940 So.2d 409 (2006)
In re AMENDMENTS TO THE FLORIDA FAMILY LAW RULES OF PROCEDURE (OUT OF CYCLE).
No. SC06-344.Supreme Court of Florida.
September 28, 2006.John Fraser Himes, Chair, Family Law Rules Committee, Tampa, FL, Honorable John M. Alexander, Past-Chair, St. Augustine, FL, and John F. Harkness, Jr., Executive Director, the Florida Bar, Tallahassee, FL, for Petitioner.
PER CURIAM.
The Family Law Rules Committee of The Florida Bar (committee) has filed an out of cycle report proposing amendments to family law forms 12.902(b) and (c) (Family Law Financial Affidavits), and 12.902(i) (Affidavit of Corroborating Witness). We have jurisdiction. See art. V, § 2(a), Fla. Const. The proposed amendments were published for comment in the March 1, 2006, edition of The Florida Bar News. No comments were received.
Upon consideration, we adopt the amendments proposed by the committee[1] with one modification. The committee recommends that form 12.902(i) (Affidavit of Corroborating Witness) be amended in order to reflect that the affiant has knowledge that a petitioner for dissolution of marriage has resided in Florida for at least six months immediately prior to the filing of the petition for dissolution of marriage, rather than, as it now states, six months prior to the date of the affidavit. However, we recognize that an affiant may not personally have knowledge of the date a petition for dissolution of marriage is filed, and we modify the committee's proposal accordingly.
Family law forms 12.902(b) and (c) (Family Law Financial Affidavits), and 12.902(i) (Affidavit of Corroborating Witness) are hereby amended as reflected in the appendix to this opinion, fully engrossed. The amendments shall become effective immediately. The forms discussed herein may be accessed and downloaded from the Florida State Courts website at www.flcourts.org.
It is so ordered.
*410 LEWIS, C.J., and WELLS, ANSTEAD, PARIENTE, QUINCE, CANTERO, and BELL, JJ., concur.
APPENDIX
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(b), FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)
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 UNDER $50,000 per year.
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 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 mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition.
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 rule 12.285, Florida Family Law Rules of Procedure.
Special notes . . .
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's 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.
HourlyIf you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount × Hours worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
DailyIf you are paid by the day, you may convert your income to monthly as follows:
Daily amount × Days worked per week = Weekly ambunt
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
WeeklyIf you are paid by the week, you may convert your income to monthly as follows:
Weekly amount × 52 Weeks per year = Yearly amoimt
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weeklyIf you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount × 26 = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Semi-monthlyIf you are paid twice per month, you may convert your income to monthly as follows:
Semi-monthly amount × 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 *411 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.
IN THE CIRCUIT COURT OF THE ____ JUDICIAL CIRCUIT, IN AND FOR ____ COUNTY, FLORIDA Case No: __________ Division: _______ ________________, Petitioner, and ________________, Respondent.FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)
(Under $50,000 Individual Gross Annual Income)
I, {full legal name} _______, being sworn, certify that the following information is true: My Occupation: _____________ Employed by: _________________ Business Address: ______________________ Pay rate: $_______ ( ) every week ( ) every other week ( ) twice a month ( ) monthly ( ) other: ___________[] Check here if unemployed and explain on a separate sheet your efforts to find employment.
SECTION I. 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 1. $ _________
2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 2. _________
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 3. _________
5. Monthly Workers' Compensation 4. _________
6. Monthly Unemployment Compensation 5. _________
7. Monthly pension, retirement, or annuity payments 6. _________
8. Monthly Social Security benefits 7. _________
9. Monthly alimony actually received 8. _________
9a. V-om this case: $ __________
9b. From other case(s): __________ Add 9a and 9b 9. _________
10. Monthly interest and dividends 10. _________
11. Monthly rental income (gross receipts minus ordinary and necessary expenses 11. _________
required to produce income) ([] Attach sheet itemizing such income
and expense items.)
