FINANCIAL AFFIDAVIT INSTRUCTIONS
YOU MUST COMPLETE THIS FORM BEFORE WE FILE AN ACTION FOR
YOU REQUESTING CHILD SUPPORT, POST SEPARATION SUPPORT
AND/OR ALIMONY.
In any case we handle for you involving support, whether or not we actually file an
action, we may require you to complete an affidavit with the same information which the
court requires. We want you to closely examine your budget so you will know how much
money it takes to meet your expenses. This information will help us know what amount
of support it will take to meet your expenses, so this process is very helpful to you.
Please take the time to accurately assess your needs so that you will have an accurate
financial picture.
You should keep a copy of the completed affidavit along with any notes and calculations
you used in preparing it. In court the other attorney may disagree with one of your
figures or may cross-examine you about your figures. You must be prepared to explain
how you arrived at the amount and you must sound convincing about your figures.
If your circumstances change, i.e., you move and your monthly rent increases, you pay
off your car, or your medical expenses increase, you MUST update your affidavit. Some
cases take weeks or months to settle or to reach court, and we need the most recent
and accurate figures available.
Your figures should be “good-faith” estimates. If you don’t know the answer, explain why
you can’t put down an amount or make as accurate a guess as possible, putting “est.”
after the figure. You should review your cancelled checks and charge account receipts
for six months to one year. Total the amount and divide by 6 or 12 to arrive at a monthly
figure. Weekly figures should be multiplied by 4.3 to arrive at a monthly figure.
Your “needs” estimates must be “reasonable”. They should be based on the
accustomed standard of living for you and your child(ren). They cannot be inflated to
allow a lavish lifestyle, and they should not be lowered to reduce your standard of living.
Often you will find a difference between your actual expenses and reasonable needs.
For example: You have a low-income job and haven’t been receiving any child support
from your spouse. After reviewing your check entries, you see that you have not spent
any money on car repairs in the past year, although you know that your car needs the oil
changed and needs new tires. You should put the amount you have actually spent in
the appropriate space, put an asterisk (*) beside that entry, and then put the amount the
oil change and tires will cost you per month in a footnote on the affidavit with an
explanation at the bottom of the affidavit.
If your expenses are greater that your income, do not be surprised, but double check
your figures for accuracy. This happens often. You may have been spending beyond
your means, but you may also have been receiving help from family or friends. You do
not have to have bills or receipts for each item on the affidavit, but you should have a
solid reason for every figure you put down.
Revised 01/07
INCOME INFORMATION
1. Fill out this section with your employer’s name, telephone number, and
address.
2. Fill in your social security number.
3. Enter your adjusted gross income from your tax return for the last tax year.
4. Put the gross amount (before any deductions) you receive monthly. If you
routinely work overtime, you should take three paychecks – one week with
little or no overtime, one week with moderate overtime and one week with
substantial overtime – add them together and divide by three to get an
average. Add a note to the affidavit that this is an average to allow for
overtime.
5. Enter your take home pay after any deductions. For overtime, use the same
three pay stubs you used for #4 and average the take home pay.
NOTE: If your are paid weekly, multiply the weekly figure by 4.3 If every two weeks,
multiply the figure by 26 then divide by 12 to get a monthly figure. If twice a month (i.e.,
first and fifteenth), multiply the amount by 24. If once per month, multiply by 12.
If you have no income skip to EXPENSES.
6. Enter any other income, such as sales commissions, interest or dividends
from investments, alimony, or child support here. If you receive a check from
Social Security for yourself or a Supplemental Security Income (SSI) check
for your child(ren), enter that amount here and note who the check is for.
Enter any other income you receive and note its source.
YOU MUST ATTACH WAGE AND EARNINGS STATEMENTS FOR TWO MONTHS
TO THIS AFFIDAVIT. If you do not keep your pay stubs, ask for copies from your
employer.
MONTHLY HEALTH INSURANCE AND OTHER CHILD PAYMENTS
1. Enter the amount you pay each month to provide health insurance for your
child(ren). If you are unsure as to how much of the premium is for the
child(ren), check with your employer. Some insurance companies have a
premium for “family coverage” which is a flat amount and covers everyone,
regardless of the number of family members. Other carriers may charge the
premium based on the number of people covered.
