Form Dr 10 PDF Details

In the realm of family law proceedings within Montgomery County, Ohio, the DR-10 form plays a pivotal role in facilitating open financial communication between parties involved in domestic relations cases. This form, properly termed the "Affidavit of Financial Disclosure," serves multiple purposes, paramount among them being to present a comprehensive overview of the affiant’s financial standings, encompassing income, liabilities, and expenditures. It's meticulously designed to aid in the determination of support orders, whether for children or a spouse, by requiring detailed documentation of employment income, other earnings, and the full spectrum of monthly expenses and debts. Additionally, it deals with temporary orders related to custody, child support, and spousal support, while also addressing matters related to dependent children of the marriage, any current domestic violence orders, and involvement in UIFSA or Juvenile Court cases. The affidavit emphasizes the importance of precisely detailing assets, including lump sum income and bank accounts, to further illuminate the affiant's financial landscape. Through the DR-10 form, the court strives to achieve equitable decisions in the realm of temporary orders and financial support by basing judgments on thoroughly disclosed financial information.

QuestionAnswer
Form NameForm Dr 10
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesohio public defenders office affidavit financial disclosure form opd 206r, ohio affidavit financial, ohio dr 10, mcohio dr forms

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DR-10 (1-11) IN THE COMMON PLEAS COURT OF MONTGOMERY COUNTY, OHIO

 

 

DIVISION OF DOMESTIC RELATIONS

 

 

 

CASE NO.

 

 

 

 

 

PLAINTIFF/PETITIONER (1)

 

 

 

Address:

 

SETS NO.

 

 

 

 

JUDGE: CROSS / WOOD

DOB:

 

 

 

 

-vs- / -and-

 

 

 

 

 

 

AFFIDAVIT OF FINANCIAL DISCLOSURE

 

 

 

(MONT. D. R. RULE 4.10)

DEFENDANT/PETITIONER (2)

 

 

 

Address:

 

 

 

DOB:

STATE OF OHIO, SS:

Now comes _______________________________, affiant herein, and having been duly cautioned and sworn, states that

he/she has been advised that this affidavit may be used for any or all of the following purposes: (1) to make complete disclosure of affiant's income, liabilities and expenses; (2) to assist in determining orders of support when applicable.

I.TEMPORARY ORDERS/OTHER ACTIVE CASES:

I do not request a temporary order.

I request a temporary order for ___________ custody, ___________ child support, and/or _____________ spousal support.

A Domestic Violence Order under Case No. ________________________________________________ currently is in effect.

A UIFSA or Juvenile Court Case under Case No. ____________________________________________ currently is in effect.

A Bankruptcy action under Case No. _______________________ was filed ________________________________________.

DATE OF SEPARATION (NEW CASES) ______________________________________

II.MINOR AND/OR DEPENDENT CHILDREN ONLY OF THIS MARRIAGE:

___________________________________________DOB:____________________Residing with_________________________________

___________________________________________DOB:____________________Residing with_________________________________

___________________________________________DOB:____________________Residing with_________________________________

___________________________________________DOB:____________________Residing with_________________________________

EMPLOYMENT OR SCHOOL RELATED CHILD CARE EXPENSES FOR THESE CHILDREN: $_______________________per year

III.TOTAL INCOME FROM ALL SOURCES, (A, plus B, plus Average of C)

PLAINTIFF $__________________________

DEFENDANT $__________________________

A.GROSS YEARLY INCOME FROM EMPLOYMENT

PLAINTIFF/PETITIONER (1)

 

DEFENDANT/PETITIONER (2)

_______ YES

______ NO

Employed?

______YES ______NO

$

...... (Actual or Estimate)

Base Yearly Wages

(Actual or Estimate) $ $

or Gross Receipts if Self-Employed

..........................Employer..........................

.....................Payroll Address.....................

......................City, State, Zip......................

1

B.OTHER YEARLY INCOME (Please list all sources of other income in Section E.)

