How to Fill Out a Financial Affidavit

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					                           Domestic Relations Financial Affidavit Instructions and Disclosure
                                          (Please read this document carefully)

The attached document is called a Domestic Relations Financial Affidavit, or DRFA, and is required to be completed and
filed with the Court in all domestic cases. This form is extremely important to your case and it is imperative that you
completely and accurately fill out this document. Accurate completion of this form will expedite the filing process and
will prevent additional billing in preparing this document. Some actions cannot even be filed, nor can a hearing be set until
the Domestic Relations Financial Affidavit is completed and filed with the court. Therefore, we ask that you thoroughly read
this instruction sheet and adhere to the following guidelines in completing the DRFA:

1) Income: Attach your two (2) most recent paystubs. We will use this information to calculate your gross and net monthly
income. Please make sure to include any overtime income and income from self-employment on Page 2 of the form.

2) Assets and Monthly Expense: Please do not leave any blanks on this section of the form. If the amount you pay for a
certain item is zero, then indicate this by placing a zero in that cell. For example, if you do not own any real property or
vehicles (you will find this on Page 3), please place a zero in the appropriate cell. If you do own real property or vehicles,
please indicate the fair market value and the debt owed for each item in the appropriate cells. We request that you follow
these same guidelines throughout the Asset and Monthly Expense sections while completing the DRFA. Please note that the
affidavit asks for your monthly expenses. Therefore, be sure to divide by 12 expenses such as auto tags which you usually
pay annually and insert that figure on the affidavit. Also, if your property taxes and property insurance are included in your
monthly mortgage payment, you may indicate that $.00 is paid monthly in these spaces. Please note that there is a separate
portion for child related expenses in this section and we request that you keep this in mind when completing this form.
However, there is a space on the affidavit for travel visitation expenses, which is not inclusive in the child related expenses

3) Child Related Expenses: We need an accurate monthly figure of your child care expenses, extraordinary educational
expenses, etc. It is extremely important that we have accurate amounts for this expense, as you may receive a credit for this
amount on the Child Support Worksheet.

4) Medical Insurance: Please complete this section to the best of your ability and be sure to indicate the monthly amount
paid, if any, for children’s medical insurance premium in the appropriate cell. These amounts should match the deduction on
your paycheck stub if your premium is paid through your employer. Please follow these same guidelines when entering the
amounts paid for dental, vision and life insurance. Again, it is extremely important that we have accurate amounts for these
items, as you may receive credits for these amounts on the Child Support Worksheet.

5) Monthly Payments to Creditors: This section should include an itemized list of all debts and payments to creditors,
with the exception of your mortgage payment, which is already listed in the Monthly Expense section. Include the name
of the creditor, the balance owed and the monthly payment for all debts, including credit cards, car payments, etc.

                    **Your cooperation in getting this information to us, although time consuming,
                               is essential to the proper preparation of your case.**

                                        Disclosure of Income, Assets, and Expenses

I, _________________________, hereby affirm that the figures and facts set forth in the attached Domestic Relations
Financial Affidavit are true and correct. I further state that I have made a full disclosure of my income, expenses, and all
assets, both marital and pre-marital, including real and personal property, to my attorney, as set forth on this form.

This ___ day of _________________, 200___.
                                                     Signed by: __________________________ (Affiant)
Form #: FL103
Revised 12/2009
                                                             Page 2 of 7

                 IN THE SUPERIOR COURT OF                                         COUNTY
                                       STATE OF GEORGIA


                           Plaintiff                                    )

  vs.                                                                   )         CIVIL ACTION NO.

                          Defendant                                     )

                                DOMESTIC RELATIONS FINANCIAL AFFIDAVIT

1 AFFIANT'S NAME:                                                                                     Age

  Spouse's or Other Parent's Name:                                                                    Age

    Date of Marriage:                                                               Date of Separation:

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

  Names                                                           Date of Birth       Resides with:

  Names and birth dates of Affiant's other children, (exclude step children):

                                                                                  Date of Initial Support Support Paid
  Names                                     Date of Birth        Resides with:            Order            by Affiant


  (a) Gross monthly income (Item 3A)                                                             $0.00

  (b) Net monthly income (Item 3B)                                                               $0.00

  (c) Average monthly expenses (Item 5A)                                                         $0.00

  (d) Monthly payments to creditors (Item 5B)                                                    $0.00

  (e) Total monthly expenses/payments to creditors (Item 5C)                                     $0.00
                                                               Page 3 of 7

3 A. AFFIANT'S GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A)
  (All income must be entered based on monthly average regardless of date of receipt.)

