Probate Family Form PDF Details

Navigating the complexities of legal procedures can be daunting, especially when it comes to personal financial matters tied to court processes. The Probate Family Form, emanating from the Commonwealth of Massachusetts' Trial Court Division, is a comprehensive document designed to distill the financial portrait of individuals involved in probate and family court matters. Central to this form is the distinguishing threshold of annual income, setting apart those who earn below $75,000—directing them towards a "Short Form" alternative, unless directed otherwise by a court. This form meticulously collects data across a wide spectrum: personal identifiers and demographics, detailed income sources, obligatory deductions, net weekly income, and an annualized income recap, alongside exhaustive listings of weekly expenses and liabilities. Moreover, it canvasses for assets held, ranging from real estate ventures, vehicles, to retirement plans. Such a holistic approach ensures that the court has a transparent view of an individual's financial standing, crucial for the equitable adjudication of financial matters, be it alimony, child support, or estate division. This form, thus, acts as a linchpin in the judicial examination of financial affairs, embodying both a tool of declaration and an instrument for fairness in proceedings.

QuestionAnswer
Form NameProbate Family Form
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesd massachusetts probate, financial statement massachusetts long form, long forms, form long financial statement

Form Preview Example

 

 

Commonwealth of Massachusetts

 

Division

 

The Trial Court

Docket No.

 

Probate and Family Court Department

 

 

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

INSTRUCTIONS: If your income is less than $75,000.00 annually, you must complete the SHORT FORM financial statement, unless otherwise ordered by the court.

Plaintiff/Petitioner

vs.

Defendant/Petitioner

I.PERSONAL INFORMATION

Your Name

 

 

 

 

 

 

 

 

Social Security No.

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Street address)

 

 

 

 

 

(City/Town)

 

 

(State)

 

 

(Zip)

Tel. No.

 

Date of Birth

 

 

 

 

 

 

 

No. of children living with you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Occupation

 

 

 

 

Employer

 

 

 

 

 

 

 

Employer's Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Street address)

 

 

 

 

 

(City/Town)

 

 

(State)

 

 

(Zip)

Employer's Phone No.

 

Do you have health insurance coverage?

If yes, name of health insurance provider

Yes

No

II.GROSS WEEKLY INCOME/RECEIPTS FROM ALL SOURCES

a) Base pay from

Salary

Wages

 

 

$

b) Overtime

 

 

 

 

$

c) Part-time job

 

 

 

 

$

d) Self-employment (attach a completed schedule A)

 

 

$

e) Tips

 

 

 

 

 

$

f)

Commissions

Bonuses

 

 

 

$

g)

Dividends

Interest

 

 

 

$

h)

Trusts

Annuities

 

 

 

$

i)

Pensions

Retirement funds

 

 

$

j) Social Security

 

 

 

 

$

k)

Disability

Unemployment insurance

Worker's compensation

$

l) Public Assistance (welfare, A.F.D.C. payments)

 

 

$

m)

Child Support

Alimony (actually received)

$

n) Rental from income producing property (attach a completed Schedule B)

$

o) Royalties and other rights

 

 

 

$

p) Contributions from household member(s)

 

 

$

q) Other (specify)

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

r) Total Gross Weekly Income/Receipts (add items a-q)

$

CJ-D 301 L (4/07)

Page 1 of 9

C.G.F.

 

 

Commonwealth of Massachusetts

 

 

 

The Trial Court

 

Division

 

Probate and Family Court Department

Docket No.

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

III.WEEKLY DEDUCTIONS FROM GROSS INCOME TAX WITHOLDING

 

a) Federal tax witholding/estimated payments

$

 

 

Number of withholding allowances claimed

 

 

b) State tax witholding/estimated payments

 

 

$

 

 

Number of withholding allowances claimed

 

 

OTHER DEDUCTIONS

 

 

 

 

c) F.I.C.A.

$

 

d) Medicare

$

 

e) Medical Insurance

$

 

f) Dental Insurance

$

 

g) Vision Insurance

$

 

h) Union Dues

$

 

i) Child Support

$

 

j) Spousal Support

$

 

k) Retirement

$

 

l) Savings

$

 

m) Deferred Compensation

$

 

n) Credit Union (Loan)

$

 

o) Credit Union (Savings)

$

 

p) Charitable Contributions

$

 

q) Life Insurance

$

 

 

r) Other (specify)

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

s) Total Weekly Deductions from Pay (Add items a-r)

IV.

NET WEEKLY INCOME

 

 

a) Enter total gross weekly income/receipts from II(r)

$

 

b) Enter total weekly deductions from pay from III(s)

- $

 

 

 

c) Net Weekly Income

= $

V.

GROSS INCOME FROM PRIOR YEAR

$

 

 

(attach copy of all W-2 and 1099 forms for prior year)

 

 

 

Number of years you have paid into Social Security

 

 

 

CJ-D 301 L (4/07)

Page 2 of 9

C.G.F.

 

 

Commonwealth of Massachusetts

 

 

 

The Trial Court

 

Division

 

Probate and Family Court Department

Docket No.

