Last updated: 5/2/2006
Financial Affidavit
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Description
IN THE CIRCUIT COURT OF THE SEVENTH JUDICIAL CIRCUIT, IN AND FOR ST. JOHNS COUNTY CASE NO: DIVISION: PETITIONER :____________________________________________ -VS- RESPONDENT :___________________________________________ FINANCIAL AFFIDAVIT Petitioner swears and says under penalty of perjury the following is tru e: Occupation: ______________________________ Business Address:_______________________________ Employed by: __________________________________Pay period: ____________________________________ ITEM 1: INCOME: Average per week, month or bi-weekly (circle). Average Gross wage $ ___________ Deduct Federal Income Tax $ ___________ Social Security $ __________ _ Other $ ___________ Total Deductions $ __________ _ Average NET wage (Gross less deductions) Other Income: $ __________ $ ___________ TOTAL NET INCOME: $ ___________ ITEM 2: ASSETS: Cash on hand or in banks Stocks, Bonds, notes, etc: $___________ $ ___________ Real Estate: Home $ ___________ Other $ ___________ Automobile(s) $ ___________ Other Personal Property $___________ Other Assets: ______________________ $ ___________ $ ___________ TOTAL ASSETS: $ ___________ ITEM 3: LIABILITIES: Real Estate mortgages $ ___________ Automobile loans $ ___________ Other notes and loans $ ___________ Other: $___________ TOTAL LIABILITIES: $ ___________ _________________________________ Affiant Sworn to and subscribed before me this day of , 20 . CHERYL STRICKLAND CLERK OF THE CIRCUIT COURT BY: (SEAL) CC FORM 4311, REVISED MAR 97 American LegalNet, Inc. www.USCourtForms.com
