Form 12.902(b), Family Law Financial Affidavit (Short Form) Instructions
This form contains 300 fields organized into 89 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Affiant Identity and Employment | ||
| Full Legal Name | Text |
Enter your full legal name exactly as it appears on legal documents (first, middle, and last name).
|
| Occupation / Job Title | Text |
Provide your current occupation or job title (the work you perform or your position). Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Employer Name | Text |
Enter the name of the company, organization, or person who employs you. Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Employer Business Address | Text |
Provide the employer's business or mailing address including street, city, state, and ZIP code. Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Asset Row 1 - Cash (on hand) | ||
| Row 1 - Cash (on hand) | Checkbox |
Check this box to mark the asset line for 'Cash (on hand)' when you are listing that cash as an asset on this form (i.e., the item exists and you are reporting it).
|
| Asset Row 1 - Cash (on hand) — Current Fair Market Value | Number |
Enter the current fair market value of the cash you have on hand for Asset Row 1.
|
| Row 1 - Nonmarital (Petitioner) | Checkbox |
Check this box if the 'Cash (on hand)' is nonmarital and belongs only to the petitioner (i.e., it should not be divided and you assert it is the petitioner’s separate property).
|
| Row 1 - Nonmarital (Respondent) | Checkbox |
Check this box if the 'Cash (on hand)' is nonmarital and belongs only to the respondent (i.e., it should not be divided and you assert it is the respondent’s separate property).
|
| Asset Row 10 - Other (description) | ||
| Row 10 (Other) — Select asset row | Checkbox |
Check this box when you are selecting or marking the Row 10 'Other' asset entry to indicate you are listing that asset for the judge to consider.
|
| Asset Row 10 — Description | Text |
Enter a brief description of the 'Other' asset you are listing for asset row 10 (e.g., item name, account last 4 digits, or other identifying details).
|
| Asset Row 10 — Current Fair Market Value | Number |
Enter the current fair market value of the asset listed in asset row 10.
|
| Row 10 (Other) — Nonmarital (Petitioner) | Checkbox |
Check this box if the Row 10 'Other' asset belongs only to the Petitioner (is nonmarital) and should not be divided.
|
| Row 10 (Other) — Nonmarital (Respondent) | Checkbox |
Check this box if the Row 10 'Other' asset belongs only to the Respondent (is nonmarital) and should not be divided.
|
| Asset Row 11 - Other (description) | ||
| Asset Row 11 - Other (request award) | Checkbox |
Check this box when you are marking the 'Other' asset on row 11 as an item you are requesting the judge to award (i.e., you want this specific asset listed/selected).
|
| Asset Row 11 - Other Description | Text |
Enter a brief description of the 'Other' asset for asset row 11 (e.g., item name, account type, last 4 digits of account number if applicable) so the asset can be identified.
|
| Asset Row 11 - Current Fair Market Value | Number |
Enter the current fair market value of the asset listed in asset row 11 as a numeric amount.
|
| Asset Row 11 - Other (nonmarital: Petitioner) | Checkbox |
Check this box when the 'Other' asset on row 11 is nonmarital and you assert it belongs solely to the Petitioner.
|
| Asset Row 11 - Other (nonmarital: Respondent) | Checkbox |
Check this box when the 'Other' asset on row 11 is nonmarital and you assert it belongs solely to the Respondent.
|
| Asset Row 12 - Other (description) | ||
| Row 12 - Select asset (award to you) | Checkbox |
Check this box when you are requesting the judge award the asset described on Asset Row 12 to you.
|
| Asset Row 12 - Description (Other) | Text |
Enter a brief description of the 'Other' asset for row 12 (what the item is, any identifying details, and last 4 digits of account number if applicable).
|
| Asset Row 12 - Current Fair Market Value | Number |
Enter the current fair market value of the asset listed in row 12.
|
| Row 12 - Nonmarital (Petitioner) | Checkbox |
Check this box when the Asset on Row 12 is nonmarital and you (the Petitioner) claim it belongs only to you and should not be divided.
|
| Row 12 - Nonmarital (Respondent) | Checkbox |
Check this box when the Asset on Row 12 is nonmarital and the Respondent is claimed to own it solely, so it should not be divided.
|
| Asset Row 13 - Other (description) | ||
| Row 13 - Select asset line (Other - description) | Checkbox |
Check this box to indicate you are selecting the asset listed on row 13 (the 'Other' description) as an item you are requesting the judge to award to you.
|
| Asset 13 - Other Description | Text |
Enter a brief description of the 'Other' asset for asset row 13, including any identifying details such as account name or last 4 digits if applicable.
|
| Asset 13 - Other Current Fair Market Value | Number |
Enter the current fair market value of the 'Other' asset listed on asset row 13.
|
| Row 13 - Nonmarital (Petitioner) | Checkbox |
Check this box if the row 13 item is nonmarital and belongs only to the Petitioner (should not be divided).
|
| Row 13 - Nonmarital (Respondent) | Checkbox |
Check this box if the row 13 item is nonmarital and belongs only to the Respondent (should not be divided).
|
| Asset Row 14 - Other (description) | ||
| Row 14 - Check if additional pages are attached | Checkbox |
Check this box if you have attached additional pages for assets (continuation of the asset list).
|
| Asset Row 14 - Description (Other) | Text |
Enter a brief description of the 'Other' asset for row 14, including any identifying details and the last four digits of account numbers if applicable.
|
| Asset Row 14 - Current Fair Market Value | Number |
Enter the current fair market value of the asset listed in row 14 as a numeric amount.
|
| Row 14 - Nonmarital (Petitioner) | Checkbox |
Check this box if the 'Other' asset on row 14 is nonmarital and belongs only to the Petitioner.
|
| Row 14 - Nonmarital (Respondent) | Checkbox |
Check this box if the 'Other' asset on row 14 is nonmarital and belongs only to the Respondent.
|
| Asset Row 15 - Attachments and Total Assets | ||
| Row 15 - Additional pages attached | Checkbox |
Check this box if you have attached additional pages with more asset entries or information for this assets section.
|
| Row 15 Total Assets | Number |
Enter the total current fair market value of all assets listed on this page to report the combined total assets.
|
| Row 15 - Total Assets (Nonmarital) - Petitioner | Checkbox |
Check this box if the Total Assets amount listed is nonmarital property belonging only to the Petitioner.
|
| Row 15 - Total Assets (Nonmarital) - Respondent | Checkbox |
Check this box if the Total Assets amount listed is nonmarital property belonging only to the Respondent.
|
| Asset Row 2 - Cash (in banks or credit unions) | ||
| check if applicable | Checkbox |
Select this box if you have cash held in banks or credit unions.
|
| Row 2 — Cash (in banks or credit unions): Current fair market value | Number |
Enter the current fair market value of the cash held in banks or credit unions for this asset row.