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

VI. WEEKLY EXPENSES NOT DEDUCTED FROM PAY

Rent

 

$

Mortgage (Principal, Interest - Taxes and Insurance, if escrowed)

$

Property taxes and assessments

$

Homeowner/Tenant Insurance

$

Maintenance Fees

Condominium Fees

$

Heat

 

$

Electricity

 

$

Propane

Natural Gas

$

Telephone

 

$

Water

Sewer

$

Food

 

$

House Supplies

 

$

Laundry

 

$

Dry Cleaning

 

$

Clothing

 

$

Life insurance

 

$

Medical insurance

 

$

Dental insurance

 

$

Vision insurance

 

$

Uninsured Medical

 

$

Uninsured Dental

 

$

Motor Vehicle Expenses

 

$

Fuel

 

$

Insurance

 

$

Maintenance

 

$

Loan payment(s)

 

$

Entertainment

 

$

Vacation

 

$

Cable TV

 

$

Child Support (attach a copy of the order, if issued by a different court)

$

Child(ren)'s Day Care Expense

$

Child(ren)'s Education

 

$

Education (self)

 

$

CJ-D 301 L (4/07)

Page 3 of 9

C.G.F.

 

 

Commonwealth of Massachusetts

 

 

 

The Trial Court

 

Division

 

Probate and Family Court Department

Docket No.

 

 

 

 

 

 

 

FINANCIAL STATEMENT

 

 

 

 

(Long Form)

 

 

 

 

Employment related expenses (which are not reimbursed)

 

 

 

 

 

Uniforms

 

 

 

$

 

Travel

 

 

 

$

 

Required continuing education

 

 

 

$

 

Other (specify)

 

 

 

 

$

Lottery tickets

 

 

 

$

Charitable Contributions

 

 

 

$

Child(ren)'s allowance

 

 

 

$

Extraordinary travel expenses for visitation with child(ren)

 

 

 

$

 

Other (specify)

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

$

TOTAL WEEKLY EXPENSES NOT DEDUCTED FROM PAY

 

 

 

VII. COUNSEL FEES

 

 

 

 

 

Retainer amount(s) paid to your attorney(s)

 

 

 

$

 

Legal fees incurred, to date, against the retainer(s)

 

 

 

$

 

Anticipated range of total legal expense to litigate this action

$

 

 

to $

 

 

 

 

 

 

 

 

VIII. ASSETS

INSTRUCTIONS: If additional space is needed for any answer or to disclose additional assets not listed below please attach additional pages.

A. REAL ESTATE

Real Estate-Primary Residence

Address

 

 

(Street address)

 

 

 

 

 

 

(City/Town)

 

 

 

(State)

 

Title held in the name of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purchase Price of the Property

$

 

 

 

 

 

 

 

 

 

 

Year of Purchase

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Assessed Value of the Property

$

 

 

 

 

 

 

 

 

 

 

Date of Last Assessment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fair Market Value of the Property

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Outstanding 1st mortgage

 

 

 

-

$

 

 

 

 

 

 

 

 

 

 

 

Outstanding 2nd mortgage or home equity loan

-

$

 

 

 

 

 

 

 

 

Equity

 

 

 

=

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CJ-D 301 L (4/07)

Page 4 of 9

C.G.F.

 

 

Commonwealth of Massachusetts

 

Division

 

The Trial Court

Docket No.

 

Probate and Family Court Department

 

 

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

Real Estate-Vacation or Second Home (including interest in time share)

Address

 

 

(Street address)

 

 

 

 

 

 

(City/Town)

 

 

 

(State)

 

Title held in the name of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purchase Price of the Property

$

 

 

 

 

 

 

 

 

 

 

Year of Purchase

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Assessed Value of the Property

$

 

 

 

 

 

 

 

 

 

 

Date of Last Assessment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fair Market Value of the Property

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Outstanding 1st mortgage

 

 

 

 

-

$

 

 

 

 

 

 

 

 

 

 

 

 

Outstanding 2nd mortgage or home equity loan

-

$

 

 

 

 

 

 

 

 

Equity

 

 

 

 

=

$

 

 

 

 

 

 

 

 

 

 

 

 

B.MOTOR VEHICLES including cars, trucks, ATV's, snowmobiles, tractors, motorcycles, boats, recreational vehicles, aircraft, farm machinery etc.

Type

 

 

 

 

 

 

 

 

 

 

 

 

 

Make

 

 

 

 

 

 

 

 

 

 

 

 

 

Model

 

 

 

 

 

 

 

 

 

 

 

 

 

Purchase Price of vehicle

$

 

 

 

 

Year of Purchase

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Fair Market Value

 

 

 

 

Outstanding Loan

-

$

Equity

=

$

Type

 

 

 

 

 

 

 

 

 

 

 

 

Make

 

 

 

 

 

 

 

 

 

 

 

 

Model

 

 

 

 

 

 

 

 

 

 

 

 

Purchase Price of vehicle

$

 

 

 

 

Year of Purchase

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Fair Market Value

 

 

 

 

Outstanding Loan

-

$

Equity

=

$

C. PENSIONS

 

Institution

Account Number

Listed Beneficiary

Current Balance/Value

 

 

 

 

 

Defined Benefit Plan

 

 

 

$

 

 

 

 

 

Defined Contribution Plan

 

 

 

$

 

 

 

 

 

CJ-D 301 L (4/07)

Page 5 of 9

C.G.F.