PLAINTIFF/PETITIONER (1)

 

DEFENDANT/PETITIONER (2)

$

Interest/Dividend Income

$

$

Unemployment Compensation

$

 

 

 

$

Workers' Compensation, Social Security

$

or Other Disability Benefits

 

Social Security &

 

$

Pension Income

$

$

Gross Self-Employment Income

$

 

Ordinary & Necessary Business

 

$

Expenses

$

C.OVERTIME, COMMISSION AND BONUSES EARNED:

[Past Three Year History - Year 3 Is Most Recent Year]

Overtime, Commission, Bonuses

Overtime, Commission, Bonuses

20_____ Year 1

$_____________________

20_____ Year 1

$_____________________

20_____ Year 2

$_____________________

20_____ Year 2

$_____________________

20_____ Year 3

$_____________________

20_____ Year 3

$_____________________

D.OTHER INFORMATION CONCERNING CHILDREN:

 

PLAINTIFF/PETITIONER (1)

 

DEFENDANT/PETITIONER (2)

 

 

Court Ordered Child Support Payable

 

 

$

per year

for Other Child(ren)

$

per year

 

 

Who Are Not of this Marriage

 

 

 

 

Court Ordered Spousal Support Payable

 

 

$

per year

to a Spouse(s)

$

per year

 

 

 

 

 

 

 

Number of Other Minor Child(ren)

 

 

 

 

Living With You (not children of this

 

 

 

 

marriage or step-children)

 

 

 

 

 

 

 

 

 

Child Support You Receive for

 

 

 

 

the Minor Child(ren) You

 

 

$

per year

Indicated on Line Above

$

per year

 

 

 

 

 

E.OTHER ASSETS AND LUMP SUM INCOME

1.Describe income sources listed in Section B (i.e., retirement/pension benefits, disability income, interests or dividend

income, rentals, annuities, etc.)

Attach additional pages if needed.

 

Name & Address

Identifying Description

Income or Benefits

of Source

(Account No., Claim No., Etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

2.List any lump sum income (bonus, gifts, inheritance, etc.) in excess of $500, expected to be received within the next six months, not otherwise listed in this affidavit. Attach additional pages if needed.

Source

 

Value

$

3.List all funds on deposit in any and all accounts in any bank, savings & loan, credit union, regulated investment company, mutual fund or other financial institution. Account includes any of the following: checking, certificate of deposit ("CD"), investment, savings, individual retirement account ("IRA"), stock option, etc. Attach additional pages if needed.

Name & Address of

 

Name(s)

 

Financial Institution

Account Number

on Account

Balance

 

 

 

 

 

 

 

 

 

 

 

 

IV. AFFIANT'S MONTHLY EXPENSES

List your ACTUAL expenses for your present household. If you expect changes in your expenses soon, attach a separate sheet with your ESTIMATED expenses. If you are living with your parents or someone is helping you with your living expenses, please identify that party _________________________________ and the amount of support provided ____________________.

A. MONTHLY EXPENSES

 

 

 

 

 

 

 

 

 

1. Housing

 

 

 

 

 

 

 

 

 

Rent or Mortgage (including taxes and insurance)

$

 

 

 

 

Utilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Gas & Electric (level billing or average per month)

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Water & Sewer

$

 

 

c. Basic Telephone (excluding long distance)

$

 

 

 

 

 

 

 

 

d. Trash Collection:

$

 

 

Other: __________________________________________

$

 

 

 

 

 

 

 

 

 

 

HOUSING TOTAL

 

 

 

 

 

 

 

 

 

 

$

 

2. Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Grocery (include food, laundry & cleaning products/toiletries etc)

$

 

 

 

 

 

 

 

 

Gasoline & Oil

$

 

 

 

 

 

 

 

 

 

 

 

Car Repairs

$

 

 

Insurance: (life/auto/renter's) ____________________________

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical (not covered by insurance)

$

 

 

 

Clothing

$

 

 

Internet

$

 

 

Other_______________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(I)

OTHER MONTHLY EXPENSES TOTAL ..............................................................

$

(II)

3

B. MONTHLY DEBT PAYMENTS

Do not list expenses previously listed in Section A (Monthly Expenses). Attach additional pages if needed.