|
| Row 2 - Cash (in banks or credit unions) - Petitioner (Nonmarital) | Checkbox |
Check this box if the cash held in banks or credit unions listed on Row 2 is nonmarital and you believe it belongs only to the Petitioner.
|
| Row 2 - Cash (in banks or credit unions) - Respondent (Nonmarital) | Checkbox |
Check this box if the cash held in banks or credit unions listed on Row 2 is nonmarital and you believe it belongs only to the Respondent.
|
| Asset Row 3 - Stocks, Bonds, Notes | ||
| Row 3 - Stocks, Bonds, Notes (item checkbox) | Checkbox |
Check this box when you are listing Stocks, Bonds, or Notes on row 3 as an asset you own or are asking the judge to award.
|
| Row 3 — Stocks, Bonds, Notes: Current Fair Market Value | Number |
Enter the current fair market dollar value of your stocks, bonds, and notes for asset row 3.
|
| Row 3 - Stocks, Bonds, Notes (Nonmarital - Petitioner) | Checkbox |
Check this box if the Stocks, Bonds, or Notes on row 3 are nonmarital and belong solely to the Petitioner.
|
| Row 3 - Stocks, Bonds, Notes (Nonmarital - Respondent) | Checkbox |
Check this box if the Stocks, Bonds, or Notes on row 3 are nonmarital and belong solely to the Respondent.
|
| Asset Row 4 - Real estate (Home) | ||
| Row 4 - Real estate (Home) | Checkbox |
Check this box to indicate you are listing the real estate (home) as an asset you are requesting the judge award to you.
|
| Real estate (Home) — Current Fair Market Value | Number |
Enter the current fair market value of the home (the present dollar amount representing what the property is worth).
|
| Row 4 - Real estate (Home) — Nonmarital (Petitioner) | Checkbox |
Check this box if the real estate (home) is nonmarital and you (the petitioner) solely own it and believe it should not be divided.
|
| Row 4 - Real estate (Home) — Nonmarital (Respondent) | Checkbox |
Check this box if the real estate (home) is nonmarital and the respondent solely owns it and you believe it should not be divided.
|
| Asset Row 5 - Other | ||
| Row 5 - Other (select asset line) | Checkbox |
Check this box when you are selecting the 'Other' asset on row 5 to identify it as an asset you are listing or requesting the judge award to you.
|
| Row 5 (Other) — Current Fair Market Value | Number |
Enter the current fair market value for the asset labeled “Other” in Asset Row 5.
|
| Row 5 - Other (Nonmarital - Petitioner) | Checkbox |
Check this box when the 'Other' asset on row 5 is nonmarital and you (the petitioner) claim it belongs only to you and should not be divided.
|
| Row 5 - Other (Nonmarital - Respondent) | Checkbox |
Check this box when the 'Other' asset on row 5 is nonmarital and you assert it belongs only to the respondent and should not be divided.
|
| Asset Row 6 - Automobiles | ||
| 6. Automobiles — Request award (line checkbox) | Checkbox |
Check this box when you are requesting that the judge award the listed automobile to you.
|
| Row 6 - Automobiles: Current Fair Market Value | Number |
Enter the current fair market value of the automobile(s) listed on row 6.
|
| 6. Automobiles — Nonmarital (Petitioner) | Checkbox |
Check this box when you believe the automobile is nonmarital property that belongs only to the Petitioner and should not be divided.
|
| 6. Automobiles — Nonmarital (Respondent) | Checkbox |
Check this box when you believe the automobile is nonmarital property that belongs only to the Respondent and should not be divided.
|
| Asset Row 7 - Other personal property | ||
| Row 7 - Other personal property (select line) | Checkbox |
Check this box when you are indicating this line for the asset ‘Other personal property’ and requesting the judge to award this specific asset to you.
|
| Asset 7 - Other personal property (Current Fair Market Value) | Number |
Enter the current fair market value of the listed other personal property for Asset Row 7.
|
| Row 7 - Other personal property (Nonmarital - Petitioner) | Checkbox |
Check this box when the 'Other personal property' item is nonmarital and you (the Petitioner) claim it belongs only to you and should not be divided.
|
| Row 7 - Other personal property (Nonmarital - Respondent) | Checkbox |
Check this box when the 'Other personal property' item is nonmarital and the Respondent (other party) is the one who owns it solely and it should not be divided.
|
| Asset Row 8 - Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) | ||
| Row 8 - Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) - Select asset | Checkbox |
Check this box when you are listing this retirement plan as an asset you are requesting the judge to consider or award on this form.
|
| Row 8 — Retirement plans: Current Fair Market Value | Number |
Enter the current fair market dollar value of the retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) for this row.
|
| Row 8 - Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) - Nonmarital (Petitioner) | Checkbox |
Check this box if this retirement plan is nonmarital and you believe it belongs only to the Petitioner (should not be divided).
|
| Row 8 - Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) - Nonmarital (Respondent) | Checkbox |
Check this box if this retirement plan is nonmarital and you believe it belongs only to the Respondent (should not be divided).
|
| Asset Row 9 - Other (description) | ||
| Row 9 (Other) — Asset selected | Checkbox |
Check this box to mark that you are listing an 'Other' asset on asset row 9 (i.e., to indicate an asset entry is being claimed on that line).
|
| Asset Row 9 - Other (description) | Text |
Enter a brief description of the 'Other' asset for asset row 9 (what the item is and any identifying details such as account name or last 4 digits if applicable).
|
| Asset Row 9 - Current Fair Market Value | Number |
Enter the current fair market value of the 'Other' asset listed on asset row 9.
|
| Row 9 (Other) — Nonmarital (Petitioner) | Checkbox |
Check this box if the 'Other' asset listed on row 9 is nonmarital and belongs solely to the Petitioner.
|
| Row 9 (Other) — Nonmarital (Respondent) | Checkbox |
Check this box if the 'Other' asset listed on row 9 is nonmarital and belongs solely to the Respondent.
|
| Auto loans (Row 5) | ||
| Row 5: Auto loans — select line | Checkbox |
Check this box to mark the Auto loans line (row 5) to indicate you are listing this debt and believe you may be responsible for it.
|
| Auto loans (Row 5) — Creditor and account info | Text |
Enter the name of the auto loan creditor and any brief identifying information (for example, last 4 digits of the account number) to identify this auto loan.
|
| Auto loans (Row 5) — Current amount owed | Number |
Enter the current outstanding balance owed on this auto loan as a numeric amount (do not include currency symbols).
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| Row 5: Auto loans — Petitioner (Nonmarital) | Checkbox |
Check this box if the petitioner is the nonmarital party responsible for (or should be charged with) the auto loan listed on row 5.
