Form DV-A 120.2 Financial Affidavit (Family & Divorce Cases) - Illinois

Form DV-A120.2 is a Illinois Circuit Court form also known as the "Financial Affidavit (family & Divorce Cases)". The latest edition of the form was released in September 1, 2016 and is available for digital filing.

Download an up-to-date Form DV-A120.2 in PDF-format down below or look it up on the Illinois Circuit Court Forms website.

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This form is approved by the Illinois Supreme Court and is required to be used in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
FINANCIAL AFFIDAVIT
(FAMILY & DIVORCE CASES)
COUNTY
 Post-Judgment
Pre-Judgment
Instructions
Enter above the
county name where
the case was filed.
Petitioner (First, middle, last name)
Enter name of the
Petitioner, the
Respondent, and the
v.
case number as listed
in the initial Petition
or Complaint.
Respondent (First, middle, last name)
Case Number
Enter the Case
Number given by the
Circuit Clerk.
IMPORTANT: (1) If you intentionally or recklessly enter inaccurate or misleading information on this form, you may face
significant penalties and sanctions, including costs and attorney's fees; and (2) If you need more room to complete this
form, complete and attach the Additional Information for the Financial Affidavit form.
I am the  Petitioner  Respondent in this case.
1.
2.
I swear or affirm the information in this Financial Affidavit and all attached documents
is true and correct as of
.
Date
3.
I attached the most recent copies of the following documents
:
In 3a-d, check the
(check all that apply)
boxes of the documents
a.  income tax returns
you are attaching to
b.  pay stubs or other proof of income
this form as evidence
c.  bank statements
of your income, assets,
and debts. If you select
d.  other supporting documents:
3d, enter the names of
the additional
4.
Information about myself:
documents you are
attaching.
a. Name:
First
Middle
Last
In 4, do not complete
4b and 4c if your
b. Phone Number:
information is
c. Home Address:
protected because of
Street Address, Apt.
domestic violence or
abuse.
City
State
ZIP
d. Date of Birth:
5.
Information about this relationship:
In 5b, if you are
already divorced from
 Yes
 No
a. We were married or united:
each other, enter the
Date
date the divorce was
granted.
 Yes
 No
b. We are divorced:
Date
In 5c, if you do not live
together, enter the date
c. We currently live together:  Yes
 No
you separated.
Date
DV-A 120.2
Page 1 of 9
(09/16)
This form is approved by the Illinois Supreme Court and is required to be used in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
FINANCIAL AFFIDAVIT
(FAMILY & DIVORCE CASES)
COUNTY
 Post-Judgment
Pre-Judgment
Instructions
Enter above the
county name where
the case was filed.
Petitioner (First, middle, last name)
Enter name of the
Petitioner, the
Respondent, and the
v.
case number as listed
in the initial Petition
or Complaint.
Respondent (First, middle, last name)
Case Number
Enter the Case
Number given by the
Circuit Clerk.
IMPORTANT: (1) If you intentionally or recklessly enter inaccurate or misleading information on this form, you may face
significant penalties and sanctions, including costs and attorney's fees; and (2) If you need more room to complete this
form, complete and attach the Additional Information for the Financial Affidavit form.
I am the  Petitioner  Respondent in this case.
1.
2.
I swear or affirm the information in this Financial Affidavit and all attached documents
is true and correct as of
.
Date
3.
I attached the most recent copies of the following documents
:
In 3a-d, check the
(check all that apply)
boxes of the documents
a.  income tax returns
you are attaching to
b.  pay stubs or other proof of income
this form as evidence
c.  bank statements
of your income, assets,
and debts. If you select
d.  other supporting documents:
3d, enter the names of
the additional
4.
Information about myself:
documents you are
attaching.
a. Name:
First
Middle
Last
In 4, do not complete
4b and 4c if your
b. Phone Number:
information is
c. Home Address:
protected because of
Street Address, Apt.
domestic violence or
abuse.
City
State
ZIP
d. Date of Birth:
5.
Information about this relationship:
In 5b, if you are
already divorced from
 Yes
 No
a. We were married or united:
each other, enter the
Date
date the divorce was
granted.
 Yes
 No
b. We are divorced:
Date
In 5c, if you do not live
together, enter the date
c. We currently live together:  Yes
 No
you separated.
Date