12. Monthly income from royalties, trusts, or estates 12. _________
13. Monthly reimbursed expenses and in-kind payments to the extent that they 13. _________
reduce personal living expenses
14. Monthly gains derived from dealing in property (not including nonrecurring 14. _________
gains)
15. Any other income of a recurring nature (list source) ____________________ 15. _________
16. __________________________________________________________________________ 16. _________
17. PRESENT MONTHLY GROSS INCOME (Add lines 1-16) TOTAL: 17. $____________
PRESENT MONTHLY DEDUCTIONS:
18. Monthly federal, state, and local income tax (corrected for filing status and
allowable dependents and income tax liabilities)
a. Filing Status _____________________
*412
b. Number of dependents claimed _______________ 18. $_________
19. Monthly FICA or self-employment taxes 19. _________
20. Monthly Medicare payments 20. _________
21. Monthly mandatory union dues 21. _________
22. Monthly mandatory retirement payments 22. _________
23. Monthly health insurance payments (including dental insurance), excluding 23. _________
portion paid for any minor children of this relationship
24. Monthly court-ordered child support actually paid for children from another 24. _________
relationship
25. Monthly court-ordered alimony actually paid
25a. from this case: $_________________
25b. from other case(s): _________________ Add 25a and 25b 25. _________
26. TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION TOTAL: 26. $_________
61.30, FLORIDA STATUTES (Add lines 18 through 25)
PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17) 27. $_________
_________
SECTION II. AVERAGE MONTHLY EXPENSES
A. HOUSEHOLD: E. OTHER EXPENSES NOT LISTED ABOVE
Mortgage or rent $________________ Clothing $______
Property taxes $________________ Medical/Dental (uninsured) $______
Utilities $________________ Grooming $______
Telephone $________________ Entertainment $______
Food $________________ Gifts $______
Meals outside home $________________ Religious organizations $______
Maintenance/Repairs $________________ Miscellaneous $______
Other: ________________ $________________ Other: __________________ $______
_________________________ $______
B. AUTOMOBILE _________________________ $______
Gasoline $________________ _________________________ $______
Repairs $________________ _________________________ $______
Insurance $________________ _________________________ $______
_________________________ $______
C. CHILD(REN)'S EXPENSES
Day care $________________ F. PAYMENTS TO CREDITORS
Lunch money $________________ MONTHLY
Clothing $________________ CREDITOR: PAYMENT
Grooming $________________ _______________________ $______
Gifts for holidays $________________ _______________________ $______
Medical/Dental (uninsured) _________________ _______________________ $______
Other: ________________ $________________ _______________________ $______
_______________________ $______
D. INSURANCE _______________________ $______
Medical/Dental $________________ _______________________ $______
Child(ren)'s medical/dental $________________ _______________________ $______
Life $________________ _______________________ $______
Other: ________________ $________________ _______________________ $______
_______________________ $______
28. TOTAL MONTHLY EXPENSES
(add ALL monthly amounts in A through F above) 28. $_______
SUMMARY
29. TOTAL PRESENT MONTHLY NET INCOME
(from line 27 of SECTION I. INCOME) 29. $_________
30. TOTAL MONTHLY EXPENSES (from line 28 above) 30. $_________
31. SURPLUS (If line 29 is more than line 30, subtract line 30 from line 29.
This is the amount of your surplus. Enter that amount here.) 31. $_________
32. (DEFICIT) (If line 30 is more than line 29, subtract line 29 from line 30.
This is the amount of your deficit. Enter that amount here.) 32. ($_______)
SECTION III. ASSETS AND LIABILITIES
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an
item is "nonmarital," meaning it belongs to only one of you and should not be divided. You should
indicate to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if
*413 property/debt was owned/owed by one spouse before the marriage. See the "General Information for SelfRepresented Litigants" found at the beginning of these forms and section 61.075(1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.)
A. ASSETS:
---------------------------------------------------------------------------------------------
DESCRIPTION OF ITEM(S). List a description of Current Fair Nonmarital
each separate item owned by you (and/or your spouse, if Market Value (✓ correct column)
this is a petition for dissolution of marriage).
____________________
DO NOT LIST ACCOUNT NUMBERS. ✓ the box
next to any asset(s) which you are requesting the judge
award to you. husband wife
_____________________________________________________________________________________________
[] Cash (on hand) $
_____________________________________________________________________________________________
[] Cash (in banks or credit unions)
_____________________________________________________________________________________________
[] Stocks, Bonds, Notes
_____________________________________________________________________________________________
[] Real estate: (Home)
_____________________________________________________________________________________________
[] (Other)
_____________________________________________________________________________________________
[] Automobiles
_____________________________________________________________________________________________
[] Other personal property
_____________________________________________________________________________________________
[] Retirement plans (Profit Sharing, Pension, IRA,
401(k)s, etc.)