TO WHOM PAID

PURPOSE/SECURITY

MONTHLY

TOTAL

(ALSO INDICATE NAME ACCOUNT IS

(IF CAR LOAN, STATE MODEL

PAYMENT

 

BALANCE

IN OR JOINT ACCOUNT)

& WHO DRIVES IT)

 

 

DUE

 

 

 

 

 

 

$

 

$

 

 

$

 

$

 

 

$

 

$

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

MONTHLY DEBT PAYMENTS

TOTAL…………………………………………………

GRAND TOTAL MONTHLY EXPENSES…………………………………………………………………

$

$

(III)

V.HEALTH INSURANCE

GROUP HEALTH INSURANCE COVERAGE AVAILABLE FOR DEPENDENT CHILDREN

(This section to be filled in ONLY when there are dependent children of the parties.)

 

PLAINTIFF/PETITIONER (1)

 

 

 

 

DEFENDANT/PETITIONER (2)

 

YES / NO

Available through employment

 

YES / NO

 

YES / NO

 

 

Other Group Plan

 

YES / NO

____________________________________

Insurance Company Name

____________________________________

 

____________________________________

 

 

 

____________________________________

 

____________________________________

 

 

Address

____________________________________

 

____________________________________

 

 

Policy Number

____________________________________

 

$

per year / month (individual)

Employee Cost

$

per year / month (individual)

$

per year / month (family)

 

 

(Indicate "0" if no cost to party)

$

per year / month (family)

 

CHECK IF CHILDREN ARE CURRENTLY ENROLLED: FAMILY PLAN or INDIVIDUAL PLAN

Affiant states that the information contained herein and attached hereto, is complete and accurate to the best of his/her information, knowledge or belief under penalty of law.

_______________________________________________

________________________________________________

Attorney for Plaintiff/Defendant/Petitioner

Affiant Plaintiff/Petitioner (1)

 

Defendant/Petitioner (2)

Sworn to and subscribed in my presence this _____________ day of ____________________________________,___________.

__________________________________________________

Notary Public

My commission expires _____________________________

4

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1. It is important to complete the ohio supreme court financial affidavit correctly, therefore be careful while filling in the sections that contain all of these blanks:

Filling in segment 1 in ohio public defenders office affidavit financial disclosure form

2. Immediately after this section is completed, proceed to type in the suitable details in all these: Now comes affiant herein and, DATE OF SEPARATION NEW CASES, MINOR ANDOR DEPENDENT CHILDREN, DOBResiding with, DOBResiding with, DOBResiding with EMPLOYMENT OR, PLAINTIFF, GROSS YEARLY INCOME FROM EMPLOYMENT, TOTAL INCOME FROM ALL SOURCES A, III A PLAINTIFFPETITIONER YES, DEFENDANT, and DEFENDANTPETITIONER.

Simple tips to prepare ohio public defenders office affidavit financial disclosure form part 2

3. Through this part, examine III A PLAINTIFFPETITIONER YES, Actual or EstimateBase Yearly, or Gross Receipts if SelfEmployed, and Employer Payroll Address City. Each of these need to be completed with highest focus on detail.

III A PLAINTIFFPETITIONER YES, Actual or EstimateBase Yearly, and Employer Payroll Address City inside ohio public defenders office affidavit financial disclosure form

When it comes to III A PLAINTIFFPETITIONER YES and Actual or EstimateBase Yearly, ensure you don't make any errors here. Both these are the most important fields in this PDF.

4. The next part requires your input in the subsequent parts: InterestDividend Income, Unemployment Compensation, Workers Compensation Social, Social Security Pension Income, Gross SelfEmployment Income, Ordinary Necessary Business, Expenses, OVERTIME COMMISSION AND BONUSES, Past Three Year History Year Is, Overtime Commission Bonuses, Year, Year, Year, OTHER INFORMATION CONCERNING, and Year. Ensure you enter all of the needed information to move onward.

Workers Compensation Social, Year, and Social Security Pension Income in ohio public defenders office affidavit financial disclosure form

5. Now, this final section is what you'll have to complete prior to using the document. The fields under consideration include the next: per year, per year, per year, Court Ordered Child Support Payable, for Other Children, Who Are Not of this Marriage, Court Ordered Spousal Support, to a Spouses, Number of Other Minor Children, Living With You not children of, marriage or stepchildren, Child Support You Receive for, the Minor Children You Indicated, per year, and per year.

Step # 5 in filling in ohio public defenders office affidavit financial disclosure form

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