DV-A 120.2
Page 1 of 9
(09/16)
Enter the Case Number given by the Circuit Clerk: _________________________________
Information about other household members:
6.
I currently live with another adult who is not the Petitioner or Respondent in this case
who helps pay my expenses:  Yes  No
7.
Children:
In 7b, check the box to
indicate who each child
a. Children were born or adopted as a result of this relationship :  Yes
 No
of this relationship
b.
Name of Child of this Relationship
Date of Birth Lives with
lives with. Check both
boxes if the child lives
 Petitioner
 Respondent
1.
with both parents. If the
 Petitioner
 Respondent
2.
child does not live with
 Petitioner
 Respondent
3.
Petitioner or
Respondent, do not
 Petitioner
 Respondent
4.
check either box.
 Petitioner
 Respondent
5.
 Yes  No
c. Other children not of this relationship live with me:
In 8a, check all that
apply. Provide all
8.
My employment:
information requested
a. I am  unemployed  self-employed
 employed by someone else
about your jobs,
b. Employer name:
including all full-time,
part-time, temporary,
c. Employer address:
contract, or other work.
Street Address, Apt.
If you need more room
to list additional
employment, complete
City
State
ZIP
and attach Additional
d. Number of paychecks per year: 
 24
12
(monthly)
(two times a month)
Information for the
Financial Affidavit.
 52
26
(every two weeks)
(weekly)
I am paid in cash
In 8e, enter your total
gross income from all
e. Gross income
so far this year
$
(before taxes and deductions)
sources from January 1
as of
of this year through the
Date
date you list.
9.
My gross income and taxes from last year:
In 9a, check only one.
 Married
 Married
 Single
a. Tax filing status:
In 9a-d, enter the
(Joint)
(Separate)
information you
 Head of Household  Did not file
submitted on last year's
b. Number of dependent exemptions claimed:
IRS tax return. If you
did not file a tax return
c. Total number of exemptions claimed:
for last year check Did
d. Amount of most recent tax refund: $
or amount owed $
not file, leave a-d
e. Gross income
last year: $
(before taxes and deductions)
blank but still complete
9e.
10. Bankruptcy in the last 5 years:
I filed for bankruptcy in the last 5 years:  Yes  No
For help in calculating
monthly amounts, see
How to Complete a
11. My gross monthly income
is:
(before taxes and deductions)
Financial Affidavit.
Regular employment earnings
$
(salary, wages, base pay, etc.)
Overtime
$
In 11, Regular
employment earnings
Commission
$
mean the monthly gross
Tips
$
income you receive on a
regular basis from
Bonus
$
employment.
DV-A 120.2
Page 2 of 9
(09/16)
Enter the Case Number given by the Circuit Clerk: _________________________________
$
Income other than
Pension and other retirement benefits
Regular employment
$
Annuity
earnings, such as
$
Interest income
Overtime,
Commission, or Bonus
$
Dividend income
should be listed
Trust income
$
separately.
Social Security:  SSI  SSDI  retirement
$
(check all that apply)
Unemployment benefits
$
For Educational funds
include fellowships,
Disability payment
$
(not Social Security)
stipends, grants,
Workers' compensation
$
scholarships, etc.
TANF and SNAP
$
Military allowances
$
Investment income
$
Rental income
$
Partnership income
$
Distributions and draws
$
In Other, list other
Royalty income
$
income from all sources,
Educational funds
$
(include payments made directly to the school)
including amounts from
Maintenance
$
the Additional
Child support for children of this relationship
$
Information for the
Financial Affidavit
Child support for children not of this relationship
$
form, if any.
Gifts of money
$
In Total Gross
Other
$
Monthly Income, add
the amounts in 11
together and enter the
Total Gross Monthly Income
$
For help in calculating
12. My monthly deductions are:
monthly amounts, see
Federal tax
$
How to Complete a
State tax
$
Financial Affidavit.
FICA
$
(or Social Security equivalent)
In 12, use information
Medicare tax
$
from your paystubs, tax
Mandatory retirement contributions
$
(by law or condition of employment)
records, and other
sources to identify all
Union dues
$
properly calculated
Health insurance premiums
$
(medical, dental, vision)
deductions.
Life insurance premiums to secure child support
$
Child support actually paid under a court order in a different case
$
Maintenance actually paid under a court order in a different case
$
Maintenance actually paid or payable under a court order in this case
$
Expenditures for repayment of debts that represent reasonable and necessary