_____________________________________________________________________________________________
[] Other
_____________________________________________________________________________________________
[]
_____________________________________________________________________________________________
[]
_____________________________________________________________________________________________
[]
_____________________________________________________________________________________________
[]
_____________________________________________________________________________________________
[]
_____________________________________________________________________________________________
[]
_____________________________________________________________________________________________
[] ✓ here if additional pages are attached.
_____________________________________________________________________________________________
Total Assets (add next column) $ _______
_____________________________________________________________________________________________
B. LIABILITIES:
___________________________________________________________________________________________________
DESCRIPTION OF ITEM(S). List a description of Current Nonmarital
each separate debt owed by you (and/or your spouse, Amount Owed (✓ correct column)
if this is a petition for dissolution of marriage). _______________________
DO NOT LIST ACCOUNT NUMBERS. ✓ the box
next to any debt(s) for which you believe you should be
responsible. husband wife
___________________________________________________________________________________________________
[] Mortgages on real estate: First mortgage on home $
___________________________________________________________________________________________________
[] Second mortgage on home
___________________________________________________________________________________________________
[] Other mortgages
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[] Auto loans
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[] Charge/credit card accounts
___________________________________________________________________________________________________
*414
[]
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[] Other
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
[] ✓ here if additional pages are attached.
___________________________________________________________________________________________________
Total Debts (add next column) $ ________
___________________________________________________________________________________________________
C. CONTINGENT ASSETS AND LIABILITIES:
INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave,
bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax
liabilities, debts assumed by another), you must list them here.
---------------------------------------------------------------------------------------------------
Contingent Assets Possible Nonmarital
Value (✓ correct column)
____________________________________
✓ the box next to any contingent asset(s) which you are
requesting the judge award to you. husband wife
___________________________________________________________________________________________________
[] $
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
Total Contingent Liabilities $ _________
===================================================================================================
Possible Nonmarital
Contingent Liabilities Amount (✓ correct column)
___________________________________
✓ the box next to any contingent debt(s) for which you Owed husband wife
believe you should be responsible.
___________________________________________________________________________________________________
[] $
___________________________________________________________________________________________________
[]
___________________________________________________________________________________________________
Total Contingent Liabilities $ __________
___________________________________________________________________________________________________
SECTION IV. CHILD SUPPORT GUIDELINES WORKSHEET
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot be waived by the parties.)
[✓ one only]
___ A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the establishment or modification of child support.
___ A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or modification of child support is not an issue in this case.
I certify that a copy of this document was [✓ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________.
Other party or his/her attorney: Name: ______________ Address: _____________ City, State, Zip: _____________ Fax Number: _______________I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and *415 that the punishment for knowingly making a false statement includes fines and/or imprisonment.
Dated: _____ __________ Signature of Party Printed Name. Address. City, State, Zip. Telephone Number Fax Number. STATE OF FLORIDA COUNTY OF ______ Sworn to or affirmed and signed before me ____________ on by _______________ NOTARY PUBLIC or DEPUTY CLERK ______________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification Type of identification produced ___________IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]
I, {full legal name and trade name of nonlawyer} ________, a nonlawyer, located at {street} ________, {city} _______, {state} _______, {phone} ______, helped {name} ___________, who is the [✓ one only] ___ petitioner or ___ respondent, fill out this form.
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT
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.
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 mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition.
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 rule 12.285, Florida Family Law Rules of Procedure.
Special notes . . .
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's 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 *416 convert those amounts. Hints are provided below for making these conversions.
HourlyIf you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount × Hours worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
DailyIf you are paid by the day, you may convert your income to monthly as follows:
Daily amount × Days worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
WeeklyIf you are paid by the week, you may convert your income to monthly as follows:
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weeklyIf you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount × 26 = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Semi-monthlyIf you are paid twice per month, you may convert your income to monthly as follows:
Semi-monthly amount × 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.