  Salary or Wages

  Commissions, Fees, Tips

  Income from self-employment, partnership, close corporations,
  and independent contractors (gross receipts minus ordinary
  and necessary expenses required to produce income)

  Rental Income (gross receipts minus ordinary and
  necessary expenses required to produce income)


  Overtime Payments

  Severance Pay

  Recurring Income from Pensions or Retirement Plans

  Interest and Dividends

  Trust Income

  Income from Annuities

  Capital Gains

  Social Security Disability or Retirement Benefits

  Workers' Compensation Benefits

  Unemployment Benefits

  Judgments from Personal Injury or Other Civil Cases

  Gifts (cash or other gifts that can be converted to cash)

  Prizes/Lottery Winnings

  Alimony and maintenance from persons not in this case

  Assets which are used for support of family

  Fringe Benefits (if significantly reduces living expenses)

  Any other income (do NOT include means-tested
  public assistance, such as TANF or food stamps)

  GROSS MONTHLY INCOME                                                                   $0.00
                                                                 Page 4 of 7

B. Affiant's net monthly income from employment
   (deducting only State and Federal Taxes, Social Security
   and Medicare withholdings)
                          Gross Monthly Income                                   $0.00
                          State Income Taxes
                          Federal Income Taxes
                          FICA Social Security Tax
                          FICA Medicare Tax

                                                                Net Monthly Income:                       $0.00

   Affiant's pay period (i.e. weekly, bi-weekly, monthly, bi-monthly):
   Number of tax exemptions claimed on IRS Form W-4 or tax return:


   (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 (PM), gift (G), inheritance (INH), source of
   funds (SoF), etc.).

                                                                  Separate Asset of       Separate Asset of         Basis of the
   Description                                     Value            the Husband               the Wife                Claim

   Stocks, bonds
   CD's/Money Market Accounts
   Bank Accounts
   (list each account):

   Retirement Pensions,
   401K, IRA, or Profit Sharing
   Money owed you:
   Tax Refund owed you:
   Real Estate:
                               debt owed:

                               debt owed:
                                Vehicle 1:
                               debt owed:
                                Vehicle 2:

                               debt owed:
                                         Page 5 of 7

 Life Insurance
 (net cash value):




 Other Assets (List):

 Total Assets:                   $0.00                  $0.00                   $0.00


 Mortgage or rent payments                  Cable TV

 Property taxes                             Misc. household and grocery items

 Homeowner/Renter Insurance                 Meals outside the home

 Electricity                                Other household expenses:

 Water                                     AUTOMOBILES

 Garbage and Sewer                          Gasoline and oil

 Telephone:                                 Repairs

 residential line:                          Auto tags and license

 cellular telephone:                        Insurance

 Internet Service                           OTHER VEHICLES

 Gas                                        (boats, trailers, RVs, etc.)

 Repairs and maintenance                    Gasoline and oil

 Lawn Care                                  Repairs

 Pest Control                               Tags and license

                                                           Page 6 of 7

CHILDREN'S EXPENSES                                           AFFIANT'S OTHER EXPENSES

Regular child care                                           Dry cleaning/laundry

Special Care (non-school periods)                             Clothing

Tutoring                                                      Medical, dental, prescription
                                                              (out of pocket/uncovered expenses)
Private lessons (e.g.,music, dance)

School tuition                                                Affiant's gifts (special holidays)

School Supplies/expenses                                      Entertainment

Lunch Money                                                   Recreational Expenses (e.g.,
                                                              fitness, golf, bowling)
Other Educational Expenses (list):


                                                              Travel Expenses for Visitation

Allowance                                                     Publications

Clothing                                                      Organizations dues, clubs, etc.

Baby Formula                                                  Religious and charities

Diapers                                                       Pet expenses
Medical, dental, prescription
(only out of pocket/uncovered
expenses)                                                     Alimony paid to a former spouse

Grooming, hygiene                                             Personal Educational Expenses

Gifts (from children to others)                               Other Expense (attach sheet)




Entertainment                                                 Child support paid for another child
Activities (e.g. extra-curricular, sports,
religious, cultural, etc.)                                  Date of initial order:

Summer Camps                                                Name of child

OTHER INSURANCE                                               Child support paid for another child

Health Insurance Premiums                                   Date of initial order:

Child(ren)'s portion:                                       Name of child

Dental Insurance Premiums                                     Child support paid for another child

Child(ren)'s portion:                                       Date of initial order:

Vision Insurance Premiums                                   Name of child

Child(ren)'s portion:

Life Insurance Premiums                                     Disability

Relationship of Beneficiary:                                  Retirement Contribution:

                                             TOTAL ABOVE EXPENSES                                  $0.00
                                                  Page 7 of 7

B PAYMENTS TO CREDITORS:                                                (Place an "X" in the column for whom is to pay this debt.)

  To Whom:                          Balance Due   Monthly Payment               Joint                Plaintiff        Defendant

  TOTAL MONTHLY PAYMENTS TO CREDITORS:                          $0.00                                             X

C TOTAL MONTHLY EXPENSES AND PAYMENTS TO CREDITORS:                                     $0.00

     Other/ Comment/ Explanation:
           Page 8 of 7

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                            Page 7 of 7

The Undersigned Affiant does state under oath (or affirmation) that
the information contained in the foregoing Domestic Relations
Financial Affidavit is true, correct, and current as of the date of this

                            Affiant: 0

Sworn to before me this

Day of               ,20

Notary Public                                                (Seal)

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