In divorce, legal separation, and custody cases, each side will be required to file a financial affidavit on a form provided by the court. This form has information that will help the judge make orders concerning money such as deciding the amount of alimony or child support to order. A financial affidavit is also needed at hearings where pendente lite (temporary) support or alimony is being decided. It may also be needed if either party is asking the court to appoint an attorney for the child. This booklet will help you fill out the financial affidavit form.
A different financial affidavit form is needed if you want to ask the court to waive certain fees, such as filing fees or services fees. In these cases, the form is called a "Fee Waiver." If you need help filling out the financial affidavit on the Application for Waiver of Fees, see the Legal Aid booklet, A Guide to Fee Waivers.
Both affidavits are under oath (meaning you swear that what you wrote is true). So if you file both forms, you should check to make sure you use the same total amount to calculate the weekly and monthly numbers. (Note: the financial affidavit form discussed below is based on WEEKLY numbers while the fee waiver form is based on MONTHLY. Therefore, your numbers should be different on the two forms.) For example, You spend $520 a year on electricity: Your weekly expense would be $10 which you would put on the Financial Affidavit form; while your monthly expense of $43.33 would go on the Fee Waiver form.
How to file a financial affidavit
Step 1. Get several Financial Affidavit forms. Get at least one extra to use as a rough draft. You can get the blank forms at the court or from the state's judicial website www.jud.ct.gov. Or you can link directly to the forms: JD-FM-6 (fillable) JD-FM-6 - (Fillable with automatic calculations)
Step 2. Gather your pay stubs, bills recently received or paid, your checkbook, and bank account statements. You will need to look at these items as you complete your financial affidavit form.Step 3. Complete the form and take it to a notary or attorney.
REMEMBER, do not sign the form until you are in front of the notary or an attorney. If you sign the form in court, you can ask any attorney or clerk to witness your signature.
Step 4. Make copies of the form for yourself, the other party, andLooking at SAMPLE FORM 1 (if you work) or FORM 1A (if you receive public benefits) begin to fill in the information on your blank form. You must give the docket number, name of the case, the address of the court, and the date. In the section "Name of Affiant", put your name. Then, check off whether you are the plaintiff (the person who complained and brought the lawsuit) or the defendant (the person who is being sued and must defend). In the samples in this book, you are noted as the plaintiff. However, if this is an existing case and you are the defendant in it, you must put a check next to "defendant."
Continue filling in the following information:
1. WEEKLY INCOME
A. From Principal Employment
If you are working, fill in your average gross (before taxes) weekly income for the past 13 weeks. You can figure this out from your wage stubs by adding your last 13 weekly gross income amounts and dividing by 13. If you are not working, put "none" or 0."
Gross Wage is your weekly wages before any deductions.
Deductions. Write down amounts that are taken from your wages. These include federal tax, state tax, FICA, wage attachments, health insurance, union dues, etc.
Total Deductions. Add up all your deductions.
Net Wages is your take-home pay. (Gross wages minus deductions)
B. All Other Income
If you have any other regular income such as from a second job, pensions, state welfare, food stamps, unemployment compensation, alimony, child support, etc., you must note it here. Then fill in gross, deductions, and net as you did for "A" above.
If you get money from your spouse sometimes in the form of alimony or child support, but you cannot count on getting this money, you can make a note as is done in Sample 1.
Total Net Weekly Income (Box A):
Add the net weekly wage and income from A and B above and write it in the dark box marked "A".
2. WEEKLY EXPENSES
Be sure to compute your expenses on a weekly basis. (NOTE: This weekly amount is different from the fee waiver affidavit form where you report expenses on a monthly basis.) If a bill is paid monthly, divide the monthly expense by 4.3 to come up with a weekly expense (there are 4.3 weeks in a month). If a bill is paid yearly, divide the yearly expense by 52 to come up with the weekly expense.