IN THE CIRCUIT COURT OF THE _____ JUDICIAL CIRCUIT, IN AND FOR ____ COUNTY, FLORIDA DA Case No.: _____________ Division: _____________ _____________, Petitioner, and _____________, Respondent.FAMILY LAW FINANCIAL AFFIDAVIT
($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. Date of Birth: ___________________________
2. My occupation is: _____________________________
3. I am currently
[✓ 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: ___________________________________
*417
_____________________________________________________________________________________
[] 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.
c. Retired. Date of retirement: ________
Employer from whom retired: _________________________________________________________
Address: ____________________________________________________________________________
City, State, Zip code: _____________________________ Telephone Number: ______________
LAST YEAR'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 1. $ ___________
2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 2. ___________
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.) 3. ___________
4. Monthly disability benefits/SSI 4. ___________
5. Monthly Workers' Compensation 5. ___________
6. Monthly Unemployment Compensation 6. ___________
7. Monthly pension, retirement, or annuity payments 7. ___________
8. Monthly Social Security benefits 8. ___________
9. Monthly alimony actually received
9a. From this case: $ ______
9b. From other case(s): ______ Add 9a and 9b 9. ___________
10. Monthly interest and dividends 10. ___________
11. Monthly rental income (gross receipts minus ordinary and necessary expenses 11. ___________
required to produce income) ([] Attach sheet itemizing such income
and expense items.)
12. Monthly income from royalties, trusts, or estates 12. ___________
13. Monthly reimbursed expenses and in-kind payments to the extent that they 13. ___________
reduce personal living expenses ([] Attach sheet itemizing each item and
amount.)
14. Monthly gains derived from dealing in property (not including nonrecurring 14. ___________
gains)
Any other income of a recurring nature (identify source)
15. ___________________________________________________________________________ 15. ___________
16. ___________________________________________________________________________ 16. ___________
17. PRESENT MONTHLY GROSS INCOME (Add lines 1B16) TOTAL: 17. $ _______________
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 __________ 18. $ __________
19. Monthly FICA or self-employment taxes 19. __________
20. Monthly Medicare payments 20. __________
21. Monthly mandatory union dues 21. __________
22. Monthly mandatory retirement payments 22. __________
23. Monthly health insurance payments (including dental insurance), excluding 23. __________
portion paid for any minor children of this relationship
24. Monthly court-ordered child support actually paid for children from another 24. __________
relationship
25. Monthly court-ordered alimony actually paid
25a. from this case: $ ____________
25b. from other case(s): ____________ Add 25a and 25b 25. __________
26. TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30,
*418
FLORIDA STATUTES (Add lines 18 through 25) TOTAL: 26. $ __________
27. PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17) 27. $ __________
=====================================================================================================
SECTION EL AVERAGE MONTHLY EXPENSES
=====================================================================================================
Proposed/Estimated Expenses. If this is a dissolution of marriage case anti 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 1. $ ___________
2. Monthly property taxes (if not included in mortgage) 2. ___________
3. Monthly insurance on residence (if not included in mortgage) 3. ___________
4. Monthly condominium maintenance fees and homeowner's association fees 4. ___________
5. Monthly electricity 5. ___________
6. Monthly water, garbage, and sewer 6. ___________
7. Monthly telephone 7. ___________
8. Monthly fuel oil or natural gas 8. ___________
9. Monthly repairs and maintenance 9. ___________
10. Monthly lawn care 10. ___________
11. Monthly pool maintenance 11. ___________
12. Monthly pest control 12. ___________
13. Monthly misc. household 13. ___________
14. Monthly food and home supplies 14. ___________
15. Monthly meals outside home 15. ___________
16. Monthly cable t.v. 16. ___________
17. Monthly alarm service contract 17. ___________
18. Monthly service contracts on appliances 18. ___________
19. Monthly maid service 19. ___________
Other:
20. __________________________________________________________________________ 20. ___________
21. __________________________________________________________________________ 21. ___________
22. __________________________________________________________________________ 22. ___________
23. __________________________________________________________________________ 23. ___________
24. __________________________________________________________________________ 24. ___________
25. SUBTOTAL (add lines 1 through 24) 25. $ ______________
AUTOMOBILE:
26. Monthly gasoline and oil 26. $ ___________
27. Monthly repairs 27. ___________
28. Monthly auto tags and emission testing 28. ___________
29. Monthly insurance 29. ___________
30. Monthly payments (lease or financing) 30. ___________
31. Monthly rental/replacements 31. ___________
32. Monthly alternative transportation (bus, rail, car pool, etc.) 32. ___________
33. Monthly tolls and parking 33. ___________
34. Other: ___________________________________________________________________ 34. ___________
35. SUBTOTAL (add lines 26 through 34) 35. $ ___________
MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES:
36. Monthly nursery, babysitting, or day care 36. $ ___________
37. Monthly school tuition 37. ___________
38. Monthly school supplies, books, and fees 38. ___________
39. Monthly after school activities 39. ___________
40. Monthly lunch money 40. ___________
41. Monthly private lessons or tutoring 41. ___________
42. Monthly allowances 42. ___________
43. Monthly clothing and uniforms 43. ___________
44. Monthly entertainment (movies, parties, etc.) 44. ___________
45. Monthly health insurance 45. ___________
46. Monthly medical, dental, prescriptions (nonreimbursed only) 46. ___________
47. Monthly psychiatric/psychological/counselor 47. ___________
48. Monthly orthodontic 48. ___________
49. Monthly vitamins 49. ___________
*419
50. Monthly beauty parlor/barber shop 50. ___________
51. Monthly nonprescription medication 51. ___________
52. Monthly cosmetics, toiletries, and sundries 52. ___________
53. Monthly gifts from child(ren) to others 53. ___________
(other children, relatives, teachers, etc.)
