Fill and Sign the Affidavit Financial Form

IN THE ___________ COURT OF _______________ (County), _______________ (State) _________________________ PLAINTIFF (Name of Plaintiff) V. CAUSE NO. ______,______ _________________________ D EFENDANT (Name of Defendant) Affidavit of Financial Resources and Debt COMES NOW ________________________ (Name of Defendant) , Defendant in the above-styled and numbered cause, by and through his attorneys, and files this Affidavit of Financial Resources and Debt. 1. I, ______________________ (name of affiant ) , am a resident of _________________ (name of county) , _________________ (name of state) . 2. My net worth is approximately $ ___________ (dollar amount of net worth) , exclusive of property exempt from execution, and over and above the amount of all my debts and liabilities. 3. My net worth includes the House and Lot, located at ____________________________ ____________________________________ (street address, city, county, state, zip code) , the title to which is of record in my name in the office of ______________________________ (name of public records office) , in ________________ (name of county) , _______________ (name of state) . 4. The current fair market value of the above-described premises is $ ___________ (dollar amount of current fair market value of premises) , and such property is subject to ____________________________________________________________________________ __________________________________ (description of encumbrances like a mortgage) . _________________________________________ Printed Name & Signature of Defendant SWORN to and subscribed before me, this the ______ day of ______________, 20______. __________________________ NOTARY PUBLIC My Commission Expires: _________________________