2. If you are paying support for a child(ren) from another relationship, enter the
amount you pay monthly in this space.
3. If you have entered another relationship and have a child(ren) from that
relationship, we must know this. The Child Support Guidelines allow a credit
for your responsibility to support this child(ren). We will determine the
amount to put in this space from the Child Support Guidelines. We will need
to know the gross monthly income of the child(ren)’s other parent in order to
determine this figure.
Revised 01/07
MONTHLY WORK RELATED CHILD COSTS
1. Enter each child’s name and the amount you pay monthly for child care that
is necessary for you to work. If you have school age child(ren) and the
monthly amount varies for the summer, multiply the amount you pay during
the summer by 3, add the two together and divide by 12 for an average
monthly figure.
EXPENSES
Note: All expense items are average or estimated amounts, calculated on a monthly
basis. Round all figures to the nearest dollar.
NON PRO-RATED MONTHLY EXPENSES
1. House payment or Rent: enter the amount you pay monthly. If you are living
With relatives and pay them something, enter that amount here. IF you have
plans to move out, determine what your rent might be and enter that amount
here – if this is an estimate, note that it is an estimate. If you are living with
your new spouse, a roommate, or boyfriend/girlfriend and you are sharing
expenses, enter the amount you are paying toward the house payment or
rent.
2. Heat: Gas or Oil, if appropriate.
3. Water: Average several months’ water bills. Use figures from both summer
and winter months so the figure will be more accurate. If included in rent,
leave blank.
4. Cablevision: If applicable.
5. House Maintenance: If you live in a rental unit this may be nothing. IF you
are purchasing your residence, include figures for yard work, painting, furnace
and air conditioning repairs and other items. If you live in a town home or
condominium or in a subdivision with home owner’s association dues, include
a monthly figure for this here and note that the total includes the dues.
If you anticipate having extraordinary repairs in the near future or if there are repairs that
you know need to be made, enter the actual amount you have paid in the blank. Put an
asterisk (*) by the figure and enter a note at the bottom of the page that certain repairs
must be made and put an estimate for those repairs.
6. Life Insurance: Monthly premiums for insurance on the life of each family
member.
7. Household Food & Supplies: Do not put down an artificial figure, such as
$100.00, unless this is your estimate. Determine what you average paying at
the grocery store each month.
8. Electricity: Average several months’ electric bills. Use figures from both
summer and winter months so the figure will be more accurate. IF included in
rent, leave blank.
9. Telephone: Average several months’ bills.
10. Car Payment: Enter the actual amount of your monthly car payment.
11. Car Insurance: Enter the monthly figure here. If you pay by the year, divide
by 12; if every six months, divide by 6; if quarterly, divide by 4.
12. Total all non-prorated monthly expenses.
Revised 01/07
INDIVIDUAL MONTHLY EXPENSES
1. Enter each child’s name and age.
2. School & Work Lunch: There are about 20 school days each month. Enter
the amount you spend on each child monthly. Enter the amount you spend
monthly on your lunch while you are working.
3. Medical/Dental: Use only out-of-pocket expenses, not those reimbursed by
insurance. Average figures for 6-12 months and add in expenses for known
future expenses, such as braces for one child. Figures should be allocated to
the person they were for. If the amount for one person is unusually high, put a
note as to shy the figure is high – i.e., includes costs of counseling, person
has a chronic medical condition requiring frequent doctor visits.
4. Drugs: Prescription or over-the-counter, such as Tylenol. Amounts should be
allocated to the person for whom the drugs were purchased. If the amount for
you or your child(ren) is unusually high because of a routine prescription,
make a note of that here.
5. Clothing: If you don’t have any idea, review your checkbook entries, as well
as your credit card statements and put an estimate. Many people don’t have
an accurate recollection of clothing expenses because these items are
charged. Women should include costs of hosiery.
6. Grooming: This includes haircuts and styling, as well as special treatments
such as coloring and permanents. Manicures, pedicures and massages also
go under this category. Don’t forget grooming products, such as shampoo,
etc., which aren’t included in your grocery bill.
7. Laundry/Cleaning: Dry cleaning or trips to a coin-operated Laundromat. This
does not include detergent purchase and accounted for with groceries.
