Form 12.902(C) "Family Law Financial Affidavit (Long Form)" - Florida

What Is Form 12.902(C)?

Form 12.902(C), Family Law Financial Affidavit (Long Form), is used during divorce proceedings to determine the average monthly cash flow of each party. This form will ask you to list all sources of income and expenses or debt an individual maintains.

Alternate Names:

  • Florida Family Law Financial Affidavit Long Form;
  • Florida Financial Affidavit Long Form.

This form is issued by the Florida Circuit Court and was last updated on January 1, 2015. A Florida Financial Affidavit Long Form is available for download below.

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How to Fill Out a Florida Financial Affidavit Long Form?

To fill out a Florida Financial Affidavit Long Form, you will be asked to submit the following details:

  1. Prior to filling out the information needed for this form, you will need to calculate your financial details based on monthly totals (for example, you cannot include items as daily, weekly, or yearly expenses or income).
  2. After filling in your name, general information, and case number, you will be asked to provide your current employment status (you can provide information for additional employers), your employer's information, how much money you receive, and if you are considering seeking a new role shortly.
  3. The total sum of income you made last year.
  4. You will then include monthly income totals and deductions (such as union dues, tax filings, health insurance, etc).
  5. You next subtract the total expenses from the total income to calculate your current net income.
  6. Section two will ask you to complete the list of expense items and calculate subtotals for the following topics:
    • Your household;
    • Automobile;
    • Childcare expenditures (if you and your partner share custody of the child);
    • Childcare expenditures (for children from a previous relationship);
    • Insurance;
    • Other costs (such as medications, pet expenses, donations);
    • Payments made to creditors;
  7. These subtotals will then be subtracted from your current monthly net income.
  8. Section three will ask you to detail assets or liabilities under your ownership or those shared with the other party. You will need to briefly describe each item and calculate its current monetary worth. Finally, you will subtract the subtotal of these items or debts from the previous net worth calculated in section two to find the total of your net worth.
  9. Complete the certification that all of the information listed is accurate to the best of your knowledge. Include your former spouse's mailing address (or their attorney's address) where a copy of the completed form will be sent.
  10. Sign and date the section at the end, and the signature and name of anyone who helped you input you complete the form.
  11. Note, a notary will also need to be present at the time Form 12.902(C) is signed.
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Download Form 12.902(C) "Family Law Financial Affidavit (Long Form)" - Florida