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| Row 5: Auto loans — Respondent (Nonmarital) | Checkbox |
Check this box if the respondent is the nonmarital party responsible for (or should be charged with) the auto loan listed on row 5.
|
| Automobile (Section B) | ||
| Automobile — Gasoline | Number |
Enter the average monthly amount you spend on gasoline for your automobile.
|
| Automobile — Repairs | Number |
Enter the average monthly amount you spend on automobile repairs and maintenance.
|
| Automobile — Insurance | Number |
Enter the average monthly amount you pay for automobile insurance.
|
| Charge/Credit Card Account - Entry 1 (Row 6) | ||
| Entry 1 - Charge/credit card accounts (Select line) | Checkbox |
Check this box to indicate you are selecting this charge/credit card account line as a debt you believe you should be responsible for.
|
| Entry 1 - Charge/credit card account description | Text |
Enter the charge or credit card account identification for this entry, such as the creditor name and the last 4 digits of the account number.
|
| Entry 1 - Current amount owed | Number |
Enter the current amount owed on this charge/credit card account.
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| Entry 1 - Charge/credit card accounts - Petitioner (Nonmarital) | Checkbox |
Check this box to show that the Petitioner claims this charge/credit card account is nonmarital (belongs to the Petitioner).
|
| Entry 1 - Charge/credit card accounts - Respondent (Nonmarital) | Checkbox |
Check this box to show that the Respondent claims this charge/credit card account is nonmarital (belongs to the Respondent).
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| Charge/Credit Card Account - Entry 2 (Row 7) | ||
| Entry 2 (Row 7) - Select debt line | Checkbox |
Check this box to mark this listed debt (the charge/credit card account on this line) as a debt you believe you should be responsible for.
|
| Entry 2 (Row 7) - Charge/Credit Card Creditor | Text |
Enter the name of the credit card account or creditor and any brief identifying details (for example last 4 digits of the account) for this charge/credit card account.
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| Entry 2 (Row 7) - Current Amount Owed | Number |
Enter the current outstanding balance owed on this charge/credit card account.
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| Entry 2 (Row 7) - Nonmarital (Petitioner) | Checkbox |
Check this box if the petitioner is claiming this charge/credit card account as nonmarital (the petitioner alone is responsible for the debt).
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| Entry 2 (Row 7) - Nonmarital (Respondent) | Checkbox |
Check this box if the respondent is claiming this charge/credit card account as nonmarital (the respondent alone is responsible for the debt).
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| Charge/Credit Card Account - Entry 3 (Row 8) | ||
| Entry 3 - Charge/credit card accounts (line selection) | Checkbox |
Check this box when you are listing a charge/credit card account on this line (Entry 3) as a debt you believe you should be responsible for.
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| Entry 3 (Row 8) - Card creditor & account last 4 | Text |
Enter the name of the charge/credit card creditor and the last four digits of the account (and any brief identifying details) for this account entry.
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| Entry 3 (Row 8) - Current amount owed | Number |
Enter the current outstanding balance owed on this charge/credit card account.
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| Entry 3 - Nonmarital (Petitioner) | Checkbox |
Check this box when the listed charge/credit card account (Entry 3) is a nonmarital debt that you assert belongs to the Petitioner.
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| Entry 3 - Nonmarital (Respondent) | Checkbox |
Check this box when the listed charge/credit card account (Entry 3) is a nonmarital debt that you assert belongs to the Respondent.
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| Child Support Worksheet Selection | ||
| A Child Support Guidelines Worksheet IS or WILL BE filed in this case | Checkbox |
Check this box when a Child Support Guidelines Worksheet (Form 12.902(e)) either has been or will be filed with the court because the case involves the establishment or modification of child support.
|
| A Child Support Guidelines Worksheet IS NOT being filed in this case | Checkbox |
Check this box when a Child Support Guidelines Worksheet will not be filed because the establishment or modification of child support is not an issue in this case.
|
| Child(ren)'s Expenses (Section C) | ||
| C - Other (description) | Text |
Enter a short description or label for any other child-related expense not listed above.
|
| C - Day care | Number |
Enter the monthly amount you pay for day care for the child(ren).
|
| C - Lunch money | Number |
Enter the monthly amount provided for the child(ren)'s lunch money.
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| C - Clothing | Number |
Enter the monthly amount spent on clothing for the child(ren).
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| C - Grooming | Number |
Enter the monthly amount spent on grooming or personal care for the child(ren).
|
| C - Gifts for holidays | Number |
Enter the monthly amount allocated for gifts for holidays for the child(ren).
|
| C - Medical/Dental (uninsured) | Number |
Enter the monthly amount you pay for uninsured medical or dental expenses for the child(ren).
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| C - Other (amount) | Number |
Enter the monthly amount for the other child-related expense you named in the description field.
|
| Contingent Asset - Entry 1 (Row 1) | ||
| Entry 1 - Contingent asset line checkbox | Checkbox |
Check this box when you are listing a contingent asset on row 1 that you are requesting the judge award to you (marks the entire line as a selected contingent asset).
|
| Entry 1 - Contingent asset description | Text |
Enter a brief description or name of the contingent asset you are listing (e.g., potential inheritance, pending lawsuit, expected bonus).
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| Entry 1 - Possible value | Number |
Enter the estimated possible monetary value of the contingent asset you listed.
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| Entry 1 - Nonmarital (Petitioner) | Checkbox |
Check this box when the contingent asset on row 1 is nonmarital and you are indicating it belongs to or should be awarded to the Petitioner.
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| Entry 1 - Nonmarital (Respondent) | Checkbox |
Check this box when the contingent asset on row 1 is nonmarital and you are indicating it belongs to or should be awarded to the Respondent.
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| Contingent Asset - Entry 2 (Row 2) | ||
| Entry 2 - Contingent Asset (select line) | Checkbox |
Check this box if this line lists a contingent asset you are claiming and requesting the judge award to you.
|
| Contingent Asset - Entry 2: Description | Text |
Enter a short description of the possible asset or asset claim for Entry 2 (what the asset is and any identifying details the court should know).
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| Contingent Asset - Entry 2: Possible Value | Number |
Enter the estimated possible monetary value for the asset listed on Entry 2.
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| Entry 2 - Nonmarital: Petitioner | Checkbox |
Check this box if the contingent asset on this line is nonmarital property belonging to the Petitioner.
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| Entry 2 - Nonmarital: Respondent | Checkbox |
Check this box if the contingent asset on this line is nonmarital property belonging to the Respondent.
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| Contingent Liability - Entry 1 (Row 1) | ||
| Entry 1: Contingent Liability — Select Line | Checkbox |
Check this box to mark this row as a contingent debt you believe you should be responsible for (use when listing the contingent liability on this line).
|
| Entry 1 — Contingent Liability Description | Text |
Provide a short description of the contingent debt for which you may be responsible (e.g., loan type, creditor name, last 4 digits of account).
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| Entry 1 — Possible Amount Owed | Number |
Enter the estimated amount you might owe for the contingent debt listed on this row.
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| Entry 1: Contingent Liability — Nonmarital (Petitioner) | Checkbox |
Check this box if the listed contingent debt is nonmarital and you are indicating it belongs to the Petitioner.
