Jdf 1111 Form PDF Details

When it comes to providing care for a loved one, understanding the legal documents associated with the process can be intimidating. The JDF 1111 form is an important component of this process, so it’s essential to have a good grasp on its purpose and contents so you can ensure your loved one is being taken care of in the best way possible. In this blog post, we will break down the JDF 1111 form - what it is, how it works, and what information needs to be provided - so that you feel confident completing all needed steps moving forward.

QuestionAnswer
Form NameJdf 1111 Form
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namessworn financial, jdf 1111 sworn financial statement, jdf 1111 ss pdf, colorado jdf r

Form Preview Example

District Court Denver Juvenile Court

 

 

___________________ County, Colorado

 

 

Court Address:

 

 

 

In re:

 

 

 

The Marriage of:

 

 

 

The Civil Union of:

 

 

 

Parental Responsibilities concerning:

 

 

______________________________________________________

 

 

Petitioner:

 

 

 

and

 

 

 

Co-Petitioner/Respondent:

 

 

COURT USE ONLY

Attorney or Party Without Attorney (Name and Address):

Case Number:

Phone Number:

E-mail:

 

 

FAX Number:

Atty. Reg. #:

Division

Courtroom

SWORN FINANCIAL STATEMENT

I, ___________________________________________________ (full name) am am not currently employed.

I am employed ____ hours per week. I am paid weekly bi-weekly twice a month monthly.

My pay is based on a Monthly Salary Hourly rate of $__________ Other: _________________________

Date employment began _______________________________.

My occupation is: ____________________________ Name of employer: _______________________________

Address of employer: _________________________________________________________________________

If unemployed, what date did you last work? _______________________

I am unemployed due to disability involuntary layoff at work other: ________________________________

This household consists of _____ adult(s), and ______ minor child(ren).

I believe the monthly gross income of the other party is $___________.

Annual gross income (last tax year 20__) for Petitioner $ _________, Co-Petitioner/Respondent $ __________

1.Monthly Income (Convert annual, bi-monthly, and weekly amounts to monthly amounts.)

Gross Monthly Income (before taxes and

$

 

Social Security Benefits (SSA)

$

deductions) from salary and wages, including

 

 

SSDI (Disability insurance entitlement

 

commissions, bonuses, overtime, self-

 

 

program)

 

employment, business income, other jobs,

 

 

 

 

 

SSI (supplemental income need based)

 

and monthly reimbursed expenses.

 

 

 

 

 

 

 

Unemployment & Veterans’ Benefits

 

 

Disability, Workers’ Compensation

 

Pension & Retirement Benefits

 

 

Interest & Dividends

 

Public Assistance (TANF)

 

 

Other - ___________________

 

 

 

 

Total Monthly Income

$

Miscellaneous Income

 

 

 

 

Royalties, Trusts, and Other Investments

$

 

Contributions from Others

$

Dependent Children’s monthly gross

 

 

All other sources, i.e. personal injury

 

income. Source of Income: __________

 

 

settlement, non-reported income, etc.

 

Rental Net Income

 

 

Expense Accounts

 

Child Support from Others

 

 

Other - ___________________

 

Spousal/Partner Support from Others

 

 

Other - ___________________

 

 

 

Total Monthly Miscellaneous Income

$

 

 

 

Total Income

$

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 1 of 7

2. Monthly Deductions (Mandatory and Voluntary)

Mandatory Deductions

Cost Per

 

Cost Per

 

Month

 

Month

Federal Income Tax

$

State/Local Income Tax

$

PERA/Civil Service

 

Social Security Tax

 

Medicare Tax

 

Other - ___________________

 

 

 

Total Mandatory Deductions

$

Voluntary Deductions

Cost Per

 

Cost Per

 

Month

 

Month

Life and Disability Insurance

$

Stocks/Bonds

$

Health, Dental, Vision Insurance Premium

 

Retirement & Deferred Compensation

 

Total number of people covered on Plan

 

 

 

 

 

 

Child Care (deducted from salary)

 

Other - ____________________

 

Flex Benefit Cafeteria Plan

 

Other - ____________________

 

 

 

Total Voluntary Deductions

$

 

 

Total Monthly Deductions

$

3.Monthly Expenses

Note: List regular monthly expenses below that you pay on an on-going basis and that are not identified in the deductions above.

