"Financial Affidavit Form"

What Is a Financial Affidavit?

A Financial Affidavit is a legal document that contains the description of the individual's financial situation that shows the income, expenses, assets, and debts in this individual's name. This document is often used as an equivalent to sworn testimony in the judicial system. For instance, you need to demonstrate your current financial situation to the court in order to influence legal decisions that affect your future, whether you are dealing with alimony, child support, or need to divide assets in a family law dispute.

Alternate Name:

  • Financial Disclosure Affidavit.

Additionally, a Financial Disclosure Affidavit is essential when you waive filing fees for a trial or apply for a loan. You may also prepare an affidavit for a bankruptcy matter - the court will review your income and debts and determine the proper way to resolve the case.

A printable Financial Affidavit Form can be downloaded through the link below.

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How to Fill Out a Financial Affidavit?

Provide the following information in the Affidavit of Financial means:

  1. Identify yourself: write down your name, driver's license number, and contact information.
  2. Indicate your income: list all sources, including social security benefits, tips, interest, marital support, alimony, disability income, etc. Depending on the situation, you need to include weekly or monthly amounts of earnings.
  3. State your expenses, including monthly household expenses, utilities, gas, mortgage payments, rent, etc.
  4. List the salary deductions you take on your tax return.
  5. Enter healthcare costs and insurance costs in a separate section, especially if you are trying to show the financial burden these expenses led to.
  6. Record your debts, including student loans, tax debts, and credit card debts.
  7. Provide a description of your assets. This includes real property, vehicles, vessels, stocks, antiques, etc.
  8. Sign the affidavit in the presence of a notary public.

How to Fill Out a Financial Affidavit for Child Support?

Probably, the most common Family Law Financial Affidavit is a Child Support Affidavit - a statement signed under oath to confirm the individual does not receive child support at the moment. It may also provide details about this person's income and expenses incurred in the process of raising children. You need to prepare this affidavit so that the court determines child support needs and modifies child support awards.

Any Affidavit for Child Support should include the following information:

  1. Names and contact details of the parents.
  2. Income and earnings of each parent certified by pay stubs, bills, and bank account statements.
  3. Breakdown of estate property and assets.
  4. Information about the children's needs. Calculate the expenses to establish the financial responsibility of each parent for the support of their children. You may list medical expenses for the children in a separate paragraph.
  5. Certification of the affidavit and signature. Do not sign before you appear in front of a notary public or a court clerk. Once this affidavit is signed, the court will determine the outcome of the child support matter based on the statements in the affidavit.

Check out these related templates below:

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Download "Financial Affidavit Form"

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Financial Affidavit
I, the undersigned, being duly sworn, hereby affirm that:
1. My name is _________________________.
2. My date of birth is _________________________.
3. My Social Security Number (SSN) is: _________________________.
4. I currently reside at the following address: _______________________________
_________________________________________________________________.
5. Employment (check one).
☐ I am currently ​ n ot​ employed.
☐ I am currently employed part-time as a _________________________.
☐ I am currently employed full time as a _________________________.
☐ I am currently self-employed as a _________________________.
Name of employer: _________________________.
Address of employer: ________________________________________________.
Salary: $_________________________ (per _________________________).
6. Additional Employer (if applicable).
☐ Not applicable.
☐ I am currently employed part-time as a _________________________.
☐ I am currently employed full time as a _________________________.
☐ I am currently self-employed as a _________________________.
Name of employer: _________________________.
Address of employer: ________________________________________________.
Salary: _________________________ (per _________________________).
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Financial Affidavit
I, the undersigned, being duly sworn, hereby affirm that:
1. My name is _________________________.
2. My date of birth is _________________________.
3. My Social Security Number (SSN) is: _________________________.
4. I currently reside at the following address: _______________________________
_________________________________________________________________.
5. Employment (check one).
☐ I am currently ​ n ot​ employed.
☐ I am currently employed part-time as a _________________________.
☐ I am currently employed full time as a _________________________.
☐ I am currently self-employed as a _________________________.
Name of employer: _________________________.
Address of employer: ________________________________________________.
Salary: $_________________________ (per _________________________).
6. Additional Employer (if applicable).
☐ Not applicable.
☐ I am currently employed part-time as a _________________________.
☐ I am currently employed full time as a _________________________.
☐ I am currently self-employed as a _________________________.
Name of employer: _________________________.
Address of employer: ________________________________________________.
Salary: _________________________ (per _________________________).
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7. Other Sources of Income.
Type/Source of Income
Description
Amount of Income
8. Gross Income (check one).
☐ I do ​ n ot​ have any gross income.
☐ My gross income for the month is: $_________________________.
9. I have the following monthly deductions from my gross income:
☐ Federal and State income tax: $_________________________.
☐ Social security: $_________________________.
☐ Medicare: $_________________________.
☐ Health insurance: $_________________________.
☐ Union dues: $_________________________.
☐ Mandatory retirement contributions: $_________________________.
☐ Child support: $_________________________.
☐ Life insurance premiums (to secure child support): $____________________.
☐ Alimony/Spousal support: $_________________________.
☐ Other: $_________________________ (for _________________________).
☐ Total Monthly Net Income: $_________________________.
10. I have the following average monthly expenses:
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_________________________, $_________________________
Type of Expense
Amount
_________________________, $_________________________
Type of Expense
Amount
_________________________, $_________________________
Type of Expense
Amount
_________________________, $_________________________
Type of Expense
Amount
_________________________, $_________________________
Type of Expense
Amount
Total Monthly Expenses and Liabilities: $_________________________.
11. Assets (check one).
☐ I do ​ n ot​ own any assets.
☐ I own the following assets:
_________________________, $_________________________
Type of Asset
Cost
_________________________, $_________________________
Type of Asset
Cost
_________________________, $_________________________
Type of Asset
Cost
_________________________, $_________________________
Type of Asset
Cost
_________________________, $_________________________
Type of Asset
Cost
Total Cash Value of Assets: $_________________________.
12. Other Financial Information.
__________________________________________________________________
__________________________________________________________________
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__________________________________________________________________
I certify under penalty of perjury that the information stated above is true, complete, and
correct.
_________________________________
Affiant's Printed Name
_________________________________
Affiant's Signature
_________________________________
Date
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Notary Acknowledgment
State of _____________________
County of ___________________
The foregoing was acknowledged before me this ____ day of _________________, by
the undersigned, _________________, who is personally known to me or satisfactorily
proven to me to be the person whose name is subscribed to the within instrument.
_________________________________
Printed Name of Notary Public
_________________________________
Signature of Notary Public
My commission expires: ___________________
(seal)
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