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| Entry 1: Contingent Liability — Nonmarital (Respondent) | Checkbox |
Check this box if the listed contingent debt is nonmarital and you are indicating it belongs to the Respondent.
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| Contingent Liability - Entry 2 (Row 2) | ||
| Entry 2: Contingent debt — select line | Checkbox |
Check this box when you are reporting a contingent debt on the second (Entry 2) line in the Contingent Liabilities section to indicate that this row describes a contingent liability you believe you should be responsible for.
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| Entry 2 - Contingent Liability Description | Text |
Enter a brief description of the contingent debt or potential liability you may be responsible for (include creditor name and last 4 digits of the account number if available).
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| Entry 2 - Possible Amount Owed | Number |
Enter the possible dollar amount owed for the contingent liability listed on this row.
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| Entry 2: Nonmarital — Petitioner | Checkbox |
Check this box if the contingent debt listed on Entry 2 is nonmarital and you assert it is the petitioner's debt.
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| Entry 2: Nonmarital — Respondent | Checkbox |
Check this box if the contingent debt listed on Entry 2 is nonmarital and you assert it is the respondent's debt.
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| Court and Case Information | ||
| Judicial Circuit | Text |
Enter the name or number of the judicial circuit where the case is filed (for example '11th' or 'Eleventh').
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| County | Text |
Enter the name of the Florida county in which the court is located (for example 'Miami-Dade').
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| Case Number | Text |
Enter the official court-assigned case number for this matter exactly as it appears on court documents.
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| Division | Text |
Enter the court division or docket designation handling the case (for example a division name, letter, or number).
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| Form Prepared For | ||
| Petitioner | Checkbox |
Check this box if the form was prepared for the Petitioner (select this option when the nonlawyer prepared the form on behalf of the petitioner).
|
| Respondent | Checkbox |
Check this box if the form was prepared for the Respondent (select this option when the nonlawyer prepared the form on behalf of the respondent).
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| Household (Section A) | ||
| Other household expense (description) | Text |
Enter a short description naming the other household expense not listed above.
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| Mortgage or rent | Number |
Enter the monthly amount you pay for mortgage or rent.
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| Property taxes | Number |
Enter the monthly property tax amount you pay.
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| Utilities | Number |
Enter the total average monthly cost for utilities (electricity, gas, water, etc.).
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| Telephone | Number |
Enter the average monthly telephone expense.
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| Food (groceries) | Number |
Enter the average monthly amount spent on food and groceries for the household.
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| Meals outside home | Number |
Enter the average monthly amount spent on meals eaten outside the home (dining out, takeout, etc.).
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| Maintenance/Repairs | Number |
Enter the average monthly amount spent on household maintenance and repairs.
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| Other household expense (amount) | Number |
Enter the monthly amount for the other household expense you described in the accompanying field.
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| Insurance (Section D) | ||
| Other insurance description | Text |
Enter the name or brief description of any other insurance coverage not listed above (e.g., policy type or insurer).
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| Medical/Dental insurance amount | Number |
Enter the monthly dollar amount you pay for medical or dental insurance if it is not listed elsewhere (lines 23 or 45). Fill only if 'Child(ren)'s medical/dental amount', 'Row 1 Creditor Name' are blank (all).
Depends on:
Child(ren)'s medical/dental amount, Row 1 Creditor Name
|
| Child(ren)'s medical/dental amount | Number |
Enter the monthly dollar amount you pay specifically for your child(ren)'s medical or dental insurance.
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| Life insurance amount | Number |
Enter the monthly dollar amount you pay for life insurance premiums.
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| Other insurance amount | Number |
Enter the monthly dollar amount for the other insurance coverage you named in the adjacent description field.
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| Liabilities - Additional pages checkbox | ||
| Additional pages attached (Liabilities) | Text |
Enter 'Yes' if you have attached additional pages listing liabilities or 'No' if no additional pages are attached.
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| Monthly alimony actually received - Row 9 (includes 9a & 9b) | ||
| Row 9: Monthly alimony actually received (total) | Number |
Enter the total monthly alimony amount you actually receive, which equals the sum of amounts entered in 9a and 9b.
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| Row 9a: Monthly alimony from this case | Number |
Enter the monthly alimony amount you receive from this case only.
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| Row 9b: Monthly alimony from other case(s) | Number |
Enter the monthly alimony amount you receive from any other case(s) separate from this one.
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| Monthly bonuses, commissions, allowances, overtime, tips - Row 2 | ||
| Row 2 - Monthly bonuses, commissions, allowances, overtime, tips | Number |
Enter the total monthly dollar amount you receive from bonuses, commissions, allowances, overtime, tips, and similar payments.
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| Monthly business income (self-employment, partnerships, etc.) - Row 3 | ||
| Row 3: Monthly business income (self-employment/partnerships) | Number |
Enter the total gross monthly business income from self-employment, partnerships, close corporations, and/or independent contracts (gross receipts minus ordinary and necessary expenses).
|
| Monthly court-ordered alimony and breakdown (lines 25, 25a, 25b) | ||
| Line 25: Monthly court-ordered alimony actually paid | Number |
Enter the total monthly court-ordered alimony you actually pay (this is the sum of lines 25a and 25b). Fill only if 'Line 25a: Alimony from this case', 'Line 25b: Alimony from other case(s)' are filled (any).
Depends on:
Line 25a: Alimony from this case, Line 25b: Alimony from other case(s)
|
| Line 25a: Alimony from this case | Number |
Enter the monthly court-ordered alimony amount that you pay under this specific case.
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| Line 25b: Alimony from other case(s) | Number |
Enter the combined monthly court-ordered alimony amount you pay for any other case(s) besides this one.
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| Monthly court-ordered child support actually paid (line 24) | ||
| Line 24 — Monthly court-ordered child support actually paid | Number |
Enter the monthly amount of court-ordered child support you actually pay for children from another relationship.
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| Monthly disability benefits/SSI - Row 4 | ||
| Row 4 - Monthly disability benefits/SSI | Number |
Enter the monthly amount you receive from disability benefits or Supplemental Security Income (SSI).
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| Monthly federal/state/local income tax and inputs | ||
| Monthly federal/state/local income tax | Number |
Enter the total monthly federal, state, and local income tax amount (corrected for filing status, allowable dependents, and other income tax liabilities) as a numeric dollar value.
|
| Filing status | Text |
Enter your tax filing status (for example, Single, Married Filing Jointly, Married Filing Separately, Head of Household) used to calculate income tax. Fill only if 'Monthly federal/state/local income tax' is filled.
Depends on:
Monthly federal/state/local income tax
|
| Number of dependents claimed | Text |
Enter the total number of dependents you claim for tax purposes as an integer. Fill only if 'Monthly federal/state/local income tax' is filled.