 

A. Housing

 

 

 

 

 

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

1st Mortgage

 

$

2nd Mortgage

$

 

Insurance (Home/Rental)

& Property

 

Condo/Homeowner’s/Maintenance

 

 

Taxes (not included in mortgage payment)

 

Fees

 

 

Rent

 

 

Other - ________________

 

 

 

 

 

 

Total Housing

 

 

$

 

B. Utilities and Miscellaneous Housing Services

 

 

 

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Gas & Electricity

 

$

Water, Sewer, Trash Removal

$

 

Telephone (local, long distance, cellular &

 

Property Care (Lawn, snow removal,

 

 

pager)

 

 

cleaning, security system, etc.)

 

 

Internet Provider, Cable & Satellite TV

 

Other - ____________________

 

 

 

 

Total Utilities and Miscellaneous Housing Services

 

 

$

 

C. Food & Supplies

 

 

 

 

 

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Groceries & Supplies

 

$

Dining Out

$

 

 

 

 

 

Total Food & Supplies

 

 

$

 

D. Health Care Costs (Co-pays, Premiums, etc.)

 

 

 

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Doctor & Vision Care

 

$

Dentist and Orthodontist

$

 

Medicine & RX Drugs

 

 

Therapist

 

 

Premiums (if not paid by employer)

 

Other - ____________________

 

 

 

 

 

 

Total Health Care

 

 

$

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 2 of 7

E. Transportation & Recreation Vehicles (Motorcycles, Motor Homes, Boats, ATV, Snowmobiles, etc.)

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

Month

 

 

 

Month

 

Primary Vehicle Payment

$

Other Vehicle Payments

 

$

 

Fuel, Parking, and Maintenance

 

Insurance & Registration/Tax Payments

 

 

 

 

 

 

 

(yearly amount(s) ÷12)

 

 

 

 

Bus & Commuter Fees

 

Other - ________________

 

 

 

 

 

 

 

Total Transportation

 

 

$

F.Children’s Expenses and Activities

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Clothing & Shoes

 

$

Child Care

$

 

Extraordinary Expenses i.e.

Special

 

Misc. Expenses, i.e. Tutor, Books,

 

 

Needs, etc.

 

 

Activities, Fees, Lunch, etc.

 

 

Tuition

 

 

Other - ________________

 

 

 

 

 

Total

Children’s Expenses and Activities

 

 

$

 

G. Education for you - Please identify status: Full-time student Part-time student

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Tuition, Books, Supplies, Fees, etc.

 

Other - ________________

 

 

 

 

 

 

Total Education

 

 

$

 

H. Maintenance (Spousal/Partner Support) & Child Support (that you pay)

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Maintenance

 

 

Child Support

 

 

This family

 

$

This family

$

 

Other family

 

 

Other family

 

 

 

 

 

Total Maintenance and Child Support

$

 

I. Miscellaneous (Please list on-going expenses not covered in the sections above)

 

 

 

 

 

Cost Per

 

 

 

Cost Per

 

 

 

 

Month

 

 

 

Month

 

Recreation/Entertainment

 

$

Personal Care (Hair, Nail, Clothing, etc.)

$

 

Legal/Accounting Fees

 

 

Subscriptions (Newspapers, Magazines, etc.)

 

 

Charity/Worship

 

 

Movie & Video Rentals

 

 

Vacation/Travel/Hobbies

 

 

Investments (Not part of payroll deductions)

 

 

Membership/Clubs

 

 

Home Furnishings

 

 

Pets/Pet Care

 

 

Sports Events/Participation

 

 

Other - ________________

 

 

Other - ________________

 

 

Other - ________________

 

 

Other - ________________

 

 

Other - ________________

 

 

Other - ________________

 

 

Other - ________________

 

 

Other - ________________

 

 

 

 

 

 

Total Miscellaneous

 

 

$

 

 

 

 

 

 

 

 

 

 

Total Monthly Expenses (Totals from A – I)

 

 

$

 

 

 

 

 

 

 

 

 

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 3 of 7

4.Debts (unsecured)

List unsecured debts such as credit cards, store charge accounts, loans from family members, back taxes owed to the I.R.S., etc. Do not list debts that are liens against your property, such as mortgages and car loans, because that payment is already listed as an expense above, and the total of the debt is shown elsewhere as a deduction from value where that asset is listed, such as under Real Estate or Motor Vehicles.

For name on account, "P" = Petitioner, "C/R” = Co-Petitioner or Respondent, "J" = Joint.

