Florida Family Law Financial Affidavit

Verified Statement Identifying Marital and Non-Marital Assets

Date of Commencement of action:

Client Information: Petitioner or Respondent

Name:

Address:

Social Security No:    Date of Birth:

Telephone No: (W)    (H)

Present Employer:

Position:

SPOUSE: Petitioner or Respondent

Name:

Address:

Social Security No:    Date of Birth:

Telephone No: (W)    (H)

Present Employer:

Address:

Position:

MARITAL INFORMATION

Date of Marriage:    City/State:

Children - Name(s), Birthday, Age, Residing With

1.

2.

3.

4.

5.

6.

7.

8.

LIQUID ASSETS

Cash not in Financial Institution - Amount:

Location of Cash not in Financial Institution:

CASH IN BANK OR AT FINANCIAL INSTITUTION

Total Bank Accounts:

FEDERAL/STATE/CITY/MUNICIPALITY OR OTHER GOVERNMENT SECURITY OR OBLIGATION

SECURITIES PUBLICLY TRADED

SECURITIES NOT PUBLICLY TRADED

OTHER INVESTMENTS

NOTES, ACCOUNTS RECEIVABLE

1.

2.

LIFE INSURANCE

REAL ESTATE

1. Homestead:

Address:

Legal Description: Lot Block

Subdivision:

Other Description:

Market value $ based upon:

Subject to the following encumbrance(s):

Contract for deed with balance $

First Mortgage with balance $

Second Mortgage with balance $

Equity Loan with balance $

Improvement Loan balance $

Title held in name(s) of:

Mortgagees Phone #:

2. Other Real Estate:

Address:

Legal Description: Lot Block

Subdivision:

Other Description:

DEFERRED COMPENSATION PLANS

How many years to retirement and/or distribution:

DEFINED BENEFIT PLAN

Plan Name: Plan #:

Plan Administrator: % of Vesting:

Number of Years to 100% Vesting: Present Value:

Funds Location:

Valuation Method:

DEFINED CONTRIBUTION PLAN

Plan Name: Plan #:

Plan Administrator: % of Vesting:

Number of Years to 100% Vesting: Present Value:

Funds Location:

Valuation Method:

IRA'S

Location of Funds: Account #:

Present Value: Maturity Date:

Rate of Interest

SEP's or KEOUGH's

Location of Funds: Account #:

Present Value: Plan Administrator:

Loans:

PERSONAL PROPERTY

Automobiles and/or Trucks

Make, Model and Year:

Current Amount Financing:

Loan Financing:

Current Value:

Valuation Method:

Automobiles and/or Trucks

Make, Model and Year:

Current Amount Financing:

Loan Financing:

Current Value:

Valuation Method:

Recreational Vehicles (Boats, Bicycles, Motorcycles, Snowmobiles, etc.)

Make, Model and Year:

Current Amount Financing:

Loan Financing:

Current Value:

Valuation Method:

HOUSEHOLD GOODS AND FURNISHINGS

JEWELRY

OTHER PROPERTY

List any items with a value of $300 or more, including but not limited to, antiques, heirlooms, guns, stereo equipment, televisions & video equipment, collections or furniture:

Basis for Description Value Value Claimed Location

Other items, attach schedules as necessary.

MISCELLANEOUS PROPERTY

Patents, Trademarks, Copyrights and Royalties

OWNED BUSINESS INTERESTS

SOLE PROPRIETORSHIPS

Proprietorship Name:

Business Location:

Type of Business:

% of Ownership: Years Established:

Last Year Tax Return Filed: Value (est.)

Valuation Method:

Buy-Sell Agreements: Yes No

PARTNERSHIP - General or Limited (specify)

Partnership Name:

Business Location:

Type of Business:

% of Ownership: Years Established:

Last Year Tax Return Filed: Value (est.)

Valuation Method:

Buy-Sell Agreements: Yes No

CORPORATIONS - Sub S OR C (specify)

Name:

Business Location:

Type of Business:

% of Ownership:

Years Established: Last Year Tax Return Filed: Value (est.)

Valuation Method:

Buy-Sell Agreements: Yes No

TRUSTS

PERSONAL PROPERTY HELD FOR YOU BY ANOTHER

(Including cash and negotiable securities)

NON-MARITAL PROPERTY

LIABILITIES

Debts (Credit cards)

Dated:

Subscribed and sworn to before me this day of , 20 .

Sign Now