Depends on:
Monthly federal/state/local income tax
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| Monthly FICA or self-employment taxes (line 19) | ||
| Monthly FICA or self-employment taxes (line 19) | Number |
Enter the taxpayer's monthly FICA (Social Security and Medicare) or self-employment tax amount paid or owed.
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| Monthly gross salary or wages - Row 1 | ||
| Row 1 - Monthly gross salary or wages | Number |
Enter your total monthly gross salary or wages (the amount earned before taxes and deductions) in dollars for the period covered.
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| Monthly health insurance payments (line 23) | ||
| Line 23 — Monthly health insurance payments | Number |
Enter the total monthly amount you pay for health insurance (including dental), excluding any portion paid for minor children of this relationship.
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| Monthly income items (lines 1–7) | ||
| Line 1 — Monthly interest and dividends | Number |
Enter the monthly amount for interest and dividend income.
|
| Line 2 — Monthly rental income | Number |
Enter the monthly rental income (gross receipts minus ordinary and necessary expenses) for the property.
|
| Line 3 — Monthly income from royalties, trusts, or estates | Number |
Enter the monthly amount received from royalties, trusts, or estates.
|
| Line 4 — Monthly reimbursed expenses and in‑kind payments | Number |
Enter the monthly amount of reimbursed expenses and in‑kind payments to the extent that they reduce personal living expenses.
|
| Line 5 — Monthly gains from dealing in property | Number |
Enter the monthly gains derived from dealing in property (exclude nonrecurring gains).
|
| Line 6 — Any other recurring monthly income (amount) | Number |
Enter the amount of any other income of a recurring nature and use the adjacent field to list the source.
|
| Line 7 — Any other recurring income (source/description) | Text |
Provide the source or brief description of any other recurring income listed on the previous field.
|
| Monthly mandatory retirement payments (line 22) | ||
| Monthly mandatory retirement payments (Line 22) | Number |
Enter the amount of mandatory retirement or pension payments paid or withheld each month (required retirement-plan contributions).
|
| Monthly mandatory union dues (line 21) | ||
| Monthly mandatory union dues (line 21) | Number |
Enter the monthly amount of mandatory union dues you pay.
|
| Monthly Medicare payments (line 20) | ||
| Line 20: Monthly Medicare payments | Number |
Enter the total amount of Medicare payments you pay each month (monthly Medicare insurance/premium payments).
|
| Monthly pension, retirement, or annuity payments - Row 7 | ||
| Row 7 - Monthly pension, retirement, or annuity payments | Number |
Enter the total monthly amount received from pensions, retirement plans, or annuity payments for Row 7.
|
| Monthly Social Security benefits - Row 8 | ||
| Row 8 - Monthly Social Security benefits | Number |
Enter the total monthly Social Security benefits you receive for Row 8, including any primary and spousal amounts as applicable.
|
| Monthly Unemployment Compensation - Row 6 | ||
| Monthly Unemployment Compensation (Row 6) | Number |
Enter the total monthly amount of unemployment compensation you receive (gross) to be used as part of your present monthly gross income.
|
| Monthly Workers' Compensation - Row 5 | ||
| Row 5 - Monthly Workers' Compensation | Number |
Enter the gross monthly amount of workers' compensation you receive (dollar amount) before deductions.
|
| Mortgages - Additional mortgage entry (Row 4) | ||
| Row 4 - Other mortgages (line selected) | Checkbox |
Check this box when you are indicating that the debt described on row 4 (Other mortgages) is a debt you believe you (or your spouse) should be responsible for.
|
| Row 4 - Mortgage description | Text |
Enter a short description of the additional mortgage (e.g., lender name, property or account purpose, and last 4 digits of the account) for the fourth mortgage row.
|
| Row 4 - Current amount owed | Number |
Enter the current outstanding balance owed on this mortgage for the fourth mortgage row.
|
| Row 4 - Nonmarital (Petitioner) | Checkbox |
Check this box when the mortgage listed on row 4 is nonmarital and should be attributed to the petitioner.
|
| Row 4 - Nonmarital (Respondent) | Checkbox |
Check this box when the mortgage listed on row 4 is nonmarital and should be attributed to the respondent.
|
| Mortgages - First mortgage on home (Row 1) | ||
| First mortgage on home (Row 1) — Item selected | Checkbox |
Check this box to indicate you are listing the first mortgage on your home on this liabilities line (i.e., that this debt is a debt you believe you should be responsible for).
|
| First mortgage (Row 1) - Current amount owed | Number |
Enter the current outstanding dollar amount owed on your first mortgage on the home (the total balance currently due for this loan).
|
| First mortgage on home (Row 1) — Nonmarital: Petitioner | Checkbox |
Check this box if the petitioner asserts the first mortgage on the home is a nonmarital (separate) debt of the petitioner.
|
| First mortgage on home (Row 1) — Nonmarital: Respondent | Checkbox |
Check this box if the respondent asserts the first mortgage on the home is a nonmarital (separate) debt of the respondent.
|
| Mortgages - Other mortgages (Row 3) | ||
| Row 3 - Other mortgages (Select line) | Checkbox |
Check this box when this 'Other mortgages' debt line applies and you (or your spouse) believe you should be responsible for the debt.
|
| Row 3 - Other mortgages: Current amount owed | Number |
Enter the current total amount owed on any other mortgages for this household (Other mortgages, row 3).
|
| Row 3 - Other mortgages - Nonmarital: Petitioner | Checkbox |
Check this box when the petitioner asserts this 'Other mortgages' debt is nonmarital (belongs only to the petitioner).
|
| Row 3 - Other mortgages - Nonmarital: Respondent | Checkbox |
Check this box when the respondent asserts this 'Other mortgages' debt is nonmarital (belongs only to the respondent).
|
| Mortgages - Second mortgage on home (Row 2) | ||
| Second mortgage on home - Line selection | Checkbox |
Check this box to indicate you are listing a second mortgage on the home on this line (i.e., that this debt applies and you are reporting it).
|
| Row 2 — Second mortgage on home: Current amount owed | Number |
Enter the current outstanding balance owed on the second mortgage for your home.
|
| Second mortgage on home - Nonmarital (Petitioner) | Checkbox |
Check this box if the second mortgage on the home is a nonmarital debt owed by the Petitioner.
|
| Second mortgage on home - Nonmarital (Respondent) | Checkbox |
Check this box if the second mortgage on the home is a nonmarital debt owed by the Respondent.
|
| Nonlawyer Assistance Details | ||
| Nonlawyer's Name | Text |
Enter the full name of the individual who helped prepare or complete this form. Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Nonlawyer's Business Name | Text |
Enter the name of the business or organization (if any) that assisted in preparing this form. Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Nonlawyer's Street Address | Text |
Enter the street address for the individual or business who assisted, including apartment or suite number if applicable. Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Nonlawyer's City | Text |
Enter the city for the address of the individual or business who assisted. Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Nonlawyer's State | Text |
Enter the state for the address of the individual or business who assisted (state name or two-letter abbreviation). Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Nonlawyer's ZIP Code | Text |
Enter the postal ZIP code for the address of the individual or business who assisted. Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Nonlawyer's Telephone Number | Text |
Enter the primary telephone number (include area code and any country code) for the individual or business who assisted. Fill only if 'Petitioner', 'Respondent' is 'Yes' (any).
