-DOMESTIC RELATIONS FINANCIAL AFFIDAVIT-

DRFA

Names and birth dates of children for whom support is to be determined in this action:

Add Remove

Names and birth dates of affiant’s other children:

Add Remove

2. SUMMARY OF AFFIANT’S INCOME AND NEEDS

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3. A. AFFIANT’S GROSS MONTHLY INCOME

(All income must be entered based on monthly average regardless of the date of receipt.)

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ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS
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ATTACH SHEET ITEMIZING YOUR CALCULATIONS
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ATTACH SHEET ITEMIZING YOUR CALCULATIONS
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GROSS MONTHLY INCOME

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(Deducting only state and federal taxes and FICA)

4. ASSETS

(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion under the appropriate spouse’s column and state the amount and the basis: pre-marital, gift, inheritance, source of funds, etc.).

4. ASSETS

(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion under the appropriate spouse’s column and state the amount and the basis: pre-marital, gift, inheritance, source of funds, etc.).

Description

Value

Plaintiff

Defendant

Joint

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5. A. AVERAGE MONTHLY EXPENSES

HOUSEHOLD

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AUTOMOBILE

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OTHER VEHICLES

(boats, trailers, RVs, etc.)

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CHILDREN’S EXPENSES

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(out of pocket/uncovered expenses)
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AFFIANT’S OTHER EXPENSES

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(out of pocket/uncovered expenses)
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OTHER INSURANCE

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TOTAL ABOVE EXPENSES

B. PAYMENTS TO CREDITORS

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Personally appeared before me, an officer authorized to administer oaths, the undersigned affiant, who upon being sworn, swears that he/she is legally competent to make this affidavit, that the affidavit is based upon personal knowledge, and that the contents of the affidavit are true and correct to the best of his/her knowledge or belief.
Affiant