Affidavit of Financial Disclosure

A financial affidavit is a sworn statement made by an individual who is disclosing their financial information in court. Disclosing this information under oath is sometimes required in certain legal proceedings such as divorce, child support, and claims for damages. The document should include the person’s income, assets, expenses, and liabilities.

Affidavit of Financial Disclosure

A financial affidavit is a sworn statement made by an individual who is disclosing their financial information in court. Disclosing this information under oath is sometimes required in certain legal proceedings such as divorce, child support, and claims for damages. The document should include the person’s income, assets, expenses, and liabilities.

Last updated December 12th, 2024

A financial affidavit is a sworn statement made by an individual who is disclosing their financial information in court. Disclosing this information under oath is sometimes required in certain legal proceedings such as divorce, child support, and claims for damages. The document should include the person’s income, assets, expenses, and liabilities.

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Common Uses

A financial affidavit is most often used in legal proceedings pertaining to divorce, dissolution, or separation of marriages and partnerships, alimony, child support, or child custody. They are also typically required when an individual is requesting to waive court and legal fees.

By State

In most states, the appropriate judicial court provides an official financial affidavit that can be used to disclose a person’s finances in divorces, separations, or child support cases.

In some cases, the individual’s level of income and the type of court case will determine which affidavit to use. Some states provide forms on a county or circuit basis instead of state-wide.

STATE FORM
Alabama Child Support Obligation Income Statement/Affidavit
Alaska Financial Declaration
Arizona By County (E.g., Maricopa)
Arkansas Affidavit of Financial Means
California Financial Statement
Colorado Sworn Financial Statement
Connecticut Financial Affidavit: Under 75k | Over 75k Income
Delaware Financial Report: Spousal Support | Child Support
Florida Family Law Financial Affidavit
Georgia Domestic Relations Financial Affidavit
Hawaii Income and Expense Statement by Circuit:
First | Second | Third | Fifth
Idaho Affidavit Verifying Income
Illinois Financial Affidavit
Indiana By County (E.g., Marion)
Iowa Dissolution of Marriage Affidavit of Financial Status
Kansas Domestic Relations Affidavit
Kentucky Verified Disclosure Statement
Louisiana Family Law Affidavit
Maine Financial Statement
Maryland Financial Statement
Massachusetts Financial Statement: Under 75k | Over 75k Income
Michigan Domestic Relations Verified Financial Information Form
Minnesota Financial Affidavit
Mississippi Financial Statement
Missouri Statement of Income and Expenses
Montana Financial Affidavit
Nebraska Financial Affidavit
Nevada General Financial Disclosure Form
New Hampshire Financial Affidavit
New Jersey Financial Statement
New Mexico Not Available Online
New York Financial Disclosure Affidavit
North Carolina Financial Affidavit
North Dakota Financial Declaration
Ohio Affidavit of Basic Information, Income, and Expenses
Oklahoma Financial Affidavit
Oregon Statement of Financial Conditions
Pennsylvania Income Statement
Rhode Island Statement of Assets, Liabilities, Income, and Expenses
South Carolina Financial Declaration
South Dakota Financial Affidavit
Tennessee N/A
Texas By County (E.g., Harris)
Utah Financial Declaration
Vermont Financial Affidavit
Virginia Financial Statement
Washington Financial Declaration
West Virginia Financial Statement
Wisconsin Financial Disclosure Statement
Wyoming Confidential Financial Affidavit

Sample

Download: PDF, Word (.docx), OpenDocument

AFFIDAVIT OF FINANCIAL DISCLOSURE

Date: [MM/DD/YYYY]
Court: [COURT] County: [COUNTY] State: [STATE] Case Number: [#]

I, [AFFIANT NAME], the affiant, residing at [AFFIANT ADDRESS], being duly sworn, hereby swear under oath that the information stated in this Financial Affidavit and the attached documents, if any, is true and correct. 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.

1. INCOME. In support of the following income information, I have attached all necessary pay stubs, income tax returns, and W-2s and/or 1099 statements.

Employed Self-Employed
Employer: [EMPLOYER NAME] Hours worked per week: [#]
Address: [EMPLOYER ADDRESS]

Gross Income: $[DOLLAR AMOUNT]  Weekly Monthly Annually
Net Income: $[DOLLAR AMOUNT]  Weekly Monthly Annually

Other Income:

Source: [INCOME TYPE] $[DOLLAR AMOUNT]  Weekly Monthly Annually
Source: [INCOME TYPE] $[DOLLAR AMOUNT]  Weekly Monthly Annually
Source: [INCOME TYPE] $[DOLLAR AMOUNT]  Weekly Monthly Annually

Number of other members in household: [#]
Income from other members: $[DOLLAR AMOUNT]  Weekly Monthly Annually

Any current child support orders? No Yes in the amount of $[DOLLAR AMOUNT] to [RECIPIENT NAME]. If yes, attach copies of all support orders.

