed to you (not evidenced by a note)	$
	$
	$
Real Estate (Home)	$
Real Estate (Other)	$
	$
	$
	$
	$
	$
Business interests	$
	$
	$
	$
	$
Automobiles	$
	$
	$
	$
Boats	$
	$
	$
Other Vehicles	$
	$
	$
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)	$
	$
	$
	$
Furniture & furnishings in home	$
	$
Furniture & furnishings elsewhere	$
	$
Collectibles	$
	$
Jewelry	$
	$
Life Insurance	$
	$
	$
Sporting and entertainment (TV, stereo, etc.) equipment	$
	$
	$
	$
	$
Other	$
	$
	$
	$
=	$
	$
=	$
=	$
check here if additional pages are attached
Total Assets	$0.00

Description of items. List a description of each separate item owned by you (and/or your spouse, if this is a petition for dissolution of marriage). DO NOT LIST ACCOUNT NUMBERS. √ the box next to any asset(s) which you are requesting the judge award to you.	Current Amount Owed	husband (Don’t check this column except for separate, non-marital items)	wife (Don’t check this column except for separate, non-marital items)
Mortgages on real estate: First mortgage on home	$
Second mortgage on home	$
Other mortgages	$
	$
Charge/credit card accounts	$
	$
	$
	$
	$
	$
Auto loans	$
	$
	$
	$
	$
	$
	$
	$
	$
	$
Other	$
	$
	$
	$
	$
	$
	$
check here if additional pages are attached
Total Debts	$0.00

Contingent Assets√ the box next to any asset(s) which you are requesting the judge award to you.	Possible Value	husband(Don’t check this column except for separate, non-marital items)	wife(Don’t check this column except for separate, non-marital items)
	$
	$
	$
	$
	$
Total contingent Assets	$0.00

Contingent Liabilities√ the box next to any asset(s) which you believe you should be responsible.	Possible Amount Owed	husband(Don’t check this column except for separate, non-marital items)	wife(Don’t check this column except for separate, non-marital items)
	$
	$
	$
	$
	$
Total contingent Liabilities	$0.00