1. Rent or Mortgage. Put the amount you pay for your home. If you have a mortgage which includes taxes, and you can't separate the two, put both under mortgage.
2. Real Estate Taxes. Weekly cost, if not included in "1" above.
3. Utilities. Weekly average. (If you are unsure of the exact amount, write "estimate" after the amount.)
4. Food. Weekly average. (If you are unsure of the exact amount, write "estimate" after the amount).
5. Clothing. Figure out how much you spend each year and divide by 52. (If you are unsure of the exact amount, write "estimate" after the amount).
6. Transportation. Include all costs to keep your car running. Write the costs under the appropriate categories of gas/oil, repairs or car loan. (For example, if you spend $15 per week on gas, and spent $300 in the last 15 weeks on repairs and oil, then the repairs average $20 per week.) If you are using public transportation, put the amount you generally spend on this as weekly expense). List car insurance premiums under the next category, Insurance Premiums.
7. Insurance Premiums. On a weekly basis. Include health insurance only if it is not already listed as a pay deduction.
8. Medical and Dental Expenses. Figure out how much you spend on medical and dental bills and prescriptions in one year and divide by 52. Do not include insurance or expenses reimbursed by insurance. Do include co-payments for doctor or hospital visits and for prescription drugs.
9. Child Support. Any court-ordered child support you pay should be stated here (not child support you are receiving).
10. Alimony. Write the amount which the court ordered you to pay.
11. Daycare. Write how much you spend weekly on child care. Include cost of nursery school, baby-sitters, after school care, etc.
12. Other. Include personal and other miscellaneous expenses (weekly). Examples include: diapers, laundry, haircuts, cigarettes, church offerings, children's school expenses, school and lunches, toys, recreation, video rentals, toiletries (such as shampoo, contact lens fluid, make-up), newspapers, stamps, etc.
Total Weekly Expenses: Add up your expenses and write in this amount. Then, compare the total to your Weekly Income. Most likely your expenses will be greater than your income. If your income is greater, are you really saving that amount each week? If not, now is a good time to find out where your money is going, or to figure how much you will need in support from your ex-spouse to meet your expenses.
3. LIABILITIES
Liabilities are debts you owe. Think of every person or company you owe money to and list them here. Don't forget to include such things as overdue utility bills, tax bills, personal loans, credit cards, outstanding medical bills, etc.
Creditor is the person or company to whom you owe money.
Under Amount of Debt, state the original debt owed.
Balance Due is the amount you still owe.
Under Date Debt Incurred, if you are not sure of the exact date you got the debt, just put the month and year or just the year. If it is an open account such as MasterCard or Visa, you do not need to put a date.
Weekly Payment is the amount you pay on the debt every week. (Again, divide your monthly payment by 4.3 to get the weekly amount). If you are not making any payments because you have not been able to do so, write "0" on this line. If you have already put your auto loan payments under Weekly Expenses, you should not put them down again.
C. Total Liabilities is the sum or total of the Balance Due column.
D. Total Weekly Liability Expense is the sum total of the Weekly Payments column.
4. ASSETS
Here you must list your assets; that is, any valuable property you own. You may estimate the value if you don't have the exact figures.
A. Real Estate.
Value. Place an estimated value of your home if it were sold today. If unsure, write "unknown".
Mortgage is the amount still owed on the home and on any liens on the property.
Equity is how much of the home you own. Your equity is the difference between the estimated value of your home and all mortgages and liens. If you own only half-interest in the house, put "half equity" and fill in value of your share.
B. Motor Vehicles.
State what car or cars you own by year, make and model.
Value is the book or present value of your car. You can look up the value in Kelly's Blue Book or on the web at www.kbb.com or another website www.nada.com.
Loan Balance is the amount still owed on any car loans.
Equity is the value of your car minus the loan balance. For example, if the value of the car is $2000 and the loan balance is $1500, then you own $500 equity in your car.
