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Financial Affidavit

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This customizable Financial Affidavit can be used when an individual is required to make a sworn statement about the state of their finances. Financial Affidavits can be required during a divorce proceeding, a child support hearing, or a bankruptcy proceeding. Customize your monthly income, your additional sources of income, your expenses, your debts, your marital status, and much more. This affidavit is ideal for individuals or small businesses that need to make a sworn statement of their finances.

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									Financial Affidavit
This customizable Financial Affidavit can be used when an individual is required to
make a sworn statement about the state of their finances. Financial Affidavits can be
required during a divorce proceeding, a child support hearing, or a bankruptcy
proceeding. Customize your monthly income, your additional sources of income, your
expenses, your debts, your marital status, and much more. This affidavit is ideal for
individuals or small businesses that need to make a sworn statement of their finances.
                                     FINANCIAL AFFIDAVIT

STATE OF _________________ [Instructions: Insert the state where this affidavit will be
signed]

COUNTY OF _________________ [Instructions: Insert the county where this affidavit will
be signed]



_________________, [Instructions: Insert the name of the individual executing this
affidavit, hereinafter referred to as the “Affiant”] being duly sworn according to law, deposes
and attests under penalty of perjury to the following:

I, _________________, [Instructions: Insert the name of the Affiant] of
_____________________________________________ [Instructions: Insert the address of
the Affiant] being first duly sworn on oath, state that:

    1. I am over 18 years of age and competent enough to testify of my own knowledge of the
       facts stated herein.

    2. All the facts stated by me herein are true, correct and complete to the best of my
       knowledge and understanding.

    3. I am currently employed by _________________, [Instructions: Insert the name of the
       Affiant’s employer] at _____________________________________________.
       [Instructions: Insert the address of the Affiant’s employer] I have been employed with
       _________________ [Instructions: Insert the name of the Affiant’s employer] for
       _________________ [Instructions: Insert the length of time Affiant has worked for
       the employer] and make $_________________ [Instructions: Insert Affiant’s gross
       monthly pay] monthly, before taxes.

    4. I currently am/am not [Instructions: Insert whether the Affiant is currently married]
       married.

    5. Excluding household furnishings, I own all of the following valuable property:

         ________________________________________________________________________
         ________________________________________________________________________
         ________________________________________________________________________
         ________________________________________________________________________

         [Instructions: Insert the Affiant’s valuable property, such as real estate, stocks,
         bonds, vehicles, retirement plans, pensions, etc.]



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    6. I have the following additional sources of income:

         Income Source: _________________
         Gross Monthly Amount: $_________________

         Income Source: _________________
         Gross Monthly Amount: $_________________

         [Instructions: Insert the Affiant’s other sources of income. Add or remove lines
         as necessary]

    7. I have the following monthly household expenses:

         Household Expense: _________________
         Monthly Expense: $_________________

         Household Expense: _________________
         Monthly Expense: $_________________

         Household Expense: _________________
         Monthly Expense: $ _________________

         [Instructions: Insert the Affiant’s monthly household expenses, such as rent,
         mortgage payments, car notes, utilities, child support, etc.]

    8. I have the following debts associated with my name:

         Type of Debt: _________________
         Debt Amount: $_________________

         Type of Debt: _________________
         Debt Amount: $_________________

         [Instructions: Insert the debts Affiant is liable for, such as mortgage loans, car loans,
         student loans, credit card debt, etc.]

    9. Including cash in hand, the total amount of money I have in all checking and savings
       accounts is $_________________. [Instructions: Insert the total amount of money the
       Affiant currently has]

    10. I have a total of _________________ [Instructions: Insert the total number of the
        Affiant’s dependents] dependents that rely on me for their primary source of caretaking
        and income.




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I swear that to the best of my knowledge, the information contained in this affidavit is true and
correct as of _________________. [Instructions: Insert the date that Affiant will sign this
affidavit]

Printed Name of Affiant: _________________ [Instructions: Insert the name of the Affiant]

Signature of Affiant: _________________________________________ [Instructions: Insert
the Affiant’s signature]
Signed on _________________ [Instructions: Insert the date that Affiant will sign this
affidavit]

Address of Affiant: _____________________________________________ [Instructions:
Insert the address of the Affiant]




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Notary Form

STATE OF                                       }
COUNTY OF                                      }

On ________________________________ before me, __________________________,
personally appeared ___________________________________________________, personally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed
the instrument.

WITNESS my hand and official seal.


_____________________________
Signature


Affiant: _____Known _____Unknown

ID Produced: __________________________


[Seal]




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