Adoption Affidavit To Establish Financial Ability

IN THE CHANCERY COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS IN RE: ADOPTION OF ____________________________________ ____________________________________ and ____________________________________ , Petitioner(s) ADOPTION AFFIDAVIT TO ESTABLISH FINANCIAL ABILITY Husband's Monthly Income: Gross: __________________ ; Source: ________________________________ Wife's Monthly Income: Gross: __________________ ; Source: ________________________________ Other: _________________________________ Total Income: Gross: __________________ ; Net: ________________________ Net: ________________________ Net: ________________________ NO. ____________________ Bank Accounts: Checking and Savings (Present Balances) : ___________________________ ___________________________ Monthly Expenses: Rent or House Note: Utilities/Phone, etc.: Groceries: Automobile Note: Automobile Gasoline, Insurance & Maintenance Doctor, Dentist, Health Insurance, etc. Miscellaneous: Laundry/Dry Cleaning; Haircuts/Beauty Parlor; Lunches; Enterntainment; etc. Charge Accounts: Total Monthly Expenses: _______________ ______________ ________________ ______________ ______________ ______________ ______________ ______________ ______________ I/We _______________________ and _______________________ make each oath that the information provided in this affidavit is true and correct. _______________________________ Petitioner _______________________________ Petitioner Sworn to and subscribed before me this ____ day of ________ , ______ . _______________________________ Notary Public My commission expires: ___________________________ American LegalNet, Inc. www.FormsWorkFlow.com