Name of Creditor

Account

P

 

C/R

 

J

Date of

Balance

 

 

Minimum

 

Reason for

 

Number

 

 

 

 

 

 

Balance

 

 

 

Monthly

 

Which Debt

 

(last 4-

 

 

 

 

 

 

 

 

 

 

Payment

 

was Incurred

 

digits

 

 

 

 

 

 

 

 

 

 

Required

 

 

 

only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

Unsecured Debt Balance

$

 

$

 

Minimum

 

 

 

 

 

 

 

 

 

 

 

 

 

Monthly

 

 

 

 

 

 

 

 

 

 

 

 

 

Payment

 

SWORN FINANCIAL STATEMENT SUMMARY

 

 

 

 

 

 

(INCOME/EXPENSES)

 

 

 

 

 

Total Income (from Page 1)

 

 

 

 

 

 

 

 

 

$ _____________

A

Total Monthly Deductions (from Page 2)

 

 

 

 

 

 

 

$ _____________

B

Total Monthly Net Income (A minus B)

 

 

 

 

$ _____________

Total Monthly Expenses (from Page 3)

 

 

 

 

 

 

 

$ _____________

C

Total Minimum Monthly Payment Required - Debts Unsecured (from Page 4)

$ _____________

D

Total Monthly Expenses and Payments

(C plus D)

 

 

 

$ _____________

Net Excess or Shortfall (Monthly Net Income less Monthly Expenses and Payments)

(+/-) $ ______________

 

 

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 4 of 7

5.Assets

You MUST disclose all assets correctly. By indicating “None”, you are stating affirmatively that you or the other party, do not have assets in that category. Please attach additional copies of pages 5 & 6 to identify your assets, if necessary.

If the parties are married or partners in a civil union, check under the heading Joint (J) all assets acquired during the marriage/civil union but not by gift or inheritance. Under the headings of Petitioner (P) or Co- Petitioner/Respondent (C/R), check assets owned before this marriage/civil union and assets acquired by gift or inheritance.

If the parties were NEVER married to each other or are using this form to modify child support,

list all of each party’s assets under the headings of Petitioner (P) or Co-Petitioner/Respondent (C/R).

"P" = Petitioner, "C/R” = Co-Petitioner or Respondent, "J" = Joint.

 

A. Real Estate (Address or Property

P

C/R

 

J

 

Estimated

Amount

Net

 

Description and Name of Creditor/ Lender)

 

 

 

 

 

Value as of

Owed

Value/Equity

 

None

 

 

 

 

 

Today

 

 

(Value minus

 

 

 

 

 

 

 

Value = what you

 

 

amount

 

 

 

 

 

 

 

could sell it for

 

 

owed)

 

 

 

 

 

 

 

in its current

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

condition.

 

 

 

 

 

 

 

$

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

$

$

 

$

 

 

 

 

 

 

 

 

 

 

 

B. Motor Vehicles & Recreation

P

C/R

 

J

 

Estimated

Amount

Net

 

Vehicles Including Motorcycles, ATV’s,

 

 

 

 

 

Value as of

Owed

Value/Equity

 

Boats, etc.) (Year, Make, Model) (Name of

 

 

 

 

 

Today

 

 

(Value minus

 

Creditor/Lender)

 

 

 

 

 

Value = what you

 

 

amount

 

None

 

 

 

 

 

could sell it for

 

 

owed)

 

 

 

 

 

 

in its current

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

condition.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

$

$

 

$

 

 

 

 

 

 

 

 

 

 

 

C. Cash on Hand, Bank, Checking,

P

C/R

 

J

 

Type of

Account #

Balance as

 

Savings, or Health Accounts (Name of

 

 

 

 

 

Account

(last 4-digits

of Today

 

Bank or Financial Institution)

 

 

 

 

 

 

only)

 

 

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

$

 

 

 

 

 

 

 

 

 

 

D. Life Insurance

P

C/R

 

J

 

Type of

Face Amount

Cash Value

 

(Name of Company/Beneficiary)

 

 

 

 

 

Policy

of Policy

today

 

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 5 of 7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Furniture, Household Goods, and

P

 

C/R

J

Current Possession Held by

Estimated

 

Other Personal Property, i.e. Jewelry,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Value as of

 

 

 

 

 

 

P

C/R

J

 

Antiques, Collectibles, Artwork, Power

 

 

 

 

 

Today

 

Tools, etc. Identify Items and report in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Value = what

 

total.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

you could sell it

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

for in its current

 

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

condition.

