Florida Your Affidavit Form Details

The family law financial affidavit 12 902 B is a form that must be filled out in order to request a divorce in the state of California. The affidavit asks for detailed information about the couple's finances, including income, assets, and debts. It is important to complete this form accurately and honestly, as it will be used by the court to determine how much support (if any) one spouse may be required to pay the other. Failing to complete the form fully or accurately can lead to inaccurate results and may impact your divorce proceedings.

This figure holds information regarding family law financial affidavit 12 902 b. It's worth taking a few minutes to read through this before you begin filling out your document.

QuestionAnswer
Form NameFamily Law Financial Affidavit 12 902 B
Form Length9 pages
Fillable?Yes
Fillable fields314
Avg. time to fill out32 min 33 sec
Other namesflorida financial affidavit short form, form 12 902 b, family law financial affidavit, family law affidavit short form florida

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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(b), FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (01/15)

When should this form be used?

This form should be used when you are involved in a family law case which requires a financial affidavit and your individual gross income is UNDER $50,000 per year unless:

(1)You are filing a simplified dissolution of marriage under rule 12.105 and both parties have waived the filing of a financial affidavit;

(2)You have no minor children, no support issues, and have filed a written settlement agreement disposing of all financial issues; or

(3)The court lacks jurisdiction to determine any financial issues.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.

What should I do next?

A copy of this form must be served on the other party in your case within 45 days of being served with the petition, if it is not served on him or her with your initial papers. Service must be in accordance with Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before pro eedi g, you should read Ge eral I for atio for “elf-Represented Litiga ts fou d at the beginning of these forms. The words that are in bold underline in these instructions are defined there. For further information, see Florida Family Law Rule of Procedure 12.285.

Special notes...

If you want to keep your address confidential because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).

The affidavit must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided below for making these conversions.

Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

Hourly - If you are paid by the hour, you may convert your income to monthly as follows:

Hourly amount

x

Hours worked per week =

Weekly amount

Weekly amount

x

52 Weeks per year

=

Yearly amount

Yearly amount

÷

12 Months per year

=

Monthly Amount

Daily - If you are paid by the day, you may convert your income to monthly as follows:

Daily amount

x

Days worked per week

=

Weekly amount

Weekly amount

x

52 Weeks per year

=

Yearly amount

Yearly amount

÷

12 Months per year

=

Monthly Amount

Weekly - If you are paid by the week, you may convert your income to monthly as follows:

Weekly amount

x

52 Weeks per year

=

Yearly amount

Yearly amount

÷

12 Months per year

=

Monthly Amount

Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as follows:

Bi-weekly amount

x

26

=

Yearly amount

Yearly amount

÷

12 Months per year

=

Monthly Amount

Semi-monthly - If you are paid twice per month, you may convert your income to monthly as follows:

Semi-monthly amount x

2

=

Monthly Amount

Expenses may be converted in the same manner.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

IN THE CIRCUIT COURT OF THE

 

 

JUDICIAL CIRCUIT,

IN AND FOR

 

 

COUNTY, FLORIDA

 

 

 

 

Case No.: ______________________

 

 

 

 

Division: _______________________

 

,

 

 

 

Petitioner,

 

 

 

and

 

 

 

 

,

 

 

 

Respondent.

 

 

 

FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)

(Under $50,000 Individual Gross Annual Income)

I, {full legal name}

 

 

 

 

, being sworn, certify that the following

information is true:

 

 

 

 

My Occupation:

 

 

 

Employed by: ___________________________

Business Address: ________________________________________________________________

Pay rate: $

 

( ) every week (

) every other week ( ) twice a month ( ) monthly

( ) other: ____________

 

 

 

___ Check here if unemployed and explain on a separate sheet your efforts to find employment.

SECTION I. PRESENT MONTHLY GROSS INCOME:

All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for a thi g that is NOT paid o thl . Atta h ore paper, if eeded. Ite s i luded u der other should

be listed separately with separate dollar amounts.

1.$______ Monthly gross salary or wages

2.______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments

3._______Monthly business income from sources such as self-employment, partnerships, close corporations, and/or independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) (Attach sheet itemizing such income and expenses.)