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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM
12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)(01/15)
When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit
and your individual gross income is $50,000 OR MORE per year unless:
(1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have
waived the filing of financial affidavits;
(2) you have no minor children, no support issues, and have filed a written settlement agreement
disposing of all financial issues; or
(3) the court lacks jurisdiction to determine any financial issues.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should then file the original with the clerk of the circuit
court in the county where the petition was filed and keep a copy for your records.
What should I do next?
A copy of this form must be served on the other party in your case within 45 days of being served with
the petition, if it is not served on him or her with your initial papers. Service must be in accordance
with Florida Rule of Judicial Administration 2.516.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information, see Florida Family Law Rule of Procedure 12.285.
Special notes...
If you want to keep your address confidential because you are the victim of sexual battery, aggravated
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence do not enter the
address, telephone, and fax information at the bottom of this form.
Instead, file Request for
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
The affidavit must be completed using monthly income and expense amounts. If you are paid or your
bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided
below for making these conversions.
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form)
(01/15)
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM
12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)(01/15)
When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit
and your individual gross income is $50,000 OR MORE per year unless:
(1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have
waived the filing of financial affidavits;
(2) you have no minor children, no support issues, and have filed a written settlement agreement
disposing of all financial issues; or
(3) the court lacks jurisdiction to determine any financial issues.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should then file the original with the clerk of the circuit
court in the county where the petition was filed and keep a copy for your records.
What should I do next?
A copy of this form must be served on the other party in your case within 45 days of being served with
the petition, if it is not served on him or her with your initial papers. Service must be in accordance
with Florida Rule of Judicial Administration 2.516.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information, see Florida Family Law Rule of Procedure 12.285.
Special notes...
If you want to keep your address confidential because you are the victim of sexual battery, aggravated
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence do not enter the
address, telephone, and fax information at the bottom of this form.
Instead, file Request for
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
The affidavit must be completed using monthly income and expense amounts. If you are paid or your
bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided
below for making these conversions.
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form)
(01/15)
Hourly - If you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount
x
Hours worked per week
=
Weekly amount
Weekly amount
x
52 Weeks per year
=
Yearly amount
Yearly amount
÷
12 Months per year
=
Monthly Amount
Daily - If you are paid by the day, you may convert your income to monthly as follows:
Daily amount
x
Days worked per week
=
Weekly amount
Weekly amount
x
52 Weeks per year
=
Yearly amount
Yearly amount
÷
12 Months per year
=
Monthly Amount
Weekly - If you are paid by the week, you may convert your income to monthly as follows:
Weekly amount
x
52 Weeks per year
=
Yearly amount
Yearly amount
÷
12 Months per year
=
Monthly Amount
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as
follows:
Bi-weekly amount
x
26
=
Yearly amount
Yearly amount
÷
12 Months per year
=
Monthly Amount
Semi-monthly - If you are paid twice per month, you may convert your income to monthly as
follows:
Semi-monthly amount x
2
=
Monthly Amount
Expenses may be converted in the same manner.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form)
(01/15)
IN THE CIRCUIT COURT OF THE
JUDICIAL CIRCUIT,
IN AND FOR
COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)
($50,000 or more Individual Gross Annual Income)
I, {full legal name}
, being sworn, certify
that the following information is true:
SECTION I. INCOME
1. My age is: ___________________
2. My occupation is: ________________________________________________________________
3. I am currently
[Check all that apply]
a. ____ Unemployed
Describe your efforts to find employment, how soon you expect to be employed, and the pay
you expect to receive: __________________________________________________________
____________________________________________________________________________
b. ____ Employed by: ____________________________________________________________
Address: ____________________________________________________________________
City, State, Zip code: ________________________________ Telephone Number: _________
Pay rate: $ ______ ( ) every week ( ) every other week ( ) twice a month
( ) monthly ( ) other: ________________________________________________________
If you are expecting to become unemployed or change jobs soon, describe the change you
expect and why and how it will affect your income: _________________________________
___________________________________________________________________________
___________________________________________________________________________.
____ Check here if you currently have more than one job. List the information above for the
second job(s) on a separate sheet and attach it to this affidavit.
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
c. _____ Retired. Date of retirement: _______________________________________________
Employer from whom retired: ___________________________________________________
Address: _____________________________________________________________________
City, State, Zip code: _______________________________ Telephone Number: __________
L!ST YE!R’S GROSS INCOME:
Your Income
Other Party’s Income (if known)
YEAR_____
$ _______
$ _______
PRESENT MONTHLY GROSS INCOME:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly. Attach more paper, if needed. Items included under “other” should
be listed separately with separate dollar amounts.
1. $______ Monthly gross salary or wages
2. _______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments
3. _______ Monthly business income from sources such as self-employment, partnerships, close
corporations, and/or independent contracts (Gross receipts minus ordinary and necessary
expenses required to produce income.)(Attach sheet itemizing such income and expenses.)
4. _______ Monthly disability benefits/SSI
5. _______ Monthly Workers’ Compensation
6. _______ Monthly Unemployment Compensation
7. _______ Monthly pension, retirement, or annuity payments
8. _______ Monthly Social Security benefits
9. _______ Monthly alimony actually received (Add 9a and 9b)
9a. From this case: $________
9b. From other case(s): ________
10. _______ Monthly interest and dividends
11. _______ Monthly rental income (gross receipts minus ordinary and necessary expenses required to
produce income) (Attach sheet itemizing such income and expense items.)
12. _______ Monthly income from royalties, trusts, or estates
13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they reduce
personal living expenses (Attach sheet itemizing each item and amount.)
14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains)
Any other income of a recurring nature (identify source)
15. _______________________________________________________________________________
16. _______________________________________________________________________________
17. $_________ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1 through 16).
PRESENT MONTHLY DEDUCTIONS:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly.
18. $_______ Monthly federal, state, and local income tax (corrected for filing status and allowable
dependents and income tax liabilities)
a. Filing Status
b. Number of dependents claimed
19. _______
Monthly FICA or self-employment taxes
20. _______
Monthly Medicare payments
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
21. _______ Monthly mandatory union dues
22. _______ Monthly mandatory retirement payments
23. _______ Monthly health insurance payments (including dental insurance), excluding portion paid for
any minor children of this relationship
24. _______ Monthly court-ordered child support actually paid for children from another relationship
25. _______ Monthly court-ordered alimony actually paid (Add 25a and 25b)
25a. from this case: $ _________
25b. from other case(s): _________
26. $______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES
(Add lines 18 through 25).
27. $______ PRESENT NET MONTHLY INCOME
(
Subtract line 26 from line 17).
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed
below do not reflect what you actually pay currently, you should write “estimate” next to each amount
that is estimated.
HOUSEHOLD:
1. $______ Monthly mortgage or rent payments
2. _______ Monthly property taxes (if not included in mortgage)
3. _______ Monthly insurance on residence (if not included in mortgage)
4. _______ Monthly condominium maintenance fees and homeowner’s association fees
5. _______ Monthly electricity
6. _______ Monthly water, garbage, and sewer
7. _______ Monthly telephone
8. _______ Monthly fuel oil or natural gas
9. _______ Monthly repairs and maintenance
10. _______ Monthly lawn care
11. _______ Monthly pool maintenance
12. _______ Monthly pest control
13. _______ Monthly misc. household
14. _______ Monthly food and home supplies
15. _______ Monthly meals outside home
16. _______ Monthly cable t.v.
17. _______ Monthly alarm service contract
18. _______ Monthly service contracts on appliances
19. _______ Monthly maid service
Other:
20. __________________________________________________________________________________
21. __________________________________________________________________________________
22. __________________________________________________________________________________
23. __________________________________________________________________________________
24. __________________________________________________________________________________
25. $_______ SUBTOTAL (add lines 1 through 24).
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
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