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F. Stocks, Bonds, Mutual Funds, Securities & Investment Accounts

 

 

 

 

 

 

 

 

 

 

 

None If owned please attach JDF 1111-SS.

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Pension, Profit Sharing, or Retirement Funds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

None If owned please attach JDF 1111-SS.

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H. Miscellaneous Assets

None If you own any of the assets identified below, please check the appropriate box and attach JDF 1111-SS to report the value.

 

Business Interests

Stock Options

Money/Loans owed to you

IRS Refunds due to you

 

Country Club &

Livestock, Crops,

Pending lawsuit or claim

Accrued Paid Leave (sick,

 

Other Memberships

Farm Equipment

by you

vacation, personal)

 

Oil and Gas Rights

Vacation Club Points

Safety Deposit Box/Vault

Trust Beneficiary

 

Frequent Flyer Miles

Education Accounts

Health Savings Accounts

Mineral and Water Rights

 

Other - __________

Other - ___________

Other - _____________

Other - _____________

 

 

 

 

 

 

 

 

Total

 

$

 

 

 

 

 

 

 

 

 

 

 

 

I. Separate Property

 

 

 

 

 

 

 

 

 

 

None If owned please attach JDF 1111-SS to identify the property and

 

 

 

Total

 

$

 

 

to report the value.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Value/Balance of All Assets (A – I)

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I swear or affirm under oath that this Sworn Financial Statement, attached schedules, and mandatory disclosures contain a complete disclosure of my income, expenses, assets, and debt as of the date of my signature.

I understand that if the information I have provided changes or needs to be updated before a final decree or order is issued by the Court, that I have a duty to provide the correct or updated information.

I understand that this oath is made under penalty of perjury. I understand that if I have omitted or misstated any material information, intentionally or not, the Court will have the power to enter orders to

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 6 of 7

address those matters, including the power to punish me for any statements made with the intent to defraud or mislead the Court or the other party.

Date: _______________________

_____________________________________________

 

Signature of Petitioner or Co-Petitioner/Respondent

 

Subscribed and affirmed, or sworn to before me in the

 

County of _________________________, State of

 

________________, this _______ day of _______, 20_____.

 

My Commission Expires: ___________________

 

________________________________________

 

Notary Public/Deputy Clerk

CERTIFICATE OF SERVICE

To be completed if the Sworn Financial Statement is not being filed with JDF 1104 - Certificate of Compliance with Mandatory Financial Disclosures

I certify that on ________________________ (date) a true and accurate copy of the SWORN FINANCIAL

STATEMENT was served on the other party by:

Hand Delivery, E-filed, Faxed to this number: ___________________, or

By placing it in the United States mail, postage pre-paid, and addressed to the following:

To: _______________________________________

 

_______________________________________

 

_______________________________________

______________________________________

 

Your signature

JDF 1111 R7/13

SWORN FINANCIAL STATEMENT FORM 35.2 © 2013 Colorado Judicial Department for use in the

Courts of Colorado

Page 7 of 7

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Tips on how to complete jdf1111 part 1

2. Right after performing the previous section, go on to the next step and fill in all required particulars in these blank fields - Date employment began, My occupation is Name of employer, Address of employer, If unemployed what date did you, This household consists of adults, I believe the monthly gross income, Social Security Benefits SSA SSDI, Gross Monthly Income before taxes, and Contributions from Others All.

Stage # 2 of completing jdf1111

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4. It is time to fill in this fourth form section! In this case you've got these Monthly Deductions Mandatory and, Cost Per Month, Cost Per, Month, Federal Income Tax PERACivil, StateLocal Income Tax Social, Cost Per, Cost Per, Month, Month, Life and Disability Insurance, StocksBonds Retirement Deferred, Other Other, Monthly Expenses, and Note List regular monthly empty form fields to do.

Filling out segment 4 of jdf1111

Concerning Other Other and Note List regular monthly, ensure that you double-check them in this current part. The two of these could be the key fields in this PDF.

5. To finish your form, the final section has several extra blank fields. Filling in st Mortgage Insurance HomeRental, nd Mortgage, Cost Per, Month, Month, Gas Electricity Telephone local, Water Sewer Trash Removal Property, removal, Cost Per, Month, Cost Per, Month, Groceries Supplies Total Food, Dining Out, and Cost Per will wrap up the process and you'll be done in a snap!

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