Introducing Referent – AI-native practice management software for modern law firms.
Explore ReferentThis 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]
1.1 Marital Status: ☐ Married ☐ Separated ☐ Divorced ☐ Single.
1.2 Dependents/Children:
[Name], age [], relationship []
[Name], age [], relationship []
[Name], age [], relationship []
1.3 Housing: ☐ Rent ☐ Own ☐ Live with family ☐ Other: [Explain].
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]
Bonuses/commissions: $[__]/year (est.)
Self-employment: $[__]/month
Benefits (unemployment/disability): $[__]/month
Rental income: $[__]/month
Other: [List]
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].
4.1 Cash/Bank Accounts:
Bank: [Name], account type: [Checking/Savings], last 4 digits: [____], balance: $[__]
Bank: [Name], account type: [Checking/Savings], last 4 digits: [____], balance: $[__]
Bank: [Name], account type: [Checking/Savings], last 4 digits: [____], balance: $[__]
4.2 Real Estate:
4.3 Vehicles:
4.4 Retirement/Investments:
4.5 Other Assets:
Business interest: [], estimated value: $[]
Personal property (jewelry, collections): [], estimated value: $[]
Other: [List]
Business interest: [], estimated value: $[]
Personal property (jewelry, collections): [], estimated value: $[]
5.1 Credit Cards:
5.2 Loans:
Student loan: [], balance: $[]
Personal loan: [], balance: $[]
Auto loan: [], balance: $[]
Other: [List]
Student loan: [], balance: $[]
Personal loan: [], balance: $[]
Auto loan: [], balance: $[]
5.3 Other Liabilities: Taxes owed: $[] | Judgments/collections: $[] | Other: [List].
6.1 Health insurance: [Provider]
6.2 Life insurance: [Provider + beneficiary]
6.3 Home/renter’s insurance: [Provider]
6.4 Auto insurance: [Provider]
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]
8.1 I declare under penalty of perjury that the information in this Financial Affidavit is true and correct to the best of my knowledge.
Affiant: [Full Name]
Date: [Date]
Signature: ___________________________
Witness Name: [Name]
Date: [Date]
Signature: ___________________________
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): ___________________
Each template already follows legal structure and best practices.
The agreement is automatically filled and adapted to your inputs.
Check the generated document, make edits if needed, and download a ready-to-use agreement.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Frequently asked
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.
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.
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.
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.
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).
AI Lawyer is an AI-powered assistant that helps you create and customize legal and business document templates online. It guides you through key sections, suggests wording, and explains complex concepts in simple language. AI Lawyer does not replace a licensed attorney or provide legal advice, but helps you prepare better documents faster and more confidently.
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