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DOMESTIC RELATIONS FINANCIAL AFFIDAVIT INSTRUCTIONS EFFECTIVE JANUARY 1, 2007 The law in Georgia concerning calculation of child support has changed. All parties, including those acting without attorneys (pro se litigants) are must file a financial affidavit as required by Uniform Superior Court Rule 24.2 (see below). This must be filed at the time that the divorce complaint is filed. Instructions and worksheets to calculate child support, which are required to be filed in any divorce involving children online at http://www.georgiacourts.org/csc/ Documents which support the proposed calculation must also be filed. Your case will not be set for a hearing or sent to the judge until both parties have submitted the required affidavit, worksheets and documents. UNIFORM SUPERIOR COURT RULE 24.2 Financial data required; scheduling and notice of temporary hearing. At the time of filing any action for temporary or permanent child support, alimony, equitable division of property, modification of child support or alimony or attorneys fees, the filing party shall file with the Clerk of Court the affidavit specifying his or her financial circumstances in the form set forth herein and, in cases involving child support, the schedules required by O.C.G.A. § 19-6-15 (effective January 1, 2007, as thereafter amended or revised), and shall serve the same upon the opposing party. In protective order actions filed under OCGA § 19-13-1, et. seq. and in other emergency actions, the affidavit and schedules may be filed and served on or before the date of the hearing or at such other time as the court orders, and shall not be required at the time of filing of the action. Notice of the date of any temporary hearing shall be served upon the adverse party at least 15 days before the date of the hearing, unless otherwise ordered by the court. The opposing party shall serve the affidavit specifying his or her financial circumstances in the form set forth herein and the schedules, where applicable, and shall file with the Clerk of Court and exchange this information with the opposing party: at least five days prior to any temporary hearing; at least five days prior to any court ordered mediation; or with his or her answer or thirty days after service of the complaint, whichever first occurs, if no application for a temporary award is made ---PAGE BREAK--- and the parties do not participate in mediation prior to trial. Any amendments to the affidavits or schedules shall be exchanged at least 10 days prior to hearing or trial. Each party shall submit the proposed worksheet required by O.C.G.A. § 19-6-15 (effective January 1, 2007 and as amended or revised thereafter) at the time of hearing or trial. On the request of either party, and upon good cause shown to the court, the affidavits, worksheets, schedules, and any other financial information may be sealed, upon order of the court. No social security numbers or account numbers shall be included in any document filed with the Court. Failure of any party to furnish the above financial information, in the discretion of the court, may subject the offending party to the penalties of contempt and may result in continuance of the hearing until such time as the required financial information is furnished or such other sanctions or remedies deemed appropriate in the court’s discretion. The affidavit shall be under oath and in substantially the following form: [FORM FOLLOWS] ---PAGE BREAK--- Page 3 In the S uperio r Court of Do uglas County, Ge orgia Plaintiff vs Civil Action Defendant DOM ESTIC RELATIO NS FIN ANCIAL AFFIDAVIT 1. AFFIANT’S Age Spouse’s Name: Age Date of Marriage: Date of Separation Names and birth dates of children for whom support is to be determined in this action: Name Date of Birth Reside s with Names and birth dates of affiant’s other children: Name Date of Birth Reside s with 2. SUMMARY OF AFFIANT’S INCOME AND NEEDS Gross m income (from item 3A) $ Net income (from item 3C ) Average m expenses (item 5A) $ payments to creditors + Total m expe nses a nd paym ents to creditors (item 5C) Instruction Sheet Page # 1 & 2 ---PAGE BREAK--- Page 4 3. A. AFFIANT’S GROSS INCOME (complete this section or attach Child Support Schedule A) (All incom e mu st be ente red bas ed on m avera ge rega rdless of date of re ceipt.) Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS Comm issions, Fees, Tips $ Income from self-employment, partnership, close corporations, and independent contracts (gros s receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS Bonuses Overtime Payments $ Severance Pay $ Recurring Income from Pensions or Retirement Plans $ Interest and Dividends $ Trust Income $ Income from Annuities $ Capital Gains $ Social Se curity Disab ility or Retirem ent Ben efits Workers’ Compensation Benefits Unemployment Benefits $ Judgments from Personal Injury or Other Civil Cases $ Gifts (cash or other gifts that can be converted to cash) $ Prizes/Lottery Winnings $ Alimony and maintenance from persons not in this case $ Assets which are used for su pport of fa mily $ Fringe Benefits (if significantly reduce living expenses) $ Any other income (do NOT include means-tested Public assistance, such as TANF or food stamps) $ ---PAGE BREAK--- Page 5 GROSS INCOME $ B. Affiant’s Net Income from employment (deducting only state and federal taxes and FICA) $ Affiant’s pay period weekly, etc.) Number of exemptions claimed 4. ASSETS (If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion under the appropriate spouse’s column and state the amount and the basis: pre-marital, gift, inheritance, source of funds, etc.). Description Value Separate Asset of the Husband Separate Asset of the Wife Basis of the Claim Cash $ Stocks, bonds $ CD’s/Money Market Accou nts $ Bank Accou nts (list each account) $ $ $ Retirement Pensions, 401K, IRA, or Profit Sharing $ Money owed you $ Tax Refund owed you $ Real Es tate home $ debt owed $ other $ debt owed $ Automobiles/Vehicles Vehicle 1 $ debt owed $ Vehicle 2 $ ---PAGE BREAK--- Page 6 debt owed $ Life Insurance (net cash value): $ Furniture/furnishings $ Jewelry $ Collectibles $ Other A ssets $ $ $ Total Assets $ 5. A. AVERAGE EXPENSES HOUSEHOLD Mortgage or rent payments $ Cable TV $ Property taxes $ Misc. household and gro cery Items $ Homeowner/Renter Insurance $ Meals outside the home $ Electricity $ Other $ W ater $ AUTOMOBILE Gas oline a nd oil $ Garbage and Sewer $ Repairs $ Telephone: residential line $ Auto tags and license $ cellular telephone $ Insurance $ Gas $ OTHER VEH ICLES(boats, trailers, RVs, etc.)Gasoline and oil $ Repairs and maintenance $ Repairs $ Lawn Care $ Tag ad License $ Pest Control $ Insurance $ ---PAGE BREAK--- Page 7 CHIL DRE N’S EXPENSES AFFIANT’S OTHER EXPENSES Child care (total cost) $ Dry cleaning/laundry $ School tuition $ Clothing $ Tutoring $ Medical, dental, prescription (out of pocket/uncovered expenses) $ Private lessons (e music, dance) $ Affiant’s gifts (special holidays) $ School supplies/expenses $ Entertainmen t $ Lunch Money $ Recre ational Expense s fitness) $ Other Educational Expen ses (list) Vacations $ $ Travel Expenses for Visitation $ $ Publications $ Allowance $ Dues, clubs $ Clothing $ Religious and charities $ Diapers $ Pet expenses $ Med ical, dental, prescription (out of po cket / uncovered expe nses) $ Alimony paid to former spouse $ Grooming, hygiene $ Child support paid for other children $ Gifts from children to others $ Date of initial order $ Entertainment $ Other (a ttach sheet) $ Activities (including extra-curricular, school, religious, cultural, etc.) $ Summer Cam ps $ OTHER INSURANCE Health $ $ Child(ren)’s portion: $ $ ---PAGE BREAK--- Page 8 Dental $ $ Child(ren)’s portion: $ $ Vision $ $ Child(ren)’s portion: $ $ Life Relationship of Beneficia ry: $ $ Disability $ $ Other(specify $ $ TOTAL ABOVE EXPENSES $ B. PAYMENTS TO CREDITORS (please check one) To Whom: Balance Due Payment Joint Plaintiff Defendant TOTAL MO PAYMENT S TO CREDITO RS: $ C. TOTAL MO EXPEN SES: $ This day of Nota ry Pub lic Affiant ---PAGE BREAK--- Page 9