2. HEALTH INSURANCE. In support of the following insurance information, I have attached proof of health insurance coverage and cost.

Insurance Coverage: Employer Private Medicaid Medicare None
Coverage Includes: Medical  Dental Vision Prescription Other: [ADDTIONAL COVERAGE] Insurance Plan Name: [INSURANCE PLAN NAME] Policy #: [#]
Cost: $[DOLLAR AMOUNT]  Weekly Monthly Annually for Family Plan.
Cost: $[DOLLAR AMOUNT]  Weekly Monthly Annually for Individual Plan.

Child’s health insurance covered by: My Plan Other Parent’s Plan Medicaid Other: [CHILD INSURANCE PROVIDER]

3. CHILD CARE. Childcare Provider: [CHILDCARE PROVIDER] Number of Hours/Week: [#] for $[DOLLAR AMOUNT] per Hour Week Month

4. ASSETS. In support of the following asset information, I have attached all necessary documents proving the value of my assets.

Bank Accounts

Bank Name (Checking): [BANK NAME] Balance: $[DOLLAR AMOUNT]
Bank Name (Savings): [BANK NAME] Balance: $[DOLLAR AMOUNT]
Bank Name (Other): [BANK NAME] Type: [ACCOUNT TYPE] Balance: $[DOLLAR AMOUNT]

Vehicle(s)

Vehicle: Year: [YYYY] Make: [MAKE] Model: [MODEL] Value: $[DOLLAR AMOUNT]
Vehicle: Year: [YYYY] Make: [MAKE] Model: [MODEL] Value: $[DOLLAR AMOUNT]

Real Property

Type: [PROPERTY TYPE] Address: [PROPERTY ADDRESS] Market Value: $[DOLLAR AMOUNT] Mortgage: $[DOLLAR AMOUNT]
Type: [PROPERTY TYPE] Address: [PROPERTY ADDRESS] Market Value: $[DOLLAR AMOUNT] Mortgage: $[DOLLAR AMOUNT]
Type: [PROPERTY TYPE] Address: [PROPERTY ADDRESS] Market Value: $[DOLLAR AMOUNT] Mortgage: $[DOLLAR AMOUNT]

Other Assets

Details: [ASSET DETAILS] Market Value: $[DOLLAR AMOUNT]
Details: [ASSET DETAILS] Market Value: $[DOLLAR AMOUNT]

5. EXPENSES. The following is a list of my expenses and the associated costs per month.

Type Cost Type Cost
Rent $[AMOUNT] Public Transport $[AMOUNT]
Mortgage $[AMOUNT] Childcare $[AMOUNT]
Home Maintenance $[AMOUNT] School Expenses $[AMOUNT]
Electricity $[AMOUNT] Food $[AMOUNT]
Heating $[AMOUNT] Clothing $[AMOUNT]
Other Utilities $[AMOUNT] Medical $[AMOUNT]
Phone $[AMOUNT] Contributions $[AMOUNT]
Internet $[AMOUNT] Health Insurance $[AMOUNT]
Cable/TV $[AMOUNT] Life Insurance $[AMOUNT]
Car Payments $[AMOUNT] Car Insurance $[AMOUNT]
Gas (Vehicle) $[AMOUNT] Home Insurance $[AMOUNT]
Other Expenses Cost
[EXPENSE DETAILS] $[AMOUNT]
[EXPENSE DETAILS] $[AMOUNT]

6. LOANS AND DEBTS. In support of the following debt information, I have attached all necessary documents related to my debts and loans.

Debt/Loan Details: [PROPERTY TYPE] Balance: $[DOLLAR AMOUNT] Payment: $[DOLLAR AMOUNT Weekly Monthly
Debt/Loan Details: [PROPERTY TYPE] Balance: $[DOLLAR AMOUNT] Payment: $[DOLLAR AMOUNT Weekly Monthly
Debt/Loan Details: [PROPERTY TYPE] Balance: $[DOLLAR AMOUNT] Payment: $[DOLLAR AMOUNT Weekly Monthly

Under penalty of perjury, I hereby declare and affirm that the above-mentioned statement is, to the best of my knowledge, true and correct.

Affiant Signature______________________________ Date: _______________

NOTARY ACKNOWLEDGMENT

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of [STATE]
County of [COUNTY]

The foregoing instrument was acknowledged before me, [NOTARY PUBLIC NAME], on [MM/DD/YYYY], by the undersigned, [AFFIANT NAME], who is personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.

WITNESS my hand and official seal.

Signature: ________________________

(Seal)