54. Monthly camp or summer activities 54. ___________
55. Monthly clubs (Boy/Girl Scouts, etc.) 55. ___________
56. Monthly access expenses (for nonresidential parent) 56. ___________
57. Monthly miscellaneous 57. ___________
58. SUBTOTAL (add lines 36 through 57) 58. $ _______________
MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP:
(other than court-ordered child support)
59. _________________________________________________________________________ 59. $ ___________
60. _________________________________________________________________________ 60. ___________
61. _________________________________________________________________________ 61. ___________
62. _________________________________________________________________________ 62. ___________
63. SUBTOTAL (add lines 59 through 62) 63. $ _______________
MONTHLY INSURANCE:
64. Health insurance, excluding portion paid for any minor child(ren) of this 64. $ ___________
relationship
65. Life insurance 65. ___________
66. Dental insurance 66. ___________
Other:
67. __________________________________________________________________________ 67. ___________
68. __________________________________________________________________________ 68. ___________
69. SUBTOTAL (add lines 64 through 68) 69. $ _______________
OTHER MONTHLY EXPENSES NOT LISTED ABOVE:
70. Monthly dry cleaning and laundry 70. $ ___________
71. Monthly clothing 71. ___________
72. Monthly medical, dental, and prescription (unreimbursed only) 72. ___________
73. Monthly psychiatric, psychological, or counselor (unreimbursed only) 73. ___________
74. Monthly non-prescription medications, cosmetics, toiletries, and sundries 74. ___________
75. Monthly grooming 75. ___________
76. Monthly gifts 76. ___________
77. Monthly pet expenses 77. ___________
78. Monthly club dues and membership 78. ___________
79. Monthly sports and hobbies 79. ___________
80. Monthly entertainment 80. ___________
81. Monthly periodicals/books/tapes/CDs 81. ___________
82. Monthly vacations 82. ___________
83. Monthly religious organizations 83. ___________
84. Monthly bank charges/credit card fees 84. ___________
85. Monthly education expenses 85. ___________
Other: (include any usual and customary expenses not otherwise mentioned in the
items listed above)
86. __________________________________________________________________________ 86. ___________
87. __________________________________________________________________________ 87. ___________
88. __________________________________________________________________________ 88. ___________
89. __________________________________________________________________________ 89. ___________
90. SUBTOTAL (add lines 70 through 89) 90. $ _______________
MONTHLY PAYMENTS TO CREDITORS: (only when payments are currently made by you on
outstanding balances)
NAME OF CREDITOR(s):
91. __________________________________________________________________________ 91. $ ___________
92. __________________________________________________________________________ 92. ___________
93. __________________________________________________________________________ 93. ___________
94. __________________________________________________________________________ 94. ___________
*420
95. __________________________________________________________________________ 95. ___________
96. __________________________________________________________________________ 96. ___________
97. __________________________________________________________________________ 97. ___________
98. __________________________________________________________________________ 98. ___________
99. __________________________________________________________________________ 99. ___________
100. __________________________________________________________________________ 100. ___________
101. __________________________________________________________________________ 101. ___________
102. __________________________________________________________________________ 102. ___________
103. __________________________________________________________________________ 103. ___________
104. SUBTOTAL (add lines 91 through 103) 104. $ _______________
105. TOTAL MONTHLY EXPENSES:
(add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, Expenses) 105 $ ===========
