Illinois > Local County > Fulton > Child Support
Financial Affidavit (Family Cases) - Illinois
| Financial Affidavit (Family Cases) Form. This is a Illinois form and can be used in Child Support Fulton Local County . |
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IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT COUNTY, ILLINOIS Petitioner, vs. Case No: Respondent. FINANCIAL AFFIDAVIT (Family Cases) (Local Court Rule G-5.1) I, contained herein is true and correct as of 1. My Name: Address: Occupation: 2. Opposing party: Address: Employer: Occupation: , having been duly sworn, upon oath, state that the information , 20 . Age: Education: Age: Education: Job Title: b. Date of Separation: D/O/B: D/O/B: 3. (If Applicable): a. Date of Marriage: c. Date final Judgment of Diss. entered: 4. My Employment Information [ ] Current Employer: Address: Address: [ ] Self Employed as: Address: [ ] Other Employment: Per [ ] Unemployed [ ] Unemployment Compensation $ Do you expect your employment to change significantly in the next 6 months? [ ] No [ ] Yes Why? Number of Paychecks per year: (Please Check box) [ ] 12 [ ] 24 [ ] 26 [ ] 52 Number of Dependents claimed on Federal Income Tax returns: [ ] Other: 5. Any Prior Support Orders (if applicable): [ ] Paid by me [ ] Paid to me. [ ] Child Support [ ] Maintenance [ ] Unallocated child support & maintenance [ ] College expenses Amount of Prior Order: $ Date of Prior Order: 6. Minor and/or dependent Children born to myself and opposing party: Name Age Date of Birth Currently Living with: (Attach additional page(s) as needed) Page 1 of 8 American LegalNet, Inc. www.FormsWorkFlow.com 7. I have additional persons dependent on me: Name Age Date of Birth Relationship (Attach additional page(s) as needed) 8. State Total Number of People in your Household: List Name of all Persons in your Household (exclude yourself): Name Age Date of Birth Relationship (Attach additional page(s) as needed) 9. Proof of Income: Pursuant to Local Court Rule G-5.1.B. [ ] I have attached or [ ] I shall have available at any hearing regarding child support, maintenance, college expenses, or disposition of property, copies of my prior year's Federal Income Tax return, including all W-2 forms and 1099 forms, and my most recent pay stub showing year to date earnings and deductions therefrom, or if the same is not provided by my employer, my five (5) most recent payroll stubs. 10. STATE AND FEDERAL INCOME TAX REFUNDS How much was your last State Income Tax Refund? $ How much was your last Federal Income Tax Refund? $ . For what tax year? . For what tax year? 11. STATEMENT OF INCOME 11a. Total Gross Monthly Earned Income Gross Salary/Wages/Base Pay Overtime/Commission Bonus Draw 11a. TOTAL GROSS MONTHLY EARNED INCOME: 11b. Total Required Monthly Deductions From Earned Income Federal Tax (based on exemptions) exemptions) State Tax (based on FICA (or Social Security equivalent: RR, Tier I) Medicare Mandatory 401(K) or retirement contributions ) Union Dues (Name of Union: Health - Medical Insurance Premiums deducted from paycheck: Myself My Dependents Prior Orders of Child Support or Mainatenance actually paid $ pursuant to Court Order No. $ Other (specify): $ Other (specify): 11b. TOTAL REQUIRED MONTHLY DEDUCTIONS FROM EARNED INCOME: 11c. TOTAL NET MONTHLY EARNED INCOME (11a. minus 11.b) 11d. TOTAL OTHER MONTHLY INCOME Social Security Page 2 of 8 American LegalNet, Inc. www.FormsWorkFlow.com $ $ $ $ $ 0.00 $ $ $ $ $ $ $ $ $ $ $ 0.00 ($ 0.00 ) Unemployment benefits Worker's Compensation /Disability payment Public Aid/Food Stamps Pension and Retirement Benefits Interest income/Dividend income Trust income Rental income Business income (including nontaxable distributions) Partnership income [ ] Other: Spousal Support received (specify) [ ] Pursuant to a prior judgment or order in another case [ ] Pursuant to a prior judgment or order in this case [ ] Voluntarily paid in this case or another case Child Support received (specify) [ ] Pursuant to a prior judgment or order in another case [ ] Pursuant to a prior judgment or order in this case [ ] Voluntarily paid in this case or another case [ ] Other: 11d. TOTAL OTHER MONTHLY INCOME $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ (Add lines 11c. and 11d.) 0.00 11. TOTAL MONTHLY NET EARNED INCOME & OTHER INCOME 12. STATEMENT OF MONTHLY LIVING EXPENSES $ 0.00 (Mark with A*@ if projected expenses. Be prepared to offer testimony in support of estimates) 12a. Household Expenses a. Mortgage or Rent (specify): $ b. Home Equity Loan payment $ c. Real Estate Taxes, Assessments (if not in mortgage) $ d. Homeowners or Renters Insurance (if not in mortgage) $ e. Condo Maintenance Fee $ f. Heat/Fuel $ g. Electricity $ h. Water $ i. Sewer $ j. Groceries and Household Supplies $ k. Garbage and Refuse Removal $ l. Home Telephone (including long distance) $ m. Cell Phone $ n. Laundry B Dry Cleaning $ o. Household help B Cleaning Services B Maid $ p. Furniture, Appliance Repair/Replacement $ q. Lawn B Garden Care / Snow removal $ r. Tobacco, Liquor, Beer, Wine, etc. $ s. Cable or Satellite Television $ t. Internet Computer Service $ $ u. Other (specify): 0.00 SUBTOTAL HOUSEHOLD EXPENSES: $ Page 3 of 8 American LegalNet, Inc. www.FormsWorkFlow.com 12b. Transportation a. Vehicle Payments (Vehicle 1) b. Vehicle Payments (Vehicle 2) c. Fuel & Oil d. License & Resgistration e. Repairs & maintenance f. Vehicle Insurance g. Other (specify): h. Other (specify): SUBTOTAL TRANSPORTATION EXPENSES: 12c. Personal Expenses (actually paid for you and dependents) a. Clothing & Shoes b. Business / Work Uniforms c. Eyeglasses / Contacts (after insurance) d. Grooming / Cosmetics e. Hairdresser / Barber f. Medical (after insurance proceeds/reimbursement) Doctor Dentist Optical Medication g. Insurance (not deducted from paycheck) Life Insurance Medical/Hospitalization Dental/Optical h. Educational Expense i. Books, magazines, newspapers, etc. j. Recreation, sports and hobby expenses k. Religious / charitable contributions l. Vacations m. Social / Club Dues n. Gifts and presents other than to children o. Other (specify): SUBTOTAL PERSONAL EXPENSES: 12d. Expenses of Minor or Dependent Children a. Education Tuition Books/Fees Lunches Transportation b. Allowance c. Child care / After-school care d. Sitters e. Child Clubs/Summer Camps f. Entertainment g. Gifts (for Holidays, birthdays, etc) h. Other (specify): SUBTOTAL CHILDREN'S EXPENSES: 12.TOTAL MONTHLY LIVING EXPENSES: $ $ $ $ $ $ $ $ $ 0.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 0.00 $ $ $ $ $ $ $ $ $ $ $ $ $ 0.00 0.00 Page 4 of 8 American LegalNet, Inc. www.FormsWorkFlow.com 13. STATEMENT OF MONTHLY MARITAL DEBT PAYMENT NOT OTHERWISE LISTED Creditor's Name Payment for Balance Due Monthly
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