 

 

Commonwealth of Massachusetts

 

Division

 

The Trial Court

Docket No.

 

Probate and Family Court Department

 

 

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

D. OTHER ASSETS. List assets which are held individually, jointly, in the name of another person for your benefit, or held by you for the benefit of your minor child(ren).

 

Institution

Account Number

Listed Beneficiary

Current Balance/Value

 

 

 

 

 

 

 

 

 

$

Checking Account(s)

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Savings Account(s)

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Cash on Hand

 

 

 

$

 

 

 

 

 

 

 

 

 

$

Certificate(s) of Deposit

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Credit Union Account(s)

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Funds Held in Escrow

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Stocks

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Bonds

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Bond Fund(s)

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Notes Held

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Cash in Brokerage

 

 

 

$

 

 

 

 

Account(s)

 

 

 

$

 

 

 

 

 

 

 

 

 

$

Money Market Account(s)

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

CJ-D 301 L (4/07)

Page 6 of 9

C.G.F.

 

Commonwealth of Massachusetts

 

Division

The Trial Court

Docket No.

 

Probate and Family Court Department

FINANCIAL STATEMENT

(Long Form)

 

 

 

Institution

Account Number

Listed Beneficiary

Current Balance/Value

 

 

 

 

 

 

 

 

 

 

 

 

 

$

U.S. Savings Bond(s)

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

IRAs

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Keough

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Profit Sharing

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Deferred Compensation

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Other Retirement Plans

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

Annuity (please specify

 

 

 

$

whether a tax deferred annuity

 

 

 

 

 

 

 

$

or a tax sheltered annuity)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Life Insurance Cash

 

 

 

$

Value (please specify whether

 

 

 

 

a term or a whole universal life

 

 

 

$

insurance policy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

Judgments/Liens

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

Pending Legacies and/or

 

 

 

$

Inheritances

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Jewelry

 

 

 

$

 

 

 

 

 

 

 

Contents of Safe or Safe

 

 

 

$

Deposit Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Firearms

 

 

 

$

 

 

 

 

 

 

 

Collections

 

 

 

$

 

 

 

 

 

 

 

Tools/Equipment

 

 

 

$

 

 

 

 

 

 

 

Crops/Livestock

 

 

 

$

 

 

 

 

 

 

 

Home Furnishings

 

 

 

$

 

 

 

 

 

 

 

Arts and Antiques

 

 

 

$

 

 

 

 

 

 

 

Other (please specify):

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

Other (please specify):

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL ASSETS

CJ-D 301 L (4/07)

Page 7 of 9

$

C.G.F.

 

 

Commonwealth of Massachusetts

 

Division

 

The Trial Court

Docket No.

 

Probate and Family Court Department

 

 

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

IX. LIABILITIES : List loans, credit card debt, consumer debt, installment debt, etc. which are NOT listed elsewhere.

CREDITOR

NATURE OF DEBT

DATE INCURRED

 

AMOUNT DUE

WEEKLY PAYMENT

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

TOTAL LIABILITIES

$

$

CJ-D 301 L (4/07)

Page 8 of 9

C.G.F.

 

 

Commonwealth of Massachusetts

 

Division

 

The Trial Court

Docket No.

 

Probate and Family Court Department

 

 

 

 

 

 

FINANCIAL STATEMENT

(Long Form)

CERTIFICATION BY AFFIANT

I certify under the penalties of perjury that the information stated on this Financial Statement and the attached Schedules, if any, is complete, true, and accurate. I UNDERSTAND THAT WILLFUL MISREPRESENTATION OF ANY OF THE

INFORMATION PROVIDED WILL SUBJECT ME TO SANCTIONS AND MAY RESULT IN CRIMINAL CHARGES BEING FILED AGAINST ME.

DateSignature

COMMONWEALTH OF MASSACHUSETTS

County of

 

 

 

 

 

Then personally appeared the above

 

 

 

 

and declared the

foregoing to be true and correct, before me this

 

 

day of

 

Notary Public

My Commission Expires:

INSTRUCTIONS: In any case where an attorney is appearing for a party, said attorney

MUST complete the Statement by Attorney.

STATEMENT BY ATTORNEY

I, the undersigned attorney, am admitted to practice law in the Commonwealth of Massachusetts-am admitted pro hoc vice for the purposes of this case-and am an officer of the court. As the attorney for the party on whose behalf this Financial Statement is submitted, I hereby state to the court that I have no knowledge that any of the information contained herein is false.

Date

(Signature of attorney)

(Print name)

(Street address)

(City/Town)(State) (Zip)

Tel. No.

B.B.O. #

CJ-D 301 L (4/07)

Page 9 of 9

C.G.F.

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Probate and Family Court Department, III, and Number of withholding allowances in massachusetts trial statement

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