Affidavit Of Income And Property (One Page)

_____________Court ____________County Case Number AFFIDAVIT OF INCOME ____________Tennessee AND P ROPERTY _____________________________________________ vs._______________________________________________ Comes now the Defendant(s) and, subject to the penalty of perjury, makes oath and says that the following facts are true and that there is NO OTHER source of income or property other than that described below: 1. Full name: Address: 7. List all land/house/real estate/property you own: Phone # DESCRIBE VALUE Soc. Sec. No. $ Employer: $ Phone # $ $ 2. List all dependents: Name Age Relationship 8. List all personal property/cars/trucks/ furniture/stocks/bonds/tools/equipm ent you own and its total value: DESCRIBE VALUE Cars $ Trucks $ 3. List all income from any source: Other $ $ per/wk /mo , $ from : $ $ per/wk /mo , $ from : $ per/wk /mo , 9. List all assets/property sold or transferred in the last six from : months: DESCRIBE VALUE I receive CHILD SUPPORT in the sum of $ $ per . $ 4. List all bank accounts: $ ACCOUNT BANK/SOURCE BALANCE $ Checking $ $ Savings $ 10. The last income tax I filed was for and it reflected Other: $ an income of $ and I attach a copy hereto or will Other: $ file the same within seven days. 5. List all debts: LIST ALL PROPERTY YOU CLAIM TO BE EXEMPT CREDITOR/ADDRESS BALANCE PURSUANT TO LAW: $ $ All clothing for myself and my family; all receptacles for said $ clothing; family portraits; family Bible; school books; and $ $ 6. List all monthly household expenses: Rent/Mortgage: $ Utilities: $ VERIFICATION AND OATH: Comes now the Health Insurance: $ Petitioner(s) / Defendant(s) and makes oath, subject to the Transportation Cost: $ penalty of perjury, that the information in this Motion for Food: $ Installment Payment is true to the best of Petitioners Clothing: $ knowledge, information and belief. Other: $ Defendant(s) $ $ $ Sworn to and subscribed before me on __________________ TOTAL $ Clerk/Deputy Clerk/Notary Public Commission Expires: (Rev 5/03)