expenses for the production of income including, but not limited to, student
loans, medical expenditures necessary to preserve life or health, reasonable
In Total Monthly
expenditures for the benefit of the child and other parent, exclusive of gifts.
$
Deductions, add the
Foster care payments paid by DCFS
$
amounts from 12
together and enter the
Total Monthly Deductions
$
total.
DV-A 120.2
Page 3 of 9
(09/16)
Enter the Case Number given by the Circuit Clerk: _________________________________
For help in calculating
13. My monthly living expenses are:
monthly amounts, see
a.
Household Expenses
How to Complete a
$
Financial Affidavit.
Mortgage or rent
$
Home equity
and second mortgage
In 13a, enter the amount
(HELOC)
your household spends
$
Real estate taxes
on each item each
$
Homeowners or condo association dues and assessments
month.
$
Homeowners or renters insurance
$
Gas
$
Electric
$
Telephone
$
Cable or satellite TV
$
Internet
In Other, list other
$
Water and sewer
Household Expenses
$
Garbage removal
from all sources,
$
Laundry and dry cleaning
including amounts from
$
House cleaning service
the Additional
$
Information for the
Necessary repairs and maintenance to my property
Financial Affidavit
$
Pet care
form, if any.
$
Groceries, household supplies, and toiletries
$
In Subtotal Monthly
Other
Household Expenses,
add the amounts in 13a
$
Subtotal Monthly Household Expenses
together and enter the
total.
b.
Transportation Expenses
In 13b, enter the amount
you spend monthly on
$
Car payment
each type of
$
Repairs and maintenance
transportation expense.
$
Insurance, license, and city stickers
$
Gasoline
If you have other
transportation expenses
$
Taxi, ride-share, bus, and train
not listed in 13b,
$
Parking
describe the expense in
$
Other and enter the
Other
amount.
Subtotal Monthly Transportation Expenses
$
In Subtotal Monthly
Transportation
c. Personal Expenses
Expenses, add the
Medical
(out-of-pocket expenses)
amounts in 13b together
$
Doctor visits
and enter the total.
$
Therapy and counseling
In 13c, enter the amount
you spend monthly only
$
Dental and orthodontia
for yourself on each
$
Optical
type of expense. Do not
$
include expenses you
Medicine
are reimbursed for
Life insurance
(not required by law to secure child support)
through insurance or
$
Life
(term)
your employer.
$
Life
(whole or annuity)
$
Clothing
$
Grooming
(hair, nails, spa, etc.)
$
Club membership dues
DV-A 120.2
Page 4 of 9
(09/16)
Enter the Case Number given by the Circuit Clerk: _________________________________
$
Entertainment, dining out, and hobbies
In Other, list other
$
Newspapers, magazines, and subscriptions
Personal Expenses from
$
Gifts
all sources, including
$
Donations
(political, religious, charity, etc.)
amounts from the
$
Vacations
Additional Information
$
for the Financial
Voluntary trade or professional association dues
Affidavit form, if any.
$
Professional fees
(accountants, tax preparers, etc.)
$
Other
In Subtotal Monthly
Personal Expenses, add
the amounts in 13c
$
Subtotal Monthly Personal Expenses
together and enter the
total.
d. Minor and Dependent Children Expenses
In 13d, enter the amount
spent monthly on the
$
Clothing
minor and dependent
$
Grooming
(hair, nails, spa, etc.)
children of this
relationship.
Education
$
Tuition
$
Books, fees, and supplies
$
School lunch
$
Transportation
$
School-sponsored trips and special events
$
Uniforms
$
Before and after-school care
$
Tutoring and summer school
Medical
In Medical, do not
(out-of-pocket expenses)
include expenses you
$
Doctor visits
are reimbursed for
$
Therapy and counseling
through insurance or
your employer.
$
Dental and orthodontia
$
Optical
$
Medicine
$
Allowance
$
Childcare and sitters
$
Extracurricular activities and sports
If there are other child-
(including equipment, uniforms, etc.)
related expenses not
$
Summer and school-break camps
listed in 13d, describe
$
Vacations
(children only)
the expense in Other
$
and enter the amount.
Entertainment, dining out, and hobbies
(children only)
$
Gifts children give to others
In Subtotal Monthly
Children Expenses,
$
Other
add the amounts in 13d
together and enter the
$
total.
Subtotal Monthly Children Expenses
$
Total Monthly Living Expenses
In Total Monthly
(add the subtotals from above)
Living Expenses, add
the Subtotals from 13a-
13d together and enter
the total.
DV-A 120.2
Page 5 of 9
(09/16)

Download Form DV-A 120.2 Financial Affidavit (Family & Divorce Cases) - Illinois

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