INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.902(b),
FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)(01/15)
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 UNDER $50,000 per year unless:
- You are filing a simplified dissolution of marriage under rule 12.105 and both parties have waived the filing of a financial affidavit;
- You have no minor children, no support issues, and have filed a written settlement agreement disposing of all financial issues; or
- 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 mailed or hand delivered to 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. The on line form does most of the converting for you, but hints are provided below.
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 online. 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:
Other Party’s legal name:
My address:
City, state, zip:
My Phone (area code and number):
My Fax (area code and number):
My email address(es):
My Occupation:
I’m employed by:
Business Address:
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Petitioner,
and
Respondent.
Employment Information
If you have a different pay period than the choices given below, or your pay varies (for instance if you have more than one job and different pay periods), estimate your total average pay as closely as possible and convert it to a monthly pay amount. Enter it here as monthly.
If you receive a regular paycheck from an employer, then choose your pay rate and pay period below, and the income table will calculate monthly totals for you, based on your pay stub deductions. However, if you have multiple jobs with different pay periods, are self-employed, retired, etc, choose “monthly” here so that no further calculations will be done on your entries in the income table.
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”.
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 online form makes conversions between other pay periods to monthy, 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. $ |
| 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 III. ASSETS AND LIABILITIES
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item is “nonmarital,” meaning it belongs to only one of you and should not be divided. You should indicate to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if property/debt was owned/owed by one spouse before the marriage. See the “General Information for Self-Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for definitions of “marital” and “nonmarital” assets and liabilities.)
A. ASSETS:
B. LIABILITIES (DEBTS):
C. CONTINGENT ASSETS AND LIABILITIES:
INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts assumed by another), you must list them here.
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