Pre Decree Affidavit Of Income Expenses And Property Of

IN THE COMMON PLEAS COURT OF SUMMIT COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS CASE NO. Plaintiff SETS NO. Address JUDGE Marital Residence Attorney Atty Address Atty Phone Yes No Phone: ___________________ MAGISTRATE vs. Defendant Address Marital Residence Attorney Atty Address Atty Phone Yes No Phone: Pre Decree Affidavit of Income, Expenses, And Property of _____________________ (Your Name) Date of Marriage Date of Separation Note:In accordance with Local Rule 2.02 of this court, this affidavit must be filed and served upon the other party with every complaint for divorce, legal separation and annulment. It must also be filed at the time of the answer or temporary hearing, whichever comes first. You are under a continuing legal duty to file an updated version of this form if you learn of any additional information. If more space is needed, attach additional page(s). I. Information Required for Support Calculation: A. Minor or Dependent Children of this Marriage (Include adopted children and any child of the parties who is over 18 and handicapped) Date of Birth Male / Female Age Residing with Initialed Financial Disclosure Affidavit Page 1 American LegalNet, Inc. www.FormsWorkFlow.com B. Other Minor Children Living in My Household Child's Name Date of Birth Male / Female Age Relationship C. Other Minor Children of Mine, Not Living in My Household Child's Name Date of Birth Male / Female Age Residing with II. Child Support Guideline Adjustment: Father (All Figures Per Year) Court ordered child support you pay for other child(ren) in another case Case number where support ordered Date of initial order Court ordered spousal support you pay to a former spouse Number of your other dependent children living with you from a different marriage or relationship Is the other parent of any of your other children also in your household? If yes, how many children do you have with the parent who lives with you? Court ordered child support you receive for the dependent child(ren) you indicated on line above (other parent not in home) Child care expenses you pay for child(ren) of this case (employment or education-related) Local income taxes paid or rate of tax where you live or work Private health insurance cost to you for children (family plan cost less individual plan cost) Total Number of dependents covered by your Insurance $ or % $ or % Mother (All Figures Per Year) Yes No Yes No Initialed Financial Disclosure Affidavit Page 2 American LegalNet, Inc. www.FormsWorkFlow.com III. Income [as defined in O.R.C. 3119.01(C)]: A. Gross Yearly Income from Employment (If not known, please estimate. Put "EST" after each estimated figure.) Husband Gross yearly employment income Employer Payroll address City, state, zip Check the number of paychecks per year 12 24 26 52 Gross yearly employment income Employer Payroll address City, state, zip Check the number of paychecks per year Wife 12 24 26 52 Year-to-date gross income Prior year's tax refund Through date of Year-to-date gross income Prior year's tax refund Through date of B. Annual Overtime, Commissions, Bonuses Husband Year 3 is Most Recent Year _____ Year 1 _____ Year 2 _____ Year 3 Y-T-D This year through: Base Income Overtime, commission, bonuses (If not known, please estimate. Put "EST" after each estimated figure.) Wife Year 3 is Most Recent Year _____ Year 1 _____ Year 2 _____ Year 3 Y-T-D This year through: Base Income Overtime, commission, bonuses C. Gross Self-Employment Income (If not known, please estimate. Figures for Most Recent Full Year. See O.R.C. 3119.01(C) Put "EST" after each estimated figure.) Use Gross Annual Husband Business receipts Ordinary & necessary business expenses Net business income Business receipts Ordinary & necessary business expenses Net business income Wife Initialed Financial Disclosure Affidavit Page 3 American LegalNet, Inc. www.FormsWorkFlow.com D. Other Income All other income, actual or expected, including pension, social security, workers compensation, commissions, royalties, disability benefits, trust income, annuities, reoccurring capital gains, unemployment benefits, rents, expense-sharing, dividends, interest, AFDC, SSI, food stamps, spousal support received from a prior spouse, etc. (If not known, please estimate. Put "EST" after each estimated figure.) Husband Describe Per Year Describe Wife Per Year E. Total Annual Income Husband Total gross annual income Total average gross monthly income Average monthly deductions Total net monthly income 12 = Less = Total gross annual income Total average gross monthly income Average monthly deductions Total net monthly income Wife 12 = Less = F. Benefits of Employment (Use of company car, country club memberships, stock options, etc.) Husband Wife Benefits Values Benefits Values Initialed Financial Disclosure Affidavit Page 4 American LegalNet, Inc. www.FormsWorkFlow.com IV. Affiant's Monthly Living Expenses List your ACTUAL expenses for your present household. Give estimated expenses if you don't have exact figures. If you expect changes soon, list your ANTICIPATED expenses in your household after the divorce case. Explain why you expect your expenses to change. Also, if you are living with your parents or someone is helping you with your living expenses, please explain. The reason I expect my household living expenses to change soon is: Actual or Anticipated (Circle One) There are now present household. A. Housing Rent First mortgage adults and children living in my Actual or Anticipated (Circle One) I am assisted with my living expenses by: B. Other Necessary Living Expenses FOOD, ETC.: Grocery (include food, paper & cleaning products, toiletries, etc.) Restaurant TRANSPORTATION, ETC. Car loan or lease Gasoline Car maintenance & repair Real estate taxes (if not included above) Real estate insurance (if not included above) Second mortgage, if any UTILITIES: Electric (level billing or avg/month) Gas (if billed separately) Fuel oil/propane Water & sewer Telephone: house Telephone: cell Water softener Trash collection Cable television Home cleaning, maintenance, repair Lawn service, snow removal Other: Housing total (A) Parking, public transit CLOTHING, ETC.: Clothes Dry cleaning, laundry PERSONAL GROOMING Other: Other necessaries total (B) Initialed Financial Disclosure Affidavit Page 5 American LegalNet, Inc. www.FormsWorkFlow.com C. Child-Related Expenses Child care, work-or education-related Clothing School lunches Children's allowances Extra-curricu