Form JDF1111SC (35.2) "Sworn Financial Statement" - Colorado

What Is Form JDF1111SC (35.2)?

This is a legal form that was released by the Colorado Judicial Branch - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Colorado Judicial Branch;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form JDF1111SC (35.2) by clicking the link below or browse more documents and templates provided by the Colorado Judicial Branch.

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Download Form JDF1111SC (35.2) "Sworn Financial Statement" - Colorado

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District Court
Denver Juvenile Court
___________________ County, Colorado
Court Address:
In re:
The Marriage of:
The Civil Union of:
Parental Responsibilities concerning:
______________________________________________________
Petitioner:
and
COURT USE ONLY
Co-Petitioner/Respondent:
Attorney or Party Without Attorney
:
Case Number:
(Name and Address)
Phone Number:
E-mail:
Division
Courtroom
FAX Number:
Atty. Reg. #:
SWORN FINANCIAL STATEMENT
I, ___________________________________________________ (full name)
am
am not currently employed.
I am employed ____ hours per week. I am paid
weekly
bi-weekly
twice a month
monthly.
My pay is based on a
Monthly Salary
Hourly rate of $__________
Other: _________________________
Date employment began _______________________________.
My occupation is: ____________________________ Name of employer: _______________________________
Address of employer: _________________________________________________________________________
If unemployed, what date did you last work? _______________________
I am unemployed due to
disability
involuntary layoff at work
other: ________________________________
This household consists of _____ adult(s), and ______ minor child(ren).
I believe the monthly gross income of the other party is $___________.
Annual gross income (last tax year 20__) for Petitioner $ _________,
Co-Petitioner/Respondent $ __________
1.
Monthly Income (Convert annual, bi-monthly, and weekly amounts to monthly amounts.)
Gross Monthly Income
$
Social Security Benefits (SSA)
$
(before taxes and
deductions) from salary and wages, including
(Disability insurance – entitlement
SSDI
commissions, bonuses, overtime, self-
program)
employment, business income, other jobs,
(supplemental income – need based)
SSI
and monthly reimbursed expenses.
Unemployment & Veterans’ Benefits
Disability, Workers’ Compensation
Pension & Retirement Benefits
Interest & Dividends
Public Assistance (TANF)
Other - ___________________
Total Monthly Income
$
Miscellaneous Income
Royalties, Trusts, and Other Investments
$
Contributions from Others
$
Dependent Children’s monthly gross
All other sources, i.e. personal injury
income. Source of Income: __________
settlement, non-reported income, etc.
Rental Net Income
Expense Accounts
Child Support from Others
Other - ___________________
Spousal/Partner Support from Others
Other - ___________________
Total Monthly Miscellaneous Income
$
$
Total Income
JDF 1111SC R1/18 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 1 of 7
District Court
Denver Juvenile Court
___________________ County, Colorado
Court Address:
In re:
The Marriage of:
The Civil Union of:
Parental Responsibilities concerning:
______________________________________________________
Petitioner:
and
COURT USE ONLY
Co-Petitioner/Respondent:
Attorney or Party Without Attorney
:
Case Number:
(Name and Address)
Phone Number:
E-mail:
Division
Courtroom
FAX Number:
Atty. Reg. #:
SWORN FINANCIAL STATEMENT
I, ___________________________________________________ (full name)
am
am not currently employed.
I am employed ____ hours per week. I am paid
weekly
bi-weekly
twice a month
monthly.
My pay is based on a
Monthly Salary
Hourly rate of $__________
Other: _________________________
Date employment began _______________________________.
My occupation is: ____________________________ Name of employer: _______________________________
Address of employer: _________________________________________________________________________
If unemployed, what date did you last work? _______________________
I am unemployed due to
disability
involuntary layoff at work
other: ________________________________
This household consists of _____ adult(s), and ______ minor child(ren).
I believe the monthly gross income of the other party is $___________.
Annual gross income (last tax year 20__) for Petitioner $ _________,
Co-Petitioner/Respondent $ __________
1.
Monthly Income (Convert annual, bi-monthly, and weekly amounts to monthly amounts.)