Depends on:
Petitioner, Respondent
|
| Other Expenses Not Listed Above - Additional Row 1 (E Row 1) | ||
| E Row 1 - Other Expense Description | Text |
Enter a short label or name describing this other expense not listed above (for example: "Club dues", "Pet care", etc.).
|
| E Row 1 - Other Expense Amount | Number |
Enter the monthly dollar amount you pay for the described other expense.
|
| Other Expenses Not Listed Above - Additional Row 2 (E Row 2) | ||
| E (Row 2) - Other expense description | Text |
Enter a short description or label for the additional 'Other' expense in section E (Other Expenses Not Listed Above) for row 2.
|
| E (Row 2) - Other expense amount | Number |
Enter the monthly dollar amount for the additional 'Other' expense listed on row 2 in section E (Other Expenses Not Listed Above).
|
| Other Expenses Not Listed Above - Additional Row 3 (E Row 3) | ||
| E Row 3 - Other Expense Description | Text |
Enter the name or brief description of the additional expense not listed above for E (this is a short text label identifying the expense).
|
| E Row 3 - Other Expense Amount | Number |
Enter the monthly dollar amount you pay for the additional expense listed on the same row.
|
| Other Expenses Not Listed Above - Additional Row 4 (E Row 4) | ||
| E Row 4 - Other Expense Description | Text |
Enter the name or brief description of the additional, not-listed monthly expense for row 4 (e.g., subscription, fee, or service).
|
| E Row 4 - Other Expense Amount | Number |
Enter the monthly dollar amount you pay for the additional expense listed on row 4.
|
| Other Expenses Not Listed Above - Additional Row 5 (E Row 5) | ||
| E Row 5 - Other expense description | Text |
Enter a short label or description for the fifth additional 'Other Expense' under section E (for example: subscription, pet care, etc.).
|
| E Row 5 - Other expense amount | Number |
Enter the monthly dollar amount you pay for the expense described in the adjacent field.
|
| Other Expenses Not Listed Above - Additional Row 6 (E Row 6) | ||
| E Row 6 - Expense Description | Text |
Enter the name or short description of the additional monthly expense to be listed on Other Expenses row 6.
|
| E Row 6 - Expense Amount | Number |
Enter the monthly amount for the additional expense listed on Other Expenses row 6.
|
| Other Expenses Not Listed Above - Standard Items (Section E) | ||
| Clothing | Number |
Enter the average monthly amount you spend on clothing that is not listed in other expense categories.
|
| Medical/Dental (uninsured) | Number |
Enter the average monthly out‑of‑pocket medical and dental expenses that are not covered by insurance.
|
| Grooming | Number |
Enter the average monthly amount you spend on grooming and personal care (for example haircuts, toiletries, and related items).
|
| Entertainment | Number |
Enter the average monthly amount spent on entertainment and recreational activities.
|
| Gifts | Number |
Enter the average monthly amount you spend on gifts for others.
|
| Religious organizations | Number |
Enter the average monthly contributions or payments you make to religious organizations.
|
| Miscellaneous | Number |
Enter the average monthly amount for other miscellaneous expenses not included in the listed categories.
|
| Other liabilities - Entry 1 (Row 9) | ||
| Entry 1 (Row 9) - Responsible for debt | Checkbox |
Check this box if you believe you (or your spouse, for this petition) should be held responsible for the listed 'Other' debt on row 9.
|
| Entry 1 (Row 9) - Other liability description | Text |
Enter a short description of the other liability or debt (e.g., creditor name, purpose of the debt, and last 4 digits of the account number) for this entry.
|
| Entry 1 (Row 9) - Current amount owed | Number |
Enter the current total amount owed for the described other liability.
|
| Entry 1 (Row 9) - Nonmarital: Petitioner | Checkbox |
Check this box if the 'Other' debt on row 9 is a nonmarital debt that should be attributed to the Petitioner.
|
| Entry 1 (Row 9) - Nonmarital: Respondent | Checkbox |
Check this box if the 'Other' debt on row 9 is a nonmarital debt that should be attributed to the Respondent.
|
| Other liabilities - Entry 2 (Row 10) | ||
| Entry 2 - Other liabilities (line present) | Checkbox |
Check this box when you are listing an "Other" liability on Entry 2 (row 10) to indicate that this row contains a reported debt.
|
| Entry 2 (Row 10) - Description of Liability | Text |
Enter a short description of the other liability (list the type of debt and only the last 4 digits of the account number if applicable) for Entry 2 / Row 10.
|
| Entry 2 (Row 10) - Current Amount Owed | Number |
Enter the current dollar amount owed for this other liability (Entry 2 / Row 10).
|
| Entry 2 - Nonmarital (Petitioner) | Checkbox |
Check this box if the liability listed on Entry 2 (row 10) is nonmarital and should be attributed to the Petitioner.
|
| Entry 2 - Nonmarital (Respondent) | Checkbox |
Check this box if the liability listed on Entry 2 (row 10) is nonmarital and should be attributed to the Respondent.
|
| Other liabilities - Entry 3 (Row 11) | ||
| Other liabilities - Entry 3 (Row 11): Additional pages attached | Checkbox |
Check this box if you have attached additional pages that continue the Other liabilities entries for Entry 3 (Row 11).
|
| Entry 3 (Row 11) - Description of Liability | Text |
Enter a brief description of the other liability (e.g., creditor name, purpose of the debt, and last 4 digits of the account number) for Entry 3 in Row 11.
|
| Entry 3 (Row 11) - Current Amount Owed | Number |
Enter the current dollar amount owed for the liability listed in Entry 3 (Row 11).
|
| Other liabilities - Entry 3 (Row 11): Nonmarital - Petitioner | Checkbox |
Check this box if the debt listed on Entry 3 (Row 11) is nonmarital and you believe the Petitioner should be held responsible for it.
|
| Other liabilities - Entry 3 (Row 11): Nonmarital - Respondent | Checkbox |
Check this box if the debt listed on Entry 3 (Row 11) is nonmarital and you believe the Respondent should be held responsible for it.
|
| Other Party/Attorney Contact Info | ||
| Other party/attorney name | Text |
Enter the full name of the other party or their attorney as it should appear on court documents. Fill only if 'E-mailed', 'Mailed', 'Faxed', 'Hand delivered' is 'Yes' (any).
Depends on:
E-mailed, Mailed, Faxed, Hand delivered
|
| Other party/attorney street address | Text |
Enter the mailing street address for the other party or their attorney, including apartment or suite number if applicable. Fill only if 'E-mailed', 'Mailed', 'Faxed', 'Hand delivered' is 'Yes' (any).
