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Financial Affidavit Template
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Financial Affidavit Template
This Financial Affidavit (the “Affidavit”) is made on [Date] by:
Affiant: [Full Name], date of birth: [DOB], address: [Address], phone/email: [Contact].
Case (Optional): [Court/County] | Case No.: [__]
Other Party (Optional): [Name]
1. Household and Dependents
1.1 Marital Status: ☐ Married ☐ Separated ☐ Divorced ☐ Single.
1.2 Dependents/Children:
[Name], age [], relationship []
[Name], age [], relationship []
1.3 Housing: ☐ Rent ☐ Own ☐ Live with family ☐ Other: [Explain].
2. Employment and Income
2.1 Employer: [Company] | Position: [Title] | Start date: [Date].
2.2 Pay Frequency: ☐ Weekly ☐ Biweekly ☐ Monthly.
2.3 Gross Income: $[] per pay period.
2.4 Net Income (Take-Home): $[] per pay period.
2.5 Other Income:
Bonuses/commissions: $[__]/year (est.)
Self-employment: $[__]/month
Benefits (unemployment/disability): $[__]/month
Rental income: $[__]/month
Other: [List]
3. Monthly Living Expenses
3.1 Housing: Rent/mortgage $[] | Property tax/HOA $[] | Insurance $[].
3.2 Utilities: Electric $[] | Gas $[] | Water $[] | Internet $[] | Phone $[].
3.3 Food/Household: Groceries $[] | Household supplies $[].
3.4 Transportation: Car payment $[] | Fuel $[] | Insurance $[] | Public transit $[].
3.5 Medical: Health insurance $[] | Out-of-pocket $[] | Prescriptions $[].
3.6 Child-Related (If Any): Childcare $[] | School costs $[] | Activities $[].
3.7 Debt Payments: Credit cards $[] | Loans $[] | Other $[__].
3.8 Other Expenses: [List + amounts].
3.9 Total Monthly Expenses (Estimate): $[Total].
4. Assets
4.1 Cash/Bank Accounts:
Bank: [Name], account type: [Checking/Savings], last 4 digits: [____], balance: $[__]
Bank: [Name], account type: [Checking/Savings], last 4 digits: [____], balance: $[__]
4.2 Real Estate:
Address: [], estimated value: $[], mortgage balance: $[], monthly payment: $[]
4.3 Vehicles:
[Year/Make/Model], value: $[], loan balance: $[]
4.4 Retirement/Investments:
[401(k)/IRA/Brokerage], institution: [], balance: $[]
4.5 Other Assets:
Business interest: [], estimated value: $[]
Personal property (jewelry, collections): [], estimated value: $[]
Other: [List]
5. Debts and Liabilities
5.1 Credit Cards:
Creditor: [], balance: $[], minimum payment: $[__]
5.2 Loans:
Student loan: [], balance: $[]
Personal loan: [], balance: $[]
Auto loan: [], balance: $[]
Other: [List]
5.3 Other Liabilities: Taxes owed: $[] | Judgments/collections: $[] | Other: [List].
6. Insurance (Optional)
6.1 Health insurance: [Provider]
6.2 Life insurance: [Provider + beneficiary]
6.3 Home/renter’s insurance: [Provider]
6.4 Auto insurance: [Provider]
7. Supporting Documents (Attach as Available)
7.1 ☐ Pay stubs (last [])
7.2 ☐ Tax returns (last [] years)
7.3 ☐ Bank statements (last [] months)
7.4 ☐ Credit card statements (last [] months)
7.5 ☐ Mortgage/loan statements
7.6 ☐ Proof of childcare/medical expenses
7.7 ☐ Other: [List]
8. Statement Under Oath
8.1 I declare under penalty of perjury that the information in this Financial Affidavit is true and correct to the best of my knowledge.
Signatures
Affiant: [Full Name]
Date: [Date]
Signature: ___________________________
Witnesses (If Required)
Witness Name: [Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (If Required)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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Financial Affidavit Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
FINANCIAL AFFIDAVIT TEMPLATE FAQ
What is a financial affidavit?
A Financial Affidavit is a sworn statement that summarizes a person’s income, expenses, assets, and debts. It is commonly used in divorce, child support, spousal support, custody, and other family law matters to help the court or the parties understand each person’s financial situation.
When do you need one?
Many courts require a financial affidavit early in a family case, and it is also useful for settlement negotiations or mediation. Requirements vary by jurisdiction, so you should follow local court forms and rules if they are provided.
What should be included?
Include: employment and income details, monthly expenses, bank accounts, real estate, vehicles, retirement accounts, other assets, debts, and dependents. This template is organized to make it easy to fill in and attach documentation.
What documents should you attach?
Common attachments include pay stubs, tax returns, bank statements, credit card statements, mortgage statements, and proof of childcare/medical expenses. This template includes a checklist of common documents.
Is it under oath?
Often yes. Providing false information can have serious consequences. This template includes an oath statement and notarization section (optional or required depending on the court).
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