Financial Disclosure Affidavit Completed Form Examples and Samples

Attorney Memo regarding client: Marcus J. Thorne, currently residing at 442 Oak Street, Apt 3B, Springfield, IL 62704. Marcus is preparing for his upcoming child support hearing scheduled for April 14, 2026, at 10:00 AM in Part 4, Docket #2026-CV-8892, File #A-9921. He is employed as a warehouse technician at Logistics Solutions, located at 1200 Industrial Way, Springfield, IL 62703, working exactly 40 hours per week. His current gross pay is $3,200 per month, with a net take-home income of $2,450 per month. Marcus is not self-employed. He shares his home with his two younger brothers, who contribute a combined $800 per month to household expenses. Regarding his own finances, he has a checking account at First National Bank with a balance of $1,250 and a savings account at the same branch with $4,500. His primary assets include his 2021 Honda Civic, which is valued at approximately $18,000. He is not currently paying any additional child support. For insurance, he has coverage through his employer, which includes medical, dental, and prescription benefits at a cost of $150 per month. His monthly housing costs are $1,100 for rent, plus $85 for gas, $95 for electric, and $70 for phone/internet. He spends roughly $450 on food, $100 on clothing, and $50 on transit, and carries a credit card debt with Chase Bank of $2,200, paying $120 monthly. He intends to sign this affidavit on March 22, 2026.