Depends on:
E-mailed, Mailed, Faxed, Hand delivered
|
| City, State, Zip | Text |
Enter the city, two-letter state abbreviation, and ZIP code for the other party or their attorney (for example: Miami, FL 33101). Fill only if 'E-mailed', 'Mailed', 'Faxed', 'Hand delivered' is 'Yes' (any).
Depends on:
E-mailed, Mailed, Faxed, Hand delivered
|
| Telephone number | Text |
Enter a daytime telephone number for the other party or their attorney, including area code. Fill only if 'E-mailed', 'Mailed', 'Faxed', 'Hand delivered' is 'Yes' (any).
Depends on:
E-mailed, Mailed, Faxed, Hand delivered
|
| Fax number | Text |
Enter the fax number for the other party or their attorney, including area code, or leave blank if none. Fill only if 'Faxed' is 'Yes'.
Depends on:
Faxed
|
| E-mail address(es) | Text |
Enter one or more email addresses for the other party or their attorney, separated by commas if listing multiple addresses. Fill only if 'E-mailed' is 'Yes'.
Depends on:
E-mailed
|
| Parties - Petitioner and Respondent | ||
| Petitioner Name | Text |
Enter the full legal name of the Petitioner as it should appear on the court record.
|
| Respondent Name | Text |
Enter the full legal name of the Respondent as it should appear on the court record.
|
| Pay Rate, Frequency, and Unemployment | ||
| Pay Rate | Number |
Enter the employee's pay amount in dollars as reported on the form (the numeric amount shown after the $ sign). Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Every week | Checkbox |
Check this box if you are paid every week (weekly pay). Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Every other week | Checkbox |
Check this box if you are paid every other week (biweekly pay). Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Twice a month | Checkbox |
Check this box if you are paid twice a month (semimonthly pay). Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Monthly | Checkbox |
Check this box if you are paid once a month (monthly pay). Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Other | Checkbox |
Check this box if your pay frequency is not listed and write the specific frequency on the 'other' line. Fill only if 'Unemployed' is 'No'.
Depends on:
Unemployed
|
| Other Pay Frequency (specify) | Text |
If the pay frequency is not listed among the provided options, enter the word or short phrase that describes the pay schedule (for example, 'weekly twice' or 'contract per job'). Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Unemployed | Checkbox |
Check this box if you are currently unemployed and attach a separate sheet explaining your efforts to find employment.
|
| Payments to Creditors - Row 1 (Creditor & Monthly Payment) | ||
| Row 1 Creditor Name | Text |
Enter the full name of the first creditor or lending institution to which you make payments.
|
| Row 1 Monthly Payment | Number |
Enter the monthly payment amount you currently pay to the creditor listed on this row.
|
| Payments to Creditors - Row 10 (Creditor & Monthly Payment) | ||
| Row 10 Creditor Name | Text |
Enter the name of the creditor or lender for row 10 (the company or person you owe money to).
|
| Row 10 Monthly Payment | Number |
Enter the monthly payment amount you pay to the creditor listed on row 10.
|
| Payments to Creditors - Row 11 (Creditor & Monthly Payment) | ||
| Row 11 Creditor | Text |
Enter the name of the creditor or company for payment row 11 exactly as it should appear on your account or statement.
|
| Row 11 Monthly Payment | Number |
Enter the regular monthly payment amount you pay to the creditor listed on row 11 in dollars and cents (numbers only).
|
| Payments to Creditors - Row 2 (Creditor & Monthly Payment) | ||
| Row 2 - Creditor Name | Text |
Enter the name of the creditor or lending institution for row 2 (e.g., bank or card issuer).
|
| Row 2 - Monthly Payment | Number |
Enter the regular monthly payment amount you make to the creditor listed in row 2 (numeric value only).
|
| Payments to Creditors - Row 3 (Creditor & Monthly Payment) | ||
| Row 3 Creditor Name | Text |
Enter the name of the creditor or lender for row 3 (the company or individual you make payments to).
|
| Row 3 Monthly Payment | Number |
Enter the monthly payment amount you pay to the creditor listed on row 3.
|
| Payments to Creditors - Row 4 (Creditor & Monthly Payment) | ||
| Row 4 Creditor | Text |
Enter the name of the creditor for row 4 (the company or individual you owe on this line).
|
| Row 4 Monthly Payment | Number |
Enter the monthly payment amount you pay to this creditor for row 4.
|
| Payments to Creditors - Row 5 (Creditor & Monthly Payment) | ||
| Row 5 Creditor | Text |
Enter the name of the creditor (company or individual) for the fifth creditor row.
|
| Row 5 Monthly Payment | Number |
Enter the monthly payment amount owed to the creditor listed on row 5.
|
| Payments to Creditors - Row 6 (Creditor & Monthly Payment) | ||
| Row 6 Creditor Name | Text |
Enter the name of the creditor or lender for row 6 (the entity to whom payments are made).
|
| Row 6 Monthly Payment | Number |
Enter the monthly payment amount you pay or owe to the creditor listed on row 6.
|
| Payments to Creditors - Row 7 (Creditor & Monthly Payment) | ||
| Creditor (Row 7) | Text |
Enter the name of the creditor for row 7 as it appears on your billing statement or loan paperwork.
|
| Monthly Payment (Row 7) | Number |
Enter the regular monthly payment amount you pay to the creditor listed in row 7.
|
| Payments to Creditors - Row 8 (Creditor & Monthly Payment) | ||
| Row 8 Creditor Name | Text |
Enter the name of the creditor for row 8 (the company or individual to whom you owe money).
|
| Row 8 Monthly Payment | Number |
Enter the monthly payment amount you pay to the creditor listed on row 8.
|
| Payments to Creditors - Row 9 (Creditor & Monthly Payment) | ||
| Row 9 Creditor Name | Text |
Enter the name of the creditor for row 9 (the company or individual to whom you owe money).
|
| Row 9 Monthly Payment | Number |
Enter the monthly payment amount you regularly pay to the creditor listed in row 9.
|
| Present net monthly income (line 27) | ||
| Line 27 — Present Net Monthly Income | Number |
Enter the present net monthly income in dollars for line 27, calculated by subtracting Total Deductions (line 26) from Total Present Monthly Gross Income (line 17). Fill only if 'Line 17 — Total Present Monthly Gross Income', 'Line 26 — Total deductions allowable under section 61.30' are filled (all).
Depends on:
Line 17 — Total Present Monthly Gross Income, Line 26 — Total deductions allowable under section 61.30
|
| Service Method and Date | ||
| E-mailed | Checkbox |
Check this box if a copy of this document was e-mailed to the person(s) listed below on the date entered.
|
| Mailed | Checkbox |
Check this box if a copy of this document was mailed to the person(s) listed below on the date entered.
|
| Faxed | Checkbox |
Check this box if a copy of this document was faxed to the person(s) listed below on the date entered.
|
| Hand delivered | Checkbox |
Check this box if a copy of this document was hand-delivered to the person(s) listed below on the date entered.
|
| Service Date | Date |
Enter the date when the document was delivered, emailed, mailed, or faxed to the other party or their attorney. Fill only if 'E-mailed', 'Mailed', 'Faxed', 'Hand delivered' is 'Yes' (any).
