a. Unemployed Describe your efforts to find employment, how soon you expect to be employed, and the pay you expect to receive:
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- Hector Higgins
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1 SCTON. NCOM 1 My Occupation: 2 am currently: [X all that apply] a. Unemployed Describe your efforts to find employment, how soon you expect to be employed, and the pay you expect to receive: b. mployed by: Telephone: ( ) - Business ddress: City/State/Zip: Pay Rate(Regular) Pay Period: f you are expecting to become unemployed or change jobs soon, describe the change you expect and why and how it will affect your income: Check here if you currently have more than one job. ist the information above for the second job(s) on a separate piece of paper: c. Retired. Date of Retirement: mployer from whom retired: ddress: City, State and Zip code: NOT : s you complete this ffidavit, please complete each and every line that may apply. There are some specific notes in each section to help you as you go along. f you or your child(ren) have a monthly expense that SOMON S PYS, please include the expense and specify who pays it. Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 1 of 8
2 SCTON. VRG MONTHY NCOM PRSNT MONTHY GROSS NCOM ll amounts must be MONTHY. ttach more paper if needed. tems included under "other" should be listed separately with separate dollar amounts Monthly GROSS salary or wages Monthly bonuses,commissions,allowances,ot, tips & similar pymnts Monthly business income from sources such as self-employment, partnerships,close corporation, and/or independent contracts (gross receipts minus ordinary and necessary expenses required to produce income (œ ttach sheet itemizing such income and expenses) Monthly disability benefits/ss Monthly Workers' Compensation Monthly Unemployment Compensation Monthly Pension, retirement, or annuity payments Monthly Social Security benefits Monthly limony actually received (total of 9a. nd 9b.) 9a. From this case $ 9b. From other case $ Monthly interest and dividends Monthly rental income (gross receipts less ordinary and necessary expenses required to produce income). (œttach itemization of income and expense ) Monthly reimbursed expenses and in-kind payments to the extent they reduce personal living expenses. (ttach sheet itemizing each item and amount) Monthly gains derived from dealing in property (not including nonrecurring gains) ny other income of a recurring nature (identify source): dditional ncome MONTHY DDUCTONS ll mounts must be MONTHY Monthly Mandatory Union Dues Monthly Mandatory Retirement Payments Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of THS relationship Monthly court-ordered child support actually paid for children from another relationship Monthly court-ordered alimony actually paid 26a. 26b. W-2/OTHR NCOM : f you provide us with your most current pay stub, Disability statement, Social Security income statement, or other documentation of your regular ongoing pay, we can calculate your average monthly income for you. F SF MPOYD : Please provide a complete list of all income in the last 12 months, along with a complete list of expenses and we can calculate your average monthly income for you. Please provide total monthly rental income and a detailed list of all expenses associated with this property (please specify if an expense is weekly, monthly or annual) Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 2 of 8
3 SCTON. VRG MONTHY XPNSS PRSNT HOUSHOD XPNSS f this is a dissolution of marriage case ND your expenses as listed below do not reflect what you actually pay, write "estimate" next to each estimated amount. Monthly mortgage or rent Monthly property taxes (if not included in the mortgage) Monthly insurance on residence (if not included in the mortgage) Monthly condo maintenance fees and homeowner's association fees Monthly electricity Monthly water, garbage, and sewer Monthly telephone Monthly fuel oil or natural gas (residence) Monthly repairs and maintenance Monthly lawn care Monthly pool maintenance Monthly pest control Monthly miscellaneous household Monthly food and home supplies Monthly meals outside home Monthly cable TV. Monthly alarm service contract Monthly service contracts on appliances Monthly maid service Monthly household cleaning supplies Monthly cellular service For this Section, there are 3 types of expenses: 1. For expenses that vary from month to month (like electric, water, etc.) you can use a 3-6 month average of what you have spent, or provide us with the statements and we can average it for you. 2. For expenses that never change (like rent), just list what you pay each month. 3. For Groceries and ating Out t Restaurants, please provide the amount you spend on average each WK. Please be specific Monthly gasoline PRSNT UTOMOB XPNSS How many times do you fill up each month, and how much does it cost on average, CH time? Monthly repairs and oil changes Monthly auto tags and emission testing Monthly insurance Monthly payments (leasing or financing) Monthly rentals/replacements Monthly alternative transportation Monthly tolls and parking How much did you spend on repairs in the last 12 months, and what were they? (please be specific). Do you have any major repairs currently needed? What are they are how much are they estimated to cost? (please be specific). How often to you the car(s) serviced and how much does it cost each time? For multiple cars, please list them and their individual expenses separately. We will calculate the monthly averages from the information provided. How much does each car/vehicle costs to renew the registration each year? f you have a statement detailing the vehicles covered and the premiums for each one, you may provide that and we can calculate the total monthly average. Please provide your most recent statement for each car payment made monthly. nclude Sunpass here, if applicable Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 3 of 8