SUMMARY
106. TOTAL PRESENT MONTHLY NET INCOME
(from line 27 of SECTION I. INCOME) 106 $ ___________
107. TOTAL MONTHLY EXPENSES (from line 105 above) 107 $ ___________
108. SURPLUS (If line 106 is more than line 107, subtract line 107 from line 108 $ ___________
106. This is the amount of your surplus. Enter that amount here.)
109. (DEFICIT) (If line 107 is more than line 106, subtract line 106 from line 109. ($ _________)
107. This is the amount of your deficit. Enter that amount here.)
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SECTION III. ASSETS AND LIABILITIES
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A. ASSETS (This is where you list what you OWN.)
INSTRUCTIONS:
STEP 1: In column A, list a description of each separate item owned by you (and/or your spouse, if this
is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of
an item.
STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any item
that you are requesting the judge award to you.
STEP 3: In column B, write what you believe to be the current fair market value of all items listed.
STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
is "nonmarital," meaning it belongs to only one of you and should not be divided. You should
indicate to whom you believe the item belongs. (Typically, you will only use Column C if property was
owned by one spouse before the marriage. See the "General information for Self-Represented
Litigants" found at the beginning of these forms and section 61.075(1), Florida Statutes, for definitions of
"marital" and "nonmarital" assets and liabilities.)
A B C
ASSETS: DESCRIPTION OF ITEM(S) Current Fair Nonmarital
DO NOT LIST ACCOUNT NUMBERS. Market Value (✓ correct column)
__________________________
✓ the box next to any asset(s) which you are requesting
the judge award to you. husband wife
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[] Cash (on hand) $
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[] Cash (in banks or credit unions)
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[]
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[] Stocks/Bonds
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[]
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[]
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[] Notes (money owed to you in writing)
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[]
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*421
[]
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[] Money owed to you (not evidenced by a note)
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[]
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[]
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[] Real estate: (Home)
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[] (Other)
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[]
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[]
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[]
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[]
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[] Business interests
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[]
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[]
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[]
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[]
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[] Automobiles
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[]
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[]
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[]
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[] Boats
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[]
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[
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[] Other vehicles
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[]
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[]
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[] Retirement plans (Profit Sharing, Pension, IRA,
401(k)s, etc.)
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[]
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[]
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[]
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[] Furniture & furnishings in home
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[]
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[] Furniture & furnishings elsewhere
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[]
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[] Collectibles
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[]
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[] Jewelry
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[]
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*422
[] Life insurance (cash surrender value)
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[]
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[]
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[] Sporting and entertainment (T.V., stereo, etc.)
equipment
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[]
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[]
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[]
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[]
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[] Other assets
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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Total Assets (add column B) $__________
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B. LIABILITIES/DEBTS (This is where you list what you OWE.)
INSTRUCTIONS:
STEP 1: In column A, list a description of each separate debt owed by you (and/or your spouse, if this is
a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of an
item.
STEP 2: If this is a petition for dissolution of marriage, check the box in Colt= A next to any debt(s)
for which you believe you should be responsible.
STEP 3: In column B, write what you believe to be the current amount owed for all items listed.
STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
is "nonmarital," meaning the debt belongs to only one of you and should not be divided. You
should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the debt
was owed by one spouse before the marriage. See the "General Information for Self-Represented
Litigants" found at the beginning of these forms and section 61.075(1), Florida Statutes, for definitions of
"marital" and "nonmarital" assets and liabilities.)
A B C
LIABILITIES: DESCRIPTION OF ITEM(S) Current Nonmarital
DO NOT LIST ACCOUNT NUMBERS. Amount Owed (✓ correct column)
✓ the box next to any debt(s) for which you believe you
should be responsible. husband wife
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[] Mortgages on real estate: First mortgage on home $
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[] Second mortgage on home
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[] Other mortgages
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[]
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[] Charge/credit card accounts
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[]
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[]
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[]
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*423
[]
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[]
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[] Auto loan
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[] Auto loan
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[] Bank/Credit Union loans
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[]
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[]
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[]
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[] Money you owe (not evidenced by a note)
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[]
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[] Judgments
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[]
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[] Other
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[]
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[]
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[]
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[]
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[]
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[]
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Total Debts (add column B) $________
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C. NET WORTH (excluding contingent assets and liabilities)
Total Assets (enter total of Column B in Asset Table; Section A) $________
Total Liabilities (enter total of Column B in Liabilities Table; Section B) $________
TOTAL NET WORTH (Total Assets minus Total Liabilities)
(excluding contingent assets and liabilities) $========
D. CONTINGENT ASSETS AND LIABILITIES
INSTRUCTIONS:
If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance,
etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts
assumed by another), you must list them here.