C. Other Personal Property.
If you own valuable jewelry or antiques, a boat, a motorcycle, etc., list the items and their value if you were to sell them today, not what you paid for them. Used furniture, except for antiques, has a low resale value. (If you own only furniture and clothing that are not especially valuable, write "household goods-nominal value" and put a dash(--) where it says "Total Value").
D. Bank Accounts.
If you have money in a bank account, state the type of account and the amounts on deposit. (Note: If you keep a checking account only for paying bills, write "checking account - only for paying bills" and list the average monthly balance where it says "Total Bank Accounts").
E. Stocks, Bonds, Mutual Funds.
If you own any, write the name, number of shares, type and value or put "0" or "--".
F. Insurance.
This section is for life insurance you own on your own life or on someone else’s life. State the name of the insured person and the name of the company that issued the policy. There are two types of life insurance: whole life and term.
A term life insurance policy does not build cash value from which you can borrow. It only pays money when the person insured dies and is never paid up. The policy is cancelled when you stop making payments.
A whole life insurance policy requires you to make monthly payments for a specified number of years. At the end of that time, the policy is paid for and no more monthly payments are needed. The policy will have a cash value from which you can borrow.
Face Amount is the amount policy will pay if the insured person dies.
Cash Value is the amount you would receive were you to cancel a whole life policy. If you don’t know the cash value, call your insurance company or agent for the information. (Note: If you have term insurance the cash value is "0".) If you have borrowed on the policy, amount of the loan is the amount you borrowed that you have not yet repaid. (That is, the amount you still owe, not including interest). You may have to call the insurance company for this information if it is not on your monthly statement.
Calculate and write in the total value of the insurance.
G. Deferred Compensation Plans.
These are any pension or retirement plans, including IRAs or KEOGH plans. Total Value is what they are worth at the time you are filling out the affidavit.
If you have a 401K-type (defined contribution) pension plan, you should be receiving statements of the value of your interest in the plan at least once a year. Use the value as of the last statement that you received.
If you have a traditional pension plan based on your average salary and the number of years you worked (defined benefit plan), you do not receive statements as to the current value of your interest in the plan. You will have to ask your plan administrator to provide you with this information. Some plan administrators will not provide a current value, in which case you should write "unknown" in the space provided.
H. All Other Assets.
In this section, write down any other valuable items you might own. If none, write "0" for total value.
I. Total.
Add up the amounts you have written down for all your assets in parts A-H and write the total in the dark box.
(E. Total Cash Value of All Assets.)
5. HEALTH INSURANCE
If you have health insurance, put down the name and address of your health and/or dental insurance carrier, your policy number, and the names of the persons covered by the policy here.
SUMMARY
Transfer the totals from boxes A - E to Sections 1, 2, 3 and 4 on the back.
CERTIFICATION
You must swear to the truth of your financial statement and sign it in front of a notary public or an attorney, who must then sign that it was sworn to and signed in front of him/her.
You have completed the financial affidavit. Make photocopies and give the original to the court clerk, one copy to the opposing attorney, and keep one for yourself. You may have to refer to your financial affidavit during a hearing. Or, you may need to periodically update your financial affidavit--you can use the existing one as a starting point.
Blank Forms: You can get the form on the web from state's judicial web site www.jud.ct.gov or link directly to the forms: JD-FM-6 (fillable) JD-FM-6 - (Fillable with automatic calculations)
Statewide Legal Services: (860) 344-0380 (Central Connecticut and Middletown area) 1-800-453-3320 (All other regions)
This document was produced by the Legal Assistance Resource Center of CT in cooperation with Connecticut Legal Services, Greater Hartford Legal Aid, New Haven Legal Assistance Association, and Statewide Legal Services.
The information in this document is based on the laws in CT as of August 2007. We hope that the information is helpful. It is not intended as legal advice for an individual situation. If you need further help and have not done so already, please call Statewide Legal Services (see above) or contact an attorney.
Copyright: August 2007