4._______Monthly disability benefits/SSI

5._______Mo thl Workers’ Co pe satio

6._______Monthly Unemployment Compensation

7._______Monthly pension, retirement, or annuity payments

8._______Monthly Social Security benefits

9.______ Monthly alimony actually received (Add 9a and 9b)

9a. From this case: $ _______

9b. From other case(s): _______

10._______ Monthly interest and dividends

11._______Monthly rental income (gross receipts minus ordinary and necessary expenses

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

required to produce income) (Attach sheet itemizing such income and expense items.)

12._______ Monthly income from royalties, trusts, or estates

13._______ Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses

14._______ Monthly gains derived from dealing in property (not including nonrecurring gains)

15._______ Any other income of a recurring nature (list source) _________________________

16.__________________________________________________________________________

17.$ _______ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 116)

PRESENT MONTHLY DEDUCTIONS:

18.$______Monthly federal, state, and local income tax (corrected for filing status and allowable dependents and income tax liabilities)

a.Filing Status ____________

b.Number of dependents claimed _______

19._______ Monthly FICA or self-employment taxes

20._______ Monthly Medicare payments

21._______ Monthly mandatory union dues

22._______ Monthly mandatory retirement payments

23._______ Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship

24._______ Monthly court-ordered child support actually paid for children from another relationship

25._______Monthly court-ordered alimony actually paid (Add 25a and 25b)

25a. from this case: $ _______

25b. from other case(s):$ _______

26.$_______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES (Add lines 18 through 25).

27.$_______ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17)

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form)(01/15)

SECTION II. AVERAGE MONTHLY EXPENSES

Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed elow do ot refle t what ou a tuall pa urre tl , ou should write esti ate e t to ea h a ou t

that is estimated.

A. HOUSEHOLD:

 

Mortgage or rent

$ _______

Property taxes

$_______

Utilities

$_______

Telephone

$ _______

Food

$ _______

Meals outside home

$_______

Maintenance/Repairs

$ _______

Other: __________

$_______

B. AUTOMOBILE

 

Gasoline

$ _______

Repairs

$_______

Insurance

$_______

C.CHILD REN ’“ EXPEN“E“

Day care

$ _______

Lunch money

$_______

Clothing

$ _______

Grooming

$_______

Gifts for holidays

$ _______

Medical/Dental (uninsured)

$ _______

Other: ______________

$ _______

D.INSURANCE Medical/Dental (if not listed on

lines 23 or 45)

$ _______

Child re ’s edi al/de tal

$ _______

Life

$ _______

Other:

 

 

$ _______

E. OTHER EXPENSES NOT LISTED ABOVE

Clothing

$ _______

Medical/Dental (uninsured)

$_______

Grooming

$ _______

Entertainment

$_______

Gifts

$_______

Religious organizations

$_______

Miscellaneous

$_______

Other: ______________

$ _______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

F. PAYMENTS TO CREDITORS

 

CREDITOR:

MONTHLY

 

PAYMENT

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

____________________

$_______

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

28. $_______ TOTAL MONTHLY EXPENSES (add ALL monthly amounts in A through F above)

SUMMARY

29.$_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)

30.$_______ TOTAL MONTHLY EXPENSES (from line 28 above)

31.$_______ SURPLUS (If line 29 is more than line 30, subtract line 30 from line 29. This is the amount of your surplus. Enter that amount here.)

32.($_______) (DEFICIT) (If line 30 is more than line 29, subtract line 29 from line 30. This is the amount of your deficit. Enter that amount here.)

SECTION III. ASSETS AND LIABILITIES

Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item is o arital, ea i g it elo gs to o ly o e of you a d should ot e divided. You should indicate

to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if

property/debt was owned/owed by one spouse before the marriage. See the Ge eral I for atio for

Self-Represe ted Litiga ts

found at the beginning of these forms and section 61.075(1), Florida

“tatutes, for defi itio s of

arital a d o arital assets a d lia ilities.