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A B C
Contingent Assets Nonmarital
Possible Value (✓ correct column)
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✓ the box next to any contingent asset(s) which you
are requesting the judge award to you. husband wife
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[] $
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[]
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[]
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[]
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[]
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Total Contingent Assets $________
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*424
A B C
Contingent Liabilities Possible Nonmarital
Amount (✓ correct column)
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✓ the box next to any contingent asset(s) which you Owed
believe you should be responsible. husband wife
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[] $
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[]
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[]
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[]
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[]
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Total Contingent Liabilities $______
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E. CHILD SUPPORT GUIDELINES WORKSHEET. Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot be waived by the parties.
[✓ one only] ___ A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the establishment or modification of child support. ___ A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or modification of child support is not an issue in this case. I certify that a copy of this financial affidavit was: ( ) mailed, ( ) faxed and mailed, or ( ) hand delivered to the person(s) listed below on {date} _______________. Other party or his/her attorney: Name: ____________ Address: ____________ City, State, Zip: ___________ Fax Number: ______________I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.
Dated: _______ _________________ Signature of Party Printed Name: __________ Address: ___________ City, State, Zip: ________ Telephone Number: ___________ Fax Number: ____________ STATE OF FLORIDA COUNTY OF ______ Sworn to or affirmed and signed before me on ___________ by __________ _________________ NOTARY PUBLIC or DEPUTY CLERK _________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification Type of identification produced ________IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]
I, {full legal name and trade name of nonlawyer}, _______________, a nonlawyer, located at {street} ___________, {city} _______, {state} ______, {phone} _______, helped {name} _________________, who is *425 the [✓ one only] ___ petitioner or ___ respondent, fill out this form.INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(i), AFFIDAVIT OF CORROBORATING WITNESS
When should this form be used?
This form may be used to prove residency in a dissolution of marriage proceeding. To get a divorce in Florida, either the husband or the wife must have lived in Florida for at least 6 months before filing the petition. Residency may be proved by a valid Florida's driver's license, Florida identification card, or voter's registration card (issue date of document must be at least 6 months before the date the case is actually filed with the clerk of the circuit court), or the testimony or affidavit of someone other than you or your spouse. This form is used to prove residency by affidavit. The person signing this form must know that you have lived in the State of Florida for at least 6 months before the date you filed your petition for dissolution of marriage.
This form should be typed or printed in black ink, and signed in the presence of a notary public or deputy clerk. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for you records.
What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers.
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 section 61.021, Florida Statutes or section 61.052(2), Florida Statutes.
Special notes . . .
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.
IN THE CIRCUIT COURT OF THE _____ JUDICIAL CIRCUIT, IN AND FOR _____ COUNTY, FLORIDA DA Case No.: _______ Division.: _________ _____________, Petitioner, and _____________, Respondent.AFFIDAVIT OF CORROBORATING WITNESS
I, {full legal name} ________, being sworn, certify that the following statements are true: I have known {name} __________ since {approximate date} _______; to the best of my understanding the petition in this action was filed on {date} ______; and I know of my own personal knowledge that this person has resided in the State of Florida for at least*426 6 months immediately before {date} ______.
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.
Dated: ______ ________________ Signature of Corroborating Witness Printed Name: __________ Address: __________ City, State, Zip: ________ Telephone Number: ________ STATE OF FLORIDA COUNTY OF _____ Sworn to or affirmed and signed before me on ___________ by __________. ________________ NOTARY PUBLIC or DEPUTY CLERK ________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _________IF A NONLAWYER HELPED YOU FILL OUT TEES FORM, HE/SHE MUST FILL IN THE FLANKS BELOW: [fill in all blanks]
I, {full legal name and trade name of nonlawyer} ______________, a nonlawyer, located at {street} _____, {city} _______, {state} _______, {phone} _____, helped {name} ____________, who is the affiant, fill out this form.NOTES
[1] Other minor editorial changes, in addition to the amendments proposed by the committee, have also been made to the subject forms.