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Financial Disclosure Statement Template
Provide a complete and honest overview of your finances with this Financial Disclosure Statement Template.
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Financial Disclosure Statement Template
In the [Name of Court] Court of [County], [State]
Case No.: __________________________
Petitioner: [Full Name]
Respondent: [Full Name]
1. Personal Information
Full Name: [Full Name]
Address: [Street, City, State, ZIP]
Phone: [Phone Number]
Email: [Email Address]
Occupation: [Job Title/Employer Name]
Date of Birth: [MM/DD/YYYY]
2. Income
Gross Monthly Income: $[Amount]
Net Monthly Income (after taxes): $[Amount]
Source(s) of Income: [Employer, Self-Employment, Investments, Benefits, etc.]
Additional Income (bonuses, commissions, alimony, child support): $[Amount]
3. Assets
A. Real Estate:
[List all properties owned, including primary residence, rental, or vacation properties.]
Address: __________________________
Fair Market Value: $[Amount]
Mortgage Balance: $[Amount]
Equity: $[Amount]
B. Vehicles:
Make/Model: __________________________
Year: _______ Value: $[Amount] Loan Balance: $[Amount]
C. Bank Accounts:
Bank Name: __________________________
Account Type: [Checking/Savings/Other]
Balance: $[Amount]
D. Investments and Retirement:
Type: [Stocks/Bonds/401(k)/IRA/etc.]
Institution: __________________________
Current Value: $[Amount]
E. Personal Property:
Description: [Furniture, Jewelry, Art, etc.]
Estimated Value: $[Amount]
4. Debts and Liabilities
A. Credit Cards:
Card Issuer: __________________________
Balance: $[Amount] Monthly Payment: $[Amount]
B. Loans:
Type: [Auto/Student/Personal/Other]
Lender: __________________________
Balance: $[Amount] Monthly Payment: $[Amount]
C. Other Debts:
[List any additional financial obligations, such as medical bills or tax debts.]
5. Monthly Expenses
Housing (rent/mortgage): $[Amount]
Utilities: $[Amount]
Transportation: $[Amount]
Food and Groceries: $[Amount]
Insurance (health, life, auto): $[Amount]
Childcare or School: $[Amount]
Miscellaneous: $[Amount]
6. Supporting Documentation
Attach copies of:
☐ Most recent pay stubs (last 2 months)
☐ Previous year’s federal and state tax returns
☐ Bank statements (last 3 months)
☐ Mortgage or loan statements
☐ Any additional proof of income or assets
7. Certification
I declare under penalty of perjury under the laws of the State of [State] that the information contained in this Financial Disclosure Statement is true, complete, and correct to the best of my knowledge.
Signature: __________________________
Printed Name: __________________________
Date: __________________________
Notary Acknowledgment
State of [State]
County of [County]
Subscribed and sworn before me on this _____ day of __________, 20____, by [Full Name].
Notary Public Signature: __________________________
Commission Expires: __________________________
Seal:
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Financial Disclosure Statement Template
Click below for detailed info on the template.
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 Disclosure Statement FAQ
What is a Financial Disclosure Statement?
A Financial Disclosure Statement is a detailed report of a person’s financial situation — listing income, property, debts, and expenses — typically required in divorce or family court proceedings. It helps ensure fairness in property division, spousal support, and child support determinations.
Why is a Financial Disclosure Statement important?
It promotes transparency between spouses and allows courts to make equitable decisions. Failing to disclose all assets or debts can result in penalties, invalid agreements, or reopened cases.
When should you use a Financial Disclosure Statement?
This form is used at the beginning of divorce, legal separation, or modification proceedings and must be updated if significant financial changes occur before judgment.
What should be included in a Financial Disclosure Statement?
The statement must include all sources of income, real and personal property, bank accounts, retirement funds, debts, living expenses, and any anticipated changes in financial status. Supporting documents such as pay stubs or tax returns may also be required.
Is the information confidential?
Yes. Financial disclosures are typically filed under seal or shared only with the opposing party and the court to protect privacy.
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