4 PRSNT XPNSS for Children Common to Both Parties Monthly nursery, babysitting or day care Monthly school tuition Monthly school supplies, books and fees Please provide a statement or the WKY amount you pay. nclude any private school payments here Do you buy textbooks? How much do you spend on average each YR for back to school supplies? (i.e., in ugust and/or Jan) Monthly after school activities Monthly lunch money Monthly private lessons, tutoring or physical/occupational/speech therapy (not covered by insurance) Monthly allowances Monthly clothing and uniforms Monthly entertainment (movies, parties, etc.) Monthly health insurance Monthly medical, dental, prescriptions (nonreimbursed only) Monthly psychiatric/psychological/counselor Monthly orthodontic Monthly vitamins Monthly beauty parlor/barber shop Monthly nonprescription medication Monthly cosmetics, toiletries and sundries Monthly gifts from child(ren) to other (relatives, teachers etc.) Monthly camp or summer activities Monthly Clubs (Boy/Girl Scouts, etc.) Monthly access expenses for parenting contact Monthly miscellaneous arly earning cademy: BCMouse.com Family Wizard Please include all sports, music, etc. here. We can calculate the monthly averages from the detailed information provided. How much do spend each week, per child, during the school year? nything insurance does NOT pay. nything insurance does NOT pay. Please be specific NOT: This section is for any expenses you have for the CHDRN. Please complete each line item in this section even if it does not have a specific note attached. f possible, please list CH CHD's expenses SPRTY. PRSNT XPNSS for Children from nother Relationship (other than court-ordered child support) MONTHY NSURNC Health ns. (excluding portion for minor child(ren) of this relationship) ife insurance ife insurance Dental insurance Disability Please provide a current statement for any type of insurance for which you pay. Please specify if insurance premiums are a pre-tax payroll deduction. We can calculate the monthly averages using your statements and /or pay stubs. Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 4 of 8
5 OTHR MONTHY XPNSS NOT STD BOV Monthly dry cleaning and laundry Monthly clothing Monthly medical, dental and prescription (unreimbursed only) Monthly psychiatric, psychological or counselor (unreimbursed only) Monthly non-prescription medications,cosmetics,toiletries and sundries Monthly grooming Monthly gifts nything insurance does NOT pay. nything insurance does NOT pay. Monthly pet expenses nnual Vet: $, Monthly Food: $, Monthly Medications: $, Kenneling $, ny other expense: $ Monthly club dues and membership Monthly sports and hobbies Monthly entertainment Monthly periodicals/books/tapes/cd's Monthly vacations Monthly religious organizations Monthly bank charges/credit card fees Monthly education expenses NOT: This section is for your PRSON expenses. Please complete each line item in this section even if it does not have a specific note attached. Student oan: Student oan: Credit Card: Credit Card: Credit Card: Credit Card: MONTHY PYMNT TO CRDTORS (only when payments are currently made by YOU on outstanding balances) NM OF CRDTOR ND CCOUNT NUMBR Please list any and all creditors and how much you pay each creditor each month. Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 5 of 8
6 SCTON. SSTS & BTS B C D SSTS: Description of tem(s) Current Fair X You are requesting Judge to Keep Market Value H W Cash (on hand) $ - Cash (in banks or credit unions) Stocks/Bonds Notes: (money owed to you in writing) Money owed to you (not evidenced by a note) Real state: (Home) (Other) Business nterests utomobiles: Boats Other Vehicles Retirement Plans (Profit Sharing, Pension, R, 401(k)'s, etc.) Furniture and furnishings in home Furniture & furnishings elsewhere Refrigerator and outdoor patio furniture Collectibles (stamps, coins, guns, sports, etc.) Jewelry: NonMar ital Please provide the most CURRNT statement for CH bank account titled in your name, or for which you have signatory authority. Please provide the complete address for each property you own. f any property is located out of State, please provide the County in which it is located. Please list the year, make, model, body style and mileage and each vehicle you own. Please specify if the vehicle has any special features. Please provide all the specifications for any boat, trailer or engine Please provide all the specifications for any Motorcycle, TV or other vehicle, including year, make, model, body style, mileage and any special features that will help identify the vehicle for an accurate ND value search. Please provide the most CURRNT statement for Retirement, nvestment, Pension or Stock accounts you have. For Furniture/Furnishings please calculate garage sale/pawn shop values and provide a detailed list by room. You will not need to include anything with a value less than $100. Please do the same for all collectibles, guns and/or jewelry you or your spouse may have Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 6 of 8
7 B C D SSTS: Description of tem(s) NonMar Current Fair ital X tems you are requesting to keep Market Value H W ife insurance (cash surrender value) Sporting and entertainment (T.V. stereo, etc.) equipment Other assets: Washer/Dryer Computer Please provide the most CURRNT statement for CH policy you may have These may be included in your furniture lists, if it easier to do so. NOT: Please include NY asset worth more than $100 owned by either you or your spouse, even if you do not see if specified in this section. B C D BTS: Description of tem(s) Mortgages on real estate: Second mortgage on home Other mortgages Charge/credit card accounts uto oan: Bank/Credit Union oans Money you owe (not evidenced by a note): Other: Current Fair Marital Market Value H W For this section, please provide the most CURRNT statement for CH mortgage, line of credit, credit card, student loan, auto loan, promissory note or NY OTHR DBT titled in your name individually or jointly held with another person. Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 7 of 8
8 Contingent ssets B C Possible Marital Value H W C C C C C C Total Contingent ssets $ - C C C C C C B C D Contingent iabilities Possible Marital Value H W Total Contingent iabilities $ - Florida Family aw Rules of Procedure Form (c) Family aw Financial ffidavit Page 8 of 8
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