Affidavit Of Financial Information

Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: [ ] Self [ ] Petitioner [ ] Respondent State Bar Number: For Clerk's Use Only ARIZONA SUPERIOR COURT, COUNTY OF YAVAPAI Case No. Petitioner ATLAS No. 1300DO AFFIDAVIT OF FINANCIAL INFORMATION Respondent Affidavit of (Name of Person Whose Information is on this Affidavit) IMPORTANT INFORMATION ABOUT THIS DOCUMENT WARNING TO PARTIES: This Affidavit is an important document. You must fill out this Affidavit completely, and provide accurate information. You must provide copies of this Affidavit and all other required documents to the other party and to the judge. I have read the following document and know of my own knowledge that the facts and financial information stated below are true and correct, and that any false information may constitute perjury by me. I also understand that, if I fail to provide the required information or give misinformation, the judge may order sanctions against me, including assessment of fees and expenses under Rule 31. Date Signature of Person Making Affidavit Superior Court of Arizona in Yavapai County Jan 2010 Page 1 of 8 Aff.Fin.Info American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO INSTRUCTIONS 1. Complete the entire Affidavit in black ink. If the spaces provided on this form are inadequate, use separate sheets of paper to complete the answers and attach them to the Affidavit. Answer every question completely! You must complete every blank. If you do not know the answer to a question or are guessing, please state that. If a question does not apply, write "NA" for "not applicable" to indicate you read the question. Round all amounts of money to the nearest dollar. 2. You must provide the other party with copies of the following: A. Proof of your year to date income from all sources, including your two most recent pay stubs. B. Complete copies of your federal income tax returns for the last three years with all schedules and attachments. C. All W-2 and 1099 forms from all sources of income for the last three years. D. If self-employed, a member of a partnership, or a shareholder of a closely held corporation, complete copies of the business federal income tax returns for the last three years with all schedules and attachments. [ ] YES [ ] NO I have provided the other party with copies of the documents described above. If no, explain your answer. [ ] YES [ ] NO [ ] YES [ ] NO 2. 3. I attached copies of my two (2) most recent pay stubs. I attached copies of my federal income tax return for the last three (3) years, and I attached my W-2 and 1099 forms from all sources of income. 1. GENERAL INFORMATION: A. Name: Date of Birth: B. Current Address: C. Date of Marriage: Date of Divorce: D. Last date when you and the other party lived together: E. Full name(s) of child(ren) common to the parties (in this case date(s) of birth, and Social Security Number(s) (last 4 digits only): Name Date of Birth Last Four Digits of Social Security Number The name, date of birth, relationship to you, and gross monthly income for each individual who lives in your household: Name Date of Birth Relationship to you Income F. Superior Court of Arizona in Yavapai County Jan 2010 Page 2 of 8 Aff.Fin.Info American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO G. Any other person for whom you contribute support: Name Age Relationship Reside With to You You (Y/N) Court Order to Support (Y/N) H. 2. Attorney's Fees paid in this matter $ . Source of funds EMPLOYMENT INFORMATION: A. Your job/occupation/profession/title: Name and address of current employer: Date employment began: How often are you paid: B. C. [ ] Weekly [ ] Every other week [ ] Monthly [ ] Twice a month [ ] Other If you are not working, why not? Previous employer name and address: D. E. Previous job/occupation/profession/title: Date previous job began: Date previous job ended: Reason you left job: Gross monthly pay at previous job: $ Total gross income from last three (3) years' tax returns. Year 20 $ Year 20 $ Year 20 $ Your total gross income from January 1 of this year to the date of this Affidavit (yearto-date income): $ 3. YOUR EDUCATION/TRAINING: List name of school, length of time there, year of last attendance, and degree earned: A. High School: B. College: C. Post-Graduate: D. Occupational Training: YOUR GROSS MONTHLY INCOME: · List all income you receive from any source, whether private or governmental, taxable or not. · List all income payable to you individually and all non-wage income payable jointly to you and your spouse. · Use a monthly average for items that vary from month to month. · Multiply weekly income by 4.33 to arrive at the monthly total. Multiply biweekly income by 2.165 to arrive at the monthly total. 4. Superior Court of Arizona in Yavapai County Jan 2010 Page 3 of 8 Aff.Fin.Info American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO A. Gross salary/wages per month $ · Attach copies of your two most recent pay stubs. Rate of pay $ per [ ] hour [ ] week [ ] month [ ] year Expenses paid for by your employer: 1. Automobile provision or allowance 2. Auto expenses, such as gas, repairs, insurance 3. Lodging 4. Other (explain) Commissions/ bonuses Tips Self-employment income (see below) Social Security benefits Worker's compensation and/or disability income Unemployment compensation Gifts/ prizes Payments from prior spouse Rental income (net after expenses) Contributions to household living expense by others Other (explain) (Include dividends, pensions, interest, trust income, annuities or royalties.) TOTAL: B. C. D. E. F. G. H. I. J. K. L. M. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 5. SELF-EMPLOYMENT INCOME (if applicable): If you are self-employed, a member of a partnership, or a shareholder of a closely held corporation, provide the following information: Name, address and telephone no. of business: Type of business entity: State and date of incorporation/formation: Nature of your interest: Nature of business: Percent ownership: Number of shares of stock: Total issued and outstanding shares: Gross sales/revenue last 12 months: Superior Court of Arizona in Yavapai County Jan 2010 Page 4 of 8 Aff.Fin.Info American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO INSTRUCTIONS Both parties must answer item 6 if either party asks for child support. These expenses include only those expenses for children who are common to the parties, which means one party is the birth/ado