Gross Monthly Income
$
Social Security Benefits (SSA)
$
(before taxes and
deductions) from salary and wages, including
(Disability insurance – entitlement
SSDI
commissions, bonuses, overtime, self-
program)
employment, business income, other jobs,
(supplemental income – need based)
SSI
and monthly reimbursed expenses.
Unemployment & Veterans’ Benefits
Disability, Workers’ Compensation
Pension & Retirement Benefits
Interest & Dividends
Public Assistance (TANF)
Other - ___________________
Total Monthly Income
$
Miscellaneous Income
Royalties, Trusts, and Other Investments
$
Contributions from Others
$
Dependent Children’s monthly gross
All other sources, i.e. personal injury
income. Source of Income: __________
settlement, non-reported income, etc.
Rental Net Income
Expense Accounts
Child Support from Others
Other - ___________________
Spousal/Partner Support from Others
Other - ___________________
Total Monthly Miscellaneous Income
$
$
Total Income
JDF 1111SC R1/18 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 1 of 7
2. Monthly Deductions (Mandatory and Voluntary)
Mandatory Deductions
Cost Per
Cost Per
Month
Month
Federal Income Tax
$
State/Local Income Tax
$
PERA/Civil Service
Social Security Tax
Medicare Tax
Other - ___________________
Total Mandatory Deductions
$
Voluntary Deductions
Cost Per
Cost Per
Month
Month
Life and Disability Insurance
$
Stocks/Bonds
$
Health, Dental, Vision Insurance Premium
Retirement & Deferred Compensation
Total number of people covered on Plan 
Child Care (deducted from salary)
Other - ____________________
Flex Benefit Cafeteria Plan
Other - ____________________
Total Voluntary Deductions
$
$
Total Monthly Deductions
3.
Monthly Expenses
Note:
List regular monthly expenses below that you pay on an on-going basis and that are not identified
in the deductions above.
A. Housing
Cost Per
Cost Per
Month
Month
st
nd
1
Mortgage
$
2
Mortgage
$
Condo/Homeowner’s/Maintenance
Insurance (Home/Rental) & Property
Taxes
Fees
(not included in mortgage payment)
Rent
Other - ________________
Total Housing
$
B. Utilities and Miscellaneous Housing Services
Cost Per
Cost Per
Month
Month
Gas & Electricity
$
Water, Sewer, Trash Removal
$
Telephone
Property Care
(local, long distance, cellular &
(Lawn, snow removal,
pager)
cleaning, security system, etc.)
Internet Provider, Cable & Satellite TV
Other - ____________________
Total Utilities and Miscellaneous Housing Services
$
C. Food & Supplies
Cost Per
Cost Per
Month
Month
Groceries & Supplies
$
Dining Out
$
Total Food & Supplies
$
D. Health Care Costs (Co-pays, Premiums, etc.)
Cost Per
Cost Per
Month
Month
Doctor & Vision Care
$
Dentist and Orthodontist
$
Medicine & RX Drugs
Therapist
Premiums (if not paid by employer)
Other - ____________________
Total Health Care
$
JDF 1111SC R1/18 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 2 of 7
E. Transportation & Recreation Vehicles (Motorcycles, Motor Homes, Boats, ATV, Snowmobiles, etc.)
Cost Per
Cost Per
Month
Month
Primary Vehicle Payment
$
Other Vehicle Payments
$
Fuel, Parking, and Maintenance
Insurance & Registration/Tax Payments
(yearly amount(s) 12)
Bus & Commuter Fees
Other - ________________
Total Transportation
$
F. Children’s Expenses and Activities
Cost Per
Cost Per
Month
Month
Clothing & Shoes
$
Child Care
$
Extraordinary Expenses i.e. Special
Misc. Expenses, i.e. Tutor, Books,
Needs, etc.
Activities, Fees, Lunch, etc.
Tuition
Other - ________________
Total Children’s Expenses and Activities
$
G. Education for you - Please identify status:
Full-time student
Part-time student
Cost Per
Cost Per
Month
Month
Tuition, Books, Supplies, Fees, etc.
Other - ________________
Total Education
$
H. Maintenance (Spousal/Partner Support) & Child Support (that you pay)
Cost Per
Cost Per
Month
Month
Maintenance
Child Support
$
$
This family
This family
Other family
Other family
Total Maintenance and Child Support
$
I. Miscellaneous (Please list on-going expenses not covered in the sections above)
Cost Per
Cost Per
Month
Month
Recreation/Entertainment
$
Personal Care
$
(Hair, Nail, Clothing, etc.)