8. Entertainment: Includes items such as movies, video tape rental. If you
routinely entertain guests in your home, include a monthly figure for those
costs.
9. Recreation: Includes sports activities such as tennis, golf, pool memberships,
skate trips, bowling, expenses relating to the operation of a boat, etc.
10. Reading Material: Include newspapers and any books or magazines for
yourself and the child(ren).
11. Church Donations: Agreed upon tithes as well as collection plate
contributions.
12. Gifts: Under your column indicate gifts you give to others (except your
child(ren)) for birthdays and other holidays. Under each child enter the total
figure you spend each year for Christmas and the child’s birthday divided by
12. Also, include an amount you might give each child to purchase gifts for
others, such as gifts for birthday parties, etc.
13. Club Dues: For yourself, include dues for professional organizations. For the
child(ren), include boy/girl scouts, Indian Princesses, band, etc.
14. Education: Include expenses you pay for tuition, books, summer school,
tutoring, etc. Also include money paid for field trips, school supplies, etc. If
you must take continuing education classes for your employment, and those
expenses are not reimbursed by your employer, include that figure here under
your column.
15. Allowances: Even if not on a regular basis, put in a figure if you give money to
your child(ren) for their own spending.
Revised 01/07
16. Vacation: Enter the amount you actually budget or spend each year. Include
weekend trips to the beach or the mountains, or trips to visit relatives for
holidays, in addition to longer trips.
17. Gasoline: Enter the actual amount you spend for gas each month. If one
child is involved in more activities than another, then attribute more to that
child that the others.
18. Car Repairs: Estimate both repairs and maintenance on a monthly basis.
This includes oil changes, tune-ups, tire rotations and other routine
maintenance. Check with your mechanic if in doubt.
19. Eating Out: Include all meals, including snacks, which are eaten out. Most
people do not keep receipts for such meals, so make a best-guess estimate.
20. Put any additional expenses that do not fit under any other item. This may
include lot rental for a mobile home, furniture or appliance rental, pet
expenses, a cellular telephone, etc.
21. Enter totals for yourself and each child.
NOTE: If you do not have custody of your child(ren) but you do have visitation, put down
a fair estimate of the monthly amount you spend for the child(ren) when they are with
you. This includes eating out, as well as entertainment and any other expenses you
incur while they are with you. Be sure to include gifts, vacation expenses, etc. If you
routinely buy the child(ren)’s clothes and/or pay medical expenses, even though you do
not have custody, please note that this is your routine.
ASSETS AND DEBTS
1. Real Estate: Enter the fair market value of your home or for any other real
estate you own. If it is jointly titled, note “joint”. List who holds the mortgage.
Call your mortgage company for the “pay off” figure or principal balance.
Enter the monthly payment for any and all real estate here. Note “joint”, if
applicable.
2. Vehicles: Enter the “blue book” value of all automobiles. You can either call a
dealer, check at the library, or get the value off the Internet. There are two
websites: Kelley’s Blue Book (www.kbb.com) and Edmund’s Index of Car
Makes (www.edmunds.com) . There are three values: dealer trade in value,
bank loan collateral, and average retail. Use the trade-in value. You should
also add in the amounts noted for features, such as special packages, air
conditioning, etc. deduct for high mileage if applicable. List who holds the
lien for each vehicle, the total outstanding amount owed and the monthly
payment. Note “joint” if applicable.
3. Stocks & Bonds: Enter the total value of all stocks and bonds owned. Note
“joint” if applicable. Include stock purchased through your employer.
4. Loans: Should include loans from banks and finance companies, as well as
loans from family members or friends. Note who is owed. Enter the total
outstanding amount owed and the monthly payment. Note “joint” if applicable.
5. Credit Cards: Enter each card separately. Enter the total outstanding amount
owed and the monthly payment. Note “joint” if applicable.
6. Your signature must be notarized.
PLEASE CALL IF YOU HAVE ANY QUESTIONS WHILE COMPLETEING THIS
AFFIDAVIT. THIS IS A TIME CONSUMING TASK, BUT IT IS IMPORTANT FOR YOUR
CASE.
Revised 01/07
Revised 01/07