Depends on:
E-mailed, Mailed, Faxed, Hand delivered
|
| Signature | ||
| signature | Signature |
Provide your signature using an electronic or handwritten method.
|
| Signature and Date | ||
| Date Signed | Date |
Enter the date the document was signed.
|
| Signature - Printed Name | Text |
Enter the full printed name of the party signing this document.
|
| Signature - Address | Text |
Enter the street address for the signing party.
|
| Signature - City, State, ZIP | Text |
Enter the city, state, and ZIP code for the signing party's address.
|
| Signature - Telephone Number | Text |
Enter the telephone number where the signing party can be reached.
|
| Signature - Fax Number | Text |
Enter the fax number for the signing party, if applicable.
|
| Signature - E-mail Address(es) | Text |
Enter the email address or addresses for the signing party.
|
| Summary - Total Monthly Income and Expenses (Lines 28-32) | ||
| Line 28 - Total Monthly Expenses (A–F) | Number |
Enter the total of all monthly expense amounts from categories A through F.
Depends on:
Mortgage or rent, Property taxes, Utilities, Telephone, Food (groceries), Meals outside home, Maintenance/Repairs, Other household expense (amount), Automobile — Gasoline, Automobile — Repairs, Automobile — Insurance, C - Day care, C - Lunch money, C - Clothing, C - Grooming, C - Gifts for holidays, C - Medical/Dental (uninsured), C - Other (amount), Medical/Dental insurance amount, Child(ren)'s medical/dental amount, Life insurance amount, Other insurance amount, Clothing, Medical/Dental (uninsured), Grooming, Entertainment, Gifts, Religious organizations, Miscellaneous, E Row 1 - Other Expense Amount, E (Row 2) - Other expense amount, E Row 3 - Other Expense Amount, E Row 4 - Other Expense Amount, E Row 5 - Other expense amount, E Row 6 - Expense Amount
|
| Line 29 - Total Present Monthly Net Income | Number |
Enter your total present monthly net income as shown on line 27 of Section I (Income).
Depends on:
Line 27 — Present Net Monthly Income
|
| Line 30 - Total Monthly Expenses (from line 28) | Number |
Enter the total monthly expenses carried forward from line 28 above.
|
| Line 31 - Surplus | Number |
If line 29 is greater than line 30, enter the surplus amount (line 29 minus line 30). Fill only if 'Line 29 - Total Present Monthly Net Income', 'Line 30 - Total Monthly Expenses (from line 28)' is greater than field 3.
Depends on:
Line 29 - Total Present Monthly Net Income, Line 30 - Total Monthly Expenses (from line 28)
|
| Line 32 - Deficit | Number |
If line 30 is greater than line 29, enter the deficit amount (line 30 minus line 29). Fill only if 'Line 29 - Total Present Monthly Net Income', 'Line 30 - Total Monthly Expenses (from line 28)' is greater than field 2.
Depends on:
Line 30 - Total Monthly Expenses (from line 28), Line 29 - Total Present Monthly Net Income
|
| Total Contingent Assets (Summary) | ||
| Total Contingent Assets | Number |
Enter the total possible value of all contingent assets you listed on this form (the sum of the 'Possible Value' column).
|
| Total Contingent Assets — Petitioner | Checkbox |
Check this box if the petitioner is claiming the total contingent assets shown are nonmarital and should be attributed to the petitioner.
|
| Total Contingent Assets — Respondent | Checkbox |
Check this box if the respondent is claiming the total contingent assets shown are nonmarital and should be attributed to the respondent.
|
| Total Contingent Liabilities (Summary) | ||
| Total Contingent Liabilities | Number |
Enter the total amount of all contingent liabilities you listed on this form — the sum of possible debts for which you may be responsible.
|
| Total Contingent Liabilities - Petitioner | Checkbox |
Check this box if the petitioner is the nonmarital party who should be considered responsible for the total contingent liabilities listed.
|
| Total Contingent Liabilities - Respondent | Checkbox |
Check this box if the respondent is the nonmarital party who should be considered responsible for the total contingent liabilities listed.
|
| Total Debts (Summary) | ||
| Total Debts (Summary) — Current Amount Owed | Number |
Enter the total current amount owed for all debts listed in this Liabilities section (sum of the amounts from the debt lines above).
|
| Total Debts — Petitioner | Checkbox |
Check this box if the total debts listed on this page are nonmarital and are owed by the Petitioner.
|
| Total Debts — Respondent | Checkbox |
Check this box if the total debts listed on this page are nonmarital and are owed by the Respondent.
|
| Total deductions allowable under section 61.30 (line 26) | ||
| Line 26 — Total deductions allowable under section 61.30 | Number |
Enter the total monthly deductions allowable under Florida Statutes section 61.30 (sum of lines 18 through 25) as a numeric amount. Fill only if 'Monthly federal/state/local income tax', 'Monthly FICA or self-employment taxes (line 19)', 'Line 20: Monthly Medicare payments', 'Monthly mandatory union dues (line 21)', 'Monthly mandatory retirement payments (Line 22)', 'Line 23 — Monthly health insurance payments', 'Line 24 — Monthly court-ordered child support actually paid', 'Line 25: Monthly court-ordered alimony actually paid' are filled (any).
Depends on:
Monthly federal/state/local income tax, Monthly FICA or self-employment taxes (line 19), Line 20: Monthly Medicare payments, Monthly mandatory union dues (line 21), Monthly mandatory retirement payments (Line 22), Line 23 — Monthly health insurance payments, Line 24 — Monthly court-ordered child support actually paid, Line 25: Monthly court-ordered alimony actually paid
|
| Total present monthly gross income (line 17) | ||
| Line 17 — Total Present Monthly Gross Income | Number |
Enter the total present monthly gross income (the sum of lines 1 through 16) in dollars. Fill only if 'Line 1 — Monthly interest and dividends', 'Line 2 — Monthly rental income', 'Line 3 — Monthly income from royalties, trusts, or estates', 'Line 4 — Monthly reimbursed expenses and in‑kind payments', 'Line 5 — Monthly gains from dealing in property', 'Line 6 — Any other recurring monthly income (amount)', 'Line 7 — Any other recurring income (source/description)' are filled (all).
Depends on:
Line 1 — Monthly interest and dividends, Line 2 — Monthly rental income, Line 3 — Monthly income from royalties, trusts, or estates, Line 4 — Monthly reimbursed expenses and in‑kind payments, Line 5 — Monthly gains from dealing in property, Line 6 — Any other recurring monthly income (amount), Line 7 — Any other recurring income (source/description)
|