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Domestic Relations Financial Affidavit - Georgia
| Domestic Relations Financial Affidavit Form. This is a Georgia form and can be used in Domestic Violence Superior Court Gwinnett Local County . |
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In the Superior Court of Gwinnett County, Georgia ) ) ) ) ) ) ) _______________________________, Plaintiff vs. ______________________________, Defendant Civil Action No. ________________ DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT'S NAME:______________________________ Spouse's Name: _______________________________ Age _________ Age _________ Date of Marriage: _____________________ Date of Separation __________________ Names and birth dates of children for whom support is to be determined in this action: Name Date of Birth Resides with ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Names and birth dates of affiant's other children: Name Date of Birth Resides with ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. SUMMARY OF AFFIANT'S INCOME AND NEEDS (a) Gross monthly income (from item 3A) (b) Net monthly income (from item 3C) (c) Average monthly expenses (item 5A) Monthly payments to creditors Total monthly expenses and payments to creditors (item 5C) $ ______________ ______________ $ ______________ + ______________ _______________ MAG 60-44 Domestic Relations Affidavit 1 American LegalNet, Inc. www.FormsWorkflow.com 3. A. AFFIANT'S GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receipt.) Salary or Wages ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS Commissions, Fees, Tips Income from self-employment, partnership, close corporations, and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS Bonuses Overtime Payments Severance Pay Recurring Income from Pensions or Retirement Plans Interest and Dividends Trust Income Income from Annuities Capital Gains Social Security Disability or Retirement Benefits Workers' Compensation Benefits Unemployment Benefits Judgments from Personal Injury or Other Civil Cases Gifts (cash or other gifts that can be converted to cash) Prizes/Lottery Winnings Alimony and maintenance from persons not in this case Assets which are used for support of family Fringe Benefits (if significantly reduce living expenses) Any other income (do NOT include means-tested Public assistance, such as TANF or food stamps) GROSS MONTHLY INCOME MAG 60-44 Domestic Relations Affidavit $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ 2 American LegalNet, Inc. www.FormsWorkflow.com B. Affiant's Net Monthly Income from employment (deducting only state and federal taxes and FICA) $ _______________ Affiant's pay period (i.e., weekly, monthly, etc.) ___________________ Number of exemptions claimed ____________ 4. ASSETS (If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion under the appropriate spouse's column and state the amount and the basis: pre-marital, gift, inheritance, source of funds, etc.). Description Value Separate Asset of the Husband Separate Asset of the Wife Basis of the Claim Cash Stocks, bonds CD's/Money Market Accounts Bank Accounts (list each account): _______________ _______________ _______________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ Retirement Pensions, 401K, IRA, or $____________ ______________ ______________ ____________________ Profit Sharing Money owed you: Tax Refund owed you: Real Estate: home: debt owed: other: $ ___________ $ ___________ $____________ ______________ ______________ ____________________ _____________ _____________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ debt owed: $ ____________ Automobiles/Vehicles: Vehicle 1: $____________ ______________ ______________ ____________________ debt owed: $ ___________ 3 American LegalNet, Inc. www.FormsWorkflow.com MAG 60-44 Domestic Relations Affidavit Vehicle 2: debt owed: Life Insurance (net cash value): $____________ ______________ ______________ ____________________ $____________ $____________ ______________ ______________ ____________________ Furniture/furnishings: $____________ ______________ ______________ ____________________ Jewelry: Collectibles: Other Assets: _______________ _______________ _______________ Total Assets: $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ $____________ ______________ ______________ ____________________ 5. A. AVERAGE MONTHLY EXPENSES HOUSEHOLD Mortgage or rent payments Property taxes $ __________ Cable TV $ __________ Misc. household and grocery Items $ __________ Meals outside the home $ __________ Other $ __________ AUTOMOBILE Gasoline and oil $ __________ Repairs $ __________ Auto tags and license $ __________ Insurance $ __________ OTHER VEHICLES (boats, trailers, RVs, etc.) Gasoline and oil $ __________ Repairs $ __________ Tags and license $ __________ Insurance $ __________ $ __________ $ __________ $ __________ Homeowner/Renter Insurance Electricity Water Garbage and Sewer Telephone: residential line: cellular
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