Affidavit Of Income Expenses And Property {2}

Court Form 2 Eff. 7/1/08 IN THE COMMON PLEAS COURT OF HURON COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS : Plaintiff/Petitioner (1) : DOB : Address : : V. : Defendant/Petitioner (2)/Respondent DOB Address : : : : Date of Marriage Date of Separation Notes: This affidavit must be filed and served in accordance with Local Rules of Court. Pages 1 through 8 and page 13 must be completed and filed and served with every post-decree motion that concerns a modification of support. You will be required to provide proof of income per local rule and O.R.C. 3119.021. 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). Case No. CSEA No. JUDGE JAMES W. CONWAY MAGISTRATE BRADLEY E. SALES Affidavit of Income, Expenses and Property of (Name) I. A. Income [As defined in O.R.C. 3119.01]: Gross Yearly Income from Employment (If not known, please estimate. Husband/Father Gross Yearly Employment Income Employer Payroll Address City, State, Zip Check the Number of Paychecks per Year Year-to-date Gross Income Prior Year's Tax Refund Put "EST" after each estimated figure.) Wife/Mother G12 G24 G26 G52 G12 G24 G26 G52 Through date of Through date of Initialed Affidavit of Income, Expenses and Property Page 1 of 13 American LegalNet, Inc. www.FormsWorkflow.com B. Annual Overtime, Commissions, Bonuses (If not known, please estimate. Put "EST" after each estimated figure.) Husband/Father Year 3 is Most Recent Year 20__ Year 1 20__ Year 2 20__ Year 3 Year-to-Date This Year Through ____ Base Income Overtime, Commissions, Bonuses Year 3 is Most Recent Year 20__ Year 1 20__ Year 2 20__ Year 3 Year-to-Date This Year Through ____ Wife/Mother Base Income Overtime, Commissions, Bonuses C. Gross Self-Employment Income (If not known, please estimate. Put "EST" after each estimated figure.) Use Gross Annual Figures for Most Recent Full Year. See O.R.C. 3119.021 Business Receipts Ordinary & Necessary Business Expenses Net Business Income Husband/Father Wife/Mother D. Other Income All other income, actual or expected, including pension, social security, workers compensation, commissions, royalties, disability benefits, trust income, annuities, recurring 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/Father Per Year Describe Per Year Wife/Mother Describe Initialed Affidavit of Income, Expenses and Property Page 2 of 13 American LegalNet, Inc. www.FormsWorkflow.com E. Total Annual Income Husband/Father Wife/Mother Total gross annual income Total gross annual income Total average gross ÷ 12 = Total average gross ÷ 12 = Average monthly deductions Total net monthly income Less = Average monthly deductions Total net monthly income Less = F. Benefits of Employment (Use of company car, country club memberships, stock options, etc.) Husband/Father Benefits Values Benefits Wife/Mother Values II. A. Information Required for Support Calculation: Minor or Dependent Children of this Marriage (Include adopted children and any child of the parties who is over 19 and handicapped.) Child's Name Date of Birth Residing With B. Other Minor Children Living in My Household Child's Name Date of Birth Relationship C. Other Minor Children of Mine, Not Living in My Household Child's Name Date of Birth Relationship Initialed Affidavit of Income, Expenses and Property Page 3 of 13 American LegalNet, Inc. www.FormsWorkflow.com III. Child Support Guidelines Adjustment: Husband/Father (All Figures Per Year) Wife/Mother (All Figures Per Year) Court Ordered Child Support You Pay for Other Child(ren) in Another Case Court Ordered Spousal Support You Pay to a Former Spouse Number of Your Other Dependent Children Living With You From a Previous Marriage or Relationship Court Ordered Child Support You Receive for the Dependent Child(ren) You Indicated on Line Above Child Care Expenses You Pay for Child(ren) of this Marriage (Employment or Educational-Related) Local Income Taxes Paid or Rate of Tax where you Live or Work Self-Employment Tax (5.6% of A.G.I.) Health Insurance Premium for Children (Family Plan Cost Less Individual Plan Cost) For Post Decree Modifications Only: Current Spouse's Gross Income Number of Your Other Dependent Children Living with You from Your Present Marriage or Relationship [Excluding unadopted step-children] or: % or: % IV. Affiant's Monthly Living Expenses: List your ACTUAL expenses for your present household in the first column. Give estimated expenses if you don't have exact figures. If you expect changes soon, list your ANTICIPATEDexpenses in your household after the divorce case in the second column. 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. My Average Monthly Expenses There are now ____ Adults and _______ Children living in my present household. Actual Monthly Expenses in My Present Household I am assisted with my living expenses by: Anticipated Future Monthly Expenses in My Household The reason I expect my household living expenses to change soon is: Initialed Affidavit of Income, Expenses and Property Page 4 of 13 American LegalNet, Inc. www.FormsWorkflow.com A. Housing Rent or First Mortgage Real Estate Taxes (if not included above) Real Estate Insurance (if not included above) Second Mortgage, if any (or home equity loan) UTILITIES: · Electric (level billing or average/month) · Gas (if billed separately) · Fuel Oil/Propane · Water & Sewer · Telephone (basic monthly charge) · Water Softener · Trash Collection Telephone (average long distance) Cable Television Home Cleaning, Maintenance, Repair Lawn Service, Snow Removal Other:____________________________________ Housing Total Actual Anticipated (A) (A) 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 · Parking, Public Transit Actual Anticipated Initialed Affidavit of Income, Expenses and Property Page 5 of 13 American LegalNet, Inc. www.FormsWorkflow.com B. Other Necessary Living Expenses (Cont.) CLOTHING, ETC.: · Clothes · Dry Cleaning, Laundry · Personal Grooming Other: _________________