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Financial Affidavit (Short Form) - Georgia
| Financial Affidavit (Short Form) Form. This is a Georgia form and can be used in Civil State Court Chatham Local County . |
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o}a100 Financial Affidavit for the State Court of Chatham County, Georgia Date Incurred Original Debt Amount Paid Current Balance Name: Address: Debt 1 Debt 2 Debt 3 Debt 4 FOR OFFICIAL USE ONLY MONTHLY OBLIGATIONS CONTINUED Rent / Mortgage Trailer Lot Rental Telephone Cable Other Utilities Food Car Payments Car Maintenance Car Insurance Gasoline / Fuel Child Support Beeper / Pager Medical Expenses Medical Insurance Alimony Payments Loan Payments Clothing Internet Connection Cellular / Car Phone Other Payments 0.00 0.00 0.00 In the space provided below, please print the name of your employer and weekly pay. If paid monthly, divide by 4. Employment Information INCOME AFDC Alimony (Receiving) Unemployment Food Stamps Trust Fund Investment Dividends Claims / Settlements Disability Child Support GET Worker's Comp Social Security Pension Other Income Wages + Assistance 0.00 0.00 0.00 TOTALS Weekly Pay OTHER ASSETS Cash in Savings Accounts Lottery Winnings Inheritances Legal/Insurance Settlement Other Assets Not Listed Other Assets Not Listed Total Other Assets MONTHLY OBLIGATIONS Household Expenses School Garbage Pickup Gas Electric Who, if anyone, assisted in completing this form? Prepared By: Date: 0.00 BASED UPON DATA PROVIDED,NET WORTH IS 0.00 TOTAL INCOME: TOTAL EXPENSES: NET DIFFERENCE: Real Estate FMV Less Amt Owed Automobile(s) Less Amt Owed Net Real Estate Net Automobile 0.00 Stocks & Bonds Retirement Account(s) Cash, Other than savings Checking Account(s) Other Assets Not Shown Total All Assets CLEAR FORM Total Expenses I certify this is to be true and correct. DATE 14. Financial Affidavit (SF) American LegalNet, Inc. www.USCourtForms.com
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