Illinois > Local County > Montgomery > Family Law
Financial Affidavit - Illinois
| Financial Affidavit Form. This is a Illinois form and can be used in Family Law Montgomery Local County . |
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IN THE CIRCUIT COURT FOURTH JUDICIAL CIRCUIT MONTGOMERY COUNTY , ILLINOIS IN RE: THE MARRIAGE OF ________________________) ________________________) _______________________________) Petitioner No: _____________________ VS ___________________________) _______________________ ) _______________________ ) Respondent FINANCIAL AFFIDAVIT _____________________________, on oath states that my age is _______, and that: If Pre-Judgment: 1. (a) Date of Marriage______________ Date of Separation_________________ Child Support Maintenance Paid since separation: $_____________ $_____________ If Post-Judgment: 1. (a) Date of Dissolution ______________________ Date of Separation ______________________ C/S Maint. (Per week, month) Ordered to be paid: $_________ $_________ _________________ Paid since Dissolution $_________ $_________ _________________ Order has been amended _______________times. Now being paid: $_________ $_________ _________________ Current Arrearage $_________ $_________ _________________ 2. There are _______children of the marriage, as follows: NAME AGE DATE OF BIRTH IN CUSTODY OF ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 3. I have additional persons dependent on me for support as follows: NAME AGE DATE OF BIRTH RELATIONSHIP : _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 4. Present Employment____________________________________________________ Address______________________________________________________________ Hours of Employment __________________________________________________ Payroll Deductions Hourly Wage $ ___________ Weekly Gross Income $ ___________ Total Deductions $ ___________ Take Home Pay $ ___________ Number of Dependents Claimed _______ TOTAL DEDUCTIONS $ ___________ (a) Taxes $ ___________ (b) Soc. Sec. $ ___________ (c) Medical Ins. $ ___________ (d) Credit Union $ ___________ (e) Other $ ___________ 5. My MONTHLY living expenses are as follows: (Rent) or (House Payment) $__________ Electricity $_______________________ Gas $____________________________ Heating Oil $______________________ Water $ _________________________ Telephone $_______________________ Trash Collection $__________________ Sewer Charge $____________________ Groceries/Household $_______________ Restaurant Meals $__________________ Charitable Contributions $____________ Haircuts/Beauty Shop $______________ Union Dues $______________________ Car Ins. $_____________________________ Gas, Oil & Repairs $____________________ Hosp./Med. Ins. $______________________ Life Ins. $_____________________________ Personal Items $_______________________ Doctors $_____________________________ Dentists $_____________________________ Hospital $_____________________________ School (Meals/Supplies) $________________ Cleaning & Laundry $___________________ Entertainment $________________________ Gifts for Children $_____________________ Child Care $_______________________ Other $_______________________________ TOTAL MONTHLY LIVING EXPENSE $________________________ American LegalNet, Inc. www.FormsWorkFlow.com 6. Debts: (Payments to creditors other than noted at Paragraph No. 5 above) To Whom: (a) ______________ (b) ______________ (c) _____________ (d) ______________ (e) ______________ (f) ______________ (g) ______________ (h) ______________ (i) ______________ (j) ______________ (k) ______________ Purpose: Monthly Payment: Balance: Car Payment $_________________ $_________________ Furniture/Appliance $_________________ $_________________ Credit Card $_________________ $_________________ Credit Card $_________________ $_________________ __________________ $_________________ $_________________ __________________ $_________________ $_________________ __________________ $_________________ $_________________ __________________ $_________________ $_________________ __________________ $_________________ $_________________ __________________ $_________________ $_________________ __________________ $_________________ $_________________ $_________________ $_________________ TOTALS 7. Assets: (List all cash, certificates of deposit, savings, checking and Credit Union Accounts, bonds, stocks, household goods and appliances, motor vehicles, boats, real estate, and all other property, real or personal, owned by you.) Description: Location: Fair Cash/ Market Value: $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ Co-Owners Names: ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ (a)________________ (b)_______________ (c)________________ (d)________________ (e)________________ (f)________________ (g)_______________ (h)________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ (i)_________________ __________________ American LegalNet, Inc. www.FormsWorkFlow.com Type: RETIREMENT FUND Company: Contributory/ Non-contributory: ___________________ _______________ ___________________ _______________ Present Value: $_________________ $_________________ (a)_______________ (b)_______________ Type: LIFE INSURANCE Company: Beneficiary: Present Value: $_________________ $_________________ (a)________________ (b)________________ __________________ __________________ _______________ _______________ 8. Other Income: Source:__________________________Amount$________________ Source:__________________________Amount $________________ I have read the foregoing; together with _____attached sheets following hereafter, and same are true and correct. _________________________________________ Signature Subscribed and swor
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