Legal/Accounting Fees
Subscriptions
(Newspapers, Magazines, etc.)
Charity/Worship
Movie & Video Rentals
Vacation/Travel/Hobbies
Investments
(Not part of payroll deductions)
Membership/Clubs
Home Furnishings
Pets/Pet Care
Sports Events/Participation
Other - ________________
Other - ________________
Other - ________________
Other - ________________
Other - ________________
Other - ________________
Other - ________________
Other - ________________
Total Miscellaneous
$
$
Total Monthly Expenses (Totals from A – I)
JDF 1111SC R1/18 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 3 of 7
4.
Debts (unsecured)
List unsecured debts such as credit cards, store charge accounts, loans from family members, back taxes owed
to the I.R.S., etc. Do not list debts that are liens against your property, such as mortgages and car loans,
because that payment is already listed as an expense above, and the total of the debt is shown elsewhere as a
deduction from value where that asset is listed, such as under Real Estate or Motor Vehicles.
For name on account, "P" = Petitioner, "C/R” = Co-Petitioner or Respondent, "J" = Joint.
Name of Creditor
Account
P
C/R
J
Date of
Balance
Minimum
Reason for
Number
Balance
Monthly
Which Debt
(last 4-
Payment
was Incurred
digits
Required
only)
$
$
Total
Unsecured Debt Balance
$
$
Minimum
Monthly
Payment
SWORN FINANCIAL STATEMENT SUMMARY
(INCOME/EXPENSES)
Total Income
$ _____________
A
(from Page 1)
Total Monthly Deductions
$ _____________
B
(from Page 2)
Total Monthly Net Income (A minus B)
$ _____________
Total Monthly Expenses
$ _____________
C
(from Page 3)
Total Minimum Monthly Payment Required - Debts Unsecured
$ _____________
D
(from Page 4)
Total Monthly Expenses and Payments
(C plus D)
$ _____________
(+/-)
$ ______________
Net Excess or Shortfall
(Monthly Net Income less Monthly Expenses and Payments)
JDF 1111SC R1/18 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 4 of 7
5.
Assets
You MUST disclose all assets correctly. By indicating “None”, you are stating affirmatively that you or
the other party, do not have assets in that category. Please attach additional copies of pages 5 & 6 to
identify your assets, if necessary.
If the parties are married or partners in a civil union
, check under the heading Joint (J) all assets
acquired during the marriage/civil union but not by gift or inheritance. Under the headings of Petitioner (P) or Co-
Petitioner/Respondent (C/R), check assets owned before this marriage/civil union and assets acquired by gift or
inheritance.
If the parties were NEVER married to each other or are using this form to modify child support
,
list all of each party’s assets under the headings of Petitioner (P) or Co-Petitioner/Respondent (C/R).
"P" = Petitioner, "C/R” = Co-Petitioner or Respondent, "J" = Joint.
A. Real Estate
Estimated
Amount
Net
(Address or Property
P
C/R
J
Description and Name of Creditor/ Lender)
Value as of
Owed
Value/Equity
None
Today
(Value minus
Value = what you
amount
could sell it for
owed)
in its current
condition.
$
$
$
Total
$
$
$
. Motor Vehicles & Recreation
Estimated
Amount
Net
B
P
C/R
J
Vehicles Including Motorcycles, ATV’s,
Value as of
Owed
Value/Equity
Boats, etc.) (Year, Make, Model)
Today
(Value minus
(Name of
Value = what you
Creditor/Lender)
amount
could sell it for
None
owed)
in its current
condition.
Total
$
$
$
C. Cash on Hand, Bank, Checking,
P
C/R
J
Type of
Account #
Balance as
Savings, or Health Accounts (Name of
Account
(last 4-digits
of Today
Bank or Financial Institution)
only)
None
$
Total
$
D. Life Insurance
Type of
Face Amount
Cash Value
P
C/R
J
(Name of Company/Beneficiary)
Policy
of Policy
today
None
$
$
JDF 1111SC R1/18 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 5 of 7