A. ASSETS:

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIPTION OF ITEM(S). List a description of each separate item

Current

Nonmarital

 

owned by you (and/or your spouse, if this is a petition for dissolution

 

(check correct

 

Fair

 

of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check

 

column)

 

Market

 

 

the line next to any asset(s) which you are requesting the judge

 

 

 

 

Value

 

 

 

 

award to you.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

husband

wife

 

 

 

 

 

 

Cash (on hand)

$

 

 

 

 

 

Cash (in banks or credit unions)

 

 

 

 

 

 

Stocks, Bonds, Notes

 

 

 

 

 

 

Real estate: (Home)

 

 

 

 

 

 

(Other)

 

 

 

 

 

 

Automobiles

 

 

 

 

 

 

Other personal property

 

 

 

 

 

 

Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____Check here if additional pages are attached.

 

 

 

 

 

 

 

 

 

 

 

Total Assets (add next column)

$

 

 

 

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

B. LIABILITIES:

 

DESCRIPTION OF ITEM(S). List a description of each separate debt

 

Current

 

Nonmarital

 

 

 

(check correct

 

owed by you (and/or your spouse, if this is a petition for dissolution

 

 

Amount

 

column)

 

of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check

 

 

 

Owed

 

 

the line next to any debt(s) for which you believe you should be

 

 

 

 

 

 

 

 

 

 

 

 

responsible.

 

 

 

husband

wife

 

 

 

 

 

 

 

 

 

 

 

 

Mortgages on real estate: First mortgage on home

$

 

 

 

 

 

Second mortgage on home

 

 

 

 

 

 

 

Other mortgages

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Auto loans

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Charge/credit card accounts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____Check here if additional pages are attached.

 

 

 

 

 

 

Total Debts (add next column)

 

$

 

 

 

 

 

 

 

 

C. CONTINGENT ASSETS AND LIABILITIES:

INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts assumed by another), you must list them here.

 

 

Contingent Assets

 

Possible

 

Nonmarital

 

 

 

 

 

 

 

 

 

(check correct

 

Check the line next to any contingent asset(s) which you are requesting the

 

Value

 

column)

 

 

 

 

 

 

 

judge award to you.

 

 

 

husband

 

wife

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

Total Contingent Assets

$

 

 

 

 

Contingent Liabilities

 

Nonmarital

 

Possible

(check correct

Check the line next to any contingent debt(s) for which you believe you

Amount

column)

should be responsible.

Owed

 

 

 

husband

wife

 

 

 

$

 

 

Total Contingent Liabilities

$

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

SECTION IV. CHILD SUPPORT GUIDELINES WORKSHEET

(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot be waived by the parties.)

[Check one only]

____ A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the

establishment or modification of child support.

____ A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or

modification of child support is not an issue in this case.

I certify that a copy of this document was [check all used]: ( ) e-mailed ( ) mailed ( ) faxed

() hand delivered to the person(s) listed below on {date} ________________________________.

Other party or his/her attorney:

Name: _____________________________

Address: ____________________________

City, State, Zip: _______________________

Fax Number: _________________________

E-mail Address(es): _____________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated:

Signature of Party

Printed Name: ________________________________

Address: ___________________________________

City, State, Zip: ______________________________

Fax Number: ________________________________

E-mail Address(es): ____________________________

STATE OF FLORIDA

COUNTY OF

Sworn to or affirmed and signed before me on

 

 

by

 

.

 

 

________________________________

 

 

 

 

 

NOTARY PUBLIC or DEPUTY CLERK

 

 

 

________________________________

 

 

 

 

 

[Print, type, or stamp commissioned

 

 

 

 

 

name of notary or deputy clerk.]

 

____ Personally known

 

 

 

 

 

____ Produced identification

 

 

 

 

 

Type of identification produced

 

 

 

 

 

 

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the: {choose only ONE} ( ) Petitioner (

) Respondent

This form was completed with the assistance of:

 

 

{name of individual}

 

 

,

{name of business} ___________________________________________________________________,

 

{address}

________________________________,

{city}

 

________,{state} ________ {telephone number}

.

 

 

 

 

 

 

Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)

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