Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Completed Form Examples and Samples

Explore detailed examples and samples of the Uniform Domestic Relations Form – Affidavit 1 (Affidavit of Basic Information, Income, and Expenses). See how personal, financial, and family data is accurately extracted and populated, providing clear insights for legal professionals and individuals navigating domestic relations cases.

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Completed Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES

Uniform Domestic Relations Form – Affidavit of Basic Information, Income, and Expenses (Sample)

How this form was filled:

Our AI successfully extracted a wide range of personal, financial, and family data from a detailed client consultation summary, automatically populating the Uniform Domestic Relations Form – Affidavit 1. This includes complex income breakdowns, multiple expense categories, and specific dates, demonstrating the AI's ability to interpret and organize unstructured legal narratives.

Source document used: Client Consultation Summary

MEMORANDUM

TO: Senior Partner
FROM: Legal Assistant
DATE: April 10, 2025
RE: Sarah Jenkins - Divorce Proceedings (Initial Intake Summary)

Following my intake meeting with Ms. Sarah Jenkins today, I've compiled the essential details for her divorce filing against Mr. Mark Jenkins. The case will be filed in the Domestic Relations Division of Franklin County, Ohio. We anticipate Case No. D-2024-DR-001234. Judge Eleanor Vance is likely to preside, with Magistrate Laura Chen overseeing initial hearings.

Sarah's full name is Sarah Ann Jenkins, born June 15, 1985. Her phone is (614) 555-1234 and email is [email protected]. Her Social Security number ends in 7890. She confirmed she does not need an interpreter. Regarding her health, she describes it as 'fair' due to ongoing stress and anxiety related to the separation, which occasionally impacts her concentration. She holds a Bachelor's degree in Business Administration and is a certified Project Management Professional (PMP). She is not in the military.

Mark's full name is Mark Robert Jenkins, born October 20, 1983. His phone is (614) 555-5678 and email is [email protected]. His Social Security number ends in 1234. His health is generally good, and he also does not require an interpreter. Mark completed a Post Graduate MBA degree. He is not in the military.

They were married on July 12, 2010, and separated relatively recently on March 1, 2024. They have two children: Emily Jenkins, born November 5, 2012, and David Jenkins, born January 22, 2016. Both children reside with Sarah.

Sarah is employed as a Senior Project Manager at Tech Solutions Inc., located at 100 Corporate Drive, Columbus, OH 43215. She started there on August 1, 2018, and gets paid bi-weekly (26 paychecks/year). Her current base yearly salary is $98,000. Her income history shows: 2022 base $85,000, 2023 base $90,000, 2024 base $95,000. She also received annual bonuses: $5,000 in 2022, $6,000 in 2023, and $7,000 in 2024. She receives about $200 annually in interest/dividends from her savings.

Mark works at Global Finance Group at 500 Commerce Way, Columbus, OH 43216, where he started May 1, 2007. He's paid semi-monthly (24 paychecks/year). His current base yearly income is $135,000. His past income includes: 2022 base $120,000, 2023 base $125,000, 2024 base $130,000. His bonuses were $15,000 in 2022, $18,000 in 2023, and $20,000 in 2024. Additionally, he has a rental property generating $6,000 per year.

Regarding Sarah's current monthly expenses (living with the two children), her rent is $2,200, which covers taxes and insurance. Utilities include $150 for electricity, $80 for gas, $60 for water/sewer, $100 for phone/cell, $25 for trash, $90 for cable, and $70 for internet. She pays $120 for a bi-weekly cleaner. Her monthly food budget is $700 for groceries and $200 for restaurants. Her Honda CRV payment is $450, with an estimated $50 for maintenance and $180 for gas. She spends $100 on her own clothes and $30 on dry cleaning. Personal grooming (hair, nails) is $75, plus $20 for other toiletries. She pays $350 monthly for the children's after-school care, $100 for school lunches, $40 for school supplies, and $250 for their extracurriculars (dance, soccer). Child clothing is $150, and allowances total $40. Insurance premiums are $40 for life, $110 for auto, $250 for health (her contribution), and $30 for disability. Work-related professional dues are $20/month. Health expenses not covered by insurance average $50 for physician co-pays, $40 for prescriptions, and $30 for dental/vision. Miscellaneous expenses include $50 for subscriptions/books, $30 for charitable donations, $60 for a gym membership, and $50 for pet care. She's also making installment payments: $150/month on a Visa card (balance $5,000) and $100/month on a MasterCard (balance $3,000). She is currently paying $500/month towards attorney fees. There are no other adults in her household besides herself and the children.

Information used to fill out the document:

Plaintiff Name: Sarah Ann Jenkins
Defendant Name: Mark Robert Jenkins
Date of Marriage: July 12, 2010
Date of Separation: March 1, 2024
Plaintiff Current Base Yearly Income: $98,000
Plaintiff Last 3 Years Average Bonuses: $6,000
Defendant Current Base Yearly Income: $135,000
Defendant Last 3 Years Average Bonuses: $17,666.67
Children of Marriage: Emily Jenkins (Nov 5, 2012), David Jenkins (Jan 22, 2016)
Plaintiff Monthly Housing Expenses: $2,200 (Rent/Mortgage), $150 (Electric), $80 (Gas), $60 (Water), $100 (Phone), $25 (Trash), $90 (Cable), $70 (Internet), $120 (Cleaning)
Plaintiff Monthly Child-Related Expenses: $350 (Child Care), $100 (School Lunches), $40 (School Supplies), $250 (Extracurriculars), $150 (Clothing), $40 (Allowances)
Plaintiff Monthly Installment Payments: Visa: $150 (Balance $5,000), MasterCard: $100 (Balance $3,000)

What this filled form sample shows:

Extracted and correctly mapped detailed personal information for both Plaintiff and Defendant, including health status, education, and employment specifics.
Accurately identified and categorized multi-year income figures (base salary and bonuses) for both parties, enabling correct calculation of current average bonuses.
Parsed and organized a comprehensive list of monthly expenses, differentiating between housing, living, child-related, insurance, work, health, and miscellaneous categories.
Identified key dates such as marriage and separation, along with detailed information for minor children including birthdates and living arrangements.
Extracted and formatted installment payment details, including creditor, purpose, balance due, and monthly payment amounts.

Form specifications and details:

Use Case:	Divorce Filing with Child and Spousal Support Considerations
Source Document:	Client Consultation Summary for Legal Team
Form Type:	Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES
Categories:	income forms, income and expense forms, domestic relations forms
Created:	March 10, 2026 06:48 AM