Divorce Financial Affidavit

I. Personal Information

Full Name

Date of Birth

Address

Phone Number

Occupation

Employer

II. Income

Source	Monthly Amount
Employment
Business
Interest/Dividends
Other

III. Expenses

Type	Monthly Amount
Rent/Mortgage
Utilities
Food
Transportation
Insurance
Child Support
Other

IV. Assets

Description	Value	Ownership
Bank Accounts
Real Estate
Vehicles
Investments
Other

V. Liabilities

Description	Balance	Monthly Payment
Mortgage
Car Loans
Credit Cards
Other

VI. Additional Notes

Signature

Date