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Financial Declaration Form

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Financial Declaration

Superior Court of Washington, County of .

In re:

Petitioner/s (person/s who started this case):

And Respondent/s (other party/parties):

No.

Financial Declaration of

(FNDCLR)

Financial Declaration

1. Your personal information

Name:

Highest year of education you completed:    Your job/profession is:

Are you working now?

Yes. List the date you were hired (month / year):

No. List the last date you worked (month / year):

What was your monthly pay before taxes: $

Why are you not working now?

2. Summary of your financial information

(Complete this section after filling out the rest of this form.)

1. Total Monthly Net Income (copy from section 3, line C. 3.) $

2. Total Monthly Expenses After Separation (copy from section 7, line I.) $

3. Total Monthly Payments for Other Debts (copy from section 9) $

4. Total Monthly Expenses + Payments for Other Debts (add line 2 and line 3) $

3. Income

List monthly income and deductions below for you and the other person in your case. If your case involves child support, this same information is required on your Child Support Worksheets. If you do not know the other person’s financial information, give an estimate.

Tip: If you do not get paid once a month, calculate your monthly income like this: Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2

A. Gross Monthly Income (before taxes, deductions, or retirement contributions)

You

Monthly wage / salary

Income from interest / dividends

Income from business

Spousal support / maintenance received (Paid by: )

Other income

Total Gross Monthly Income (add all lines above)

Total gross income for this year before deductions (starting January 1 of this year until now)

Other Party

B. Monthly Deductions

You

Income taxes (federal and state)

FICA (Soc.Sec. + Medicare) or self-employment taxes

State Industrial Insurance (Workers’ Comp.)

Mandatory union or professional dues

Mandatory pension plan payments

Voluntary retirement contributions

Spousal support / maintenance paid

Normal business expenses

Total Monthly Deductions (add all lines above)

Other Party

C. Net Monthly Income

You

1. Total Gross Monthly Income (from A above)

2. Total Monthly Deductions (from B above)

3. Net Monthly Income (Line 1 minus Line 2)

Other Party

4. Other Income and Household Income

Tip: If this income is not once a month, calculate the monthly amount like this: Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2

A. Other Income (Do not repeat income you already listed on page 2.)

You

Child support received from other relationships

Other income (From: )

Other income (From: )

Total Other Income (add all lines above)

Other Party

B. Household Income (Monthly income of other adults living in the home)

Your Home

Other adult’s gross income (Name: )

Other adult’s gross income (Name: )

Total Household Income of other adults in the home (add all lines above)

Other Party’s Home

5. Disputed Income

If you disagree with the other party’s statements about anyone’s income, explain why the other party’s statements are not correct, and your statements are correct:

6. Available Assets

List your liquid assets, like cash, stocks, bonds, that can be easily cashed.

Cash on hand and money in all checking & savings accounts $

Stocks, bonds, CDs and other liquid financial accounts $

Cash value of life insurance $

Other liquid assets $

Total Available Assets (add all lines above)

7. Monthly Expenses After Separation

Tell the court what your monthly expenses are (or will be) after separation. If you have dependent children, your expenses must be based on the parenting plan or schedule you expect to have for the children.

A. Housing Expenses

Rent / Mortgage Payment

Property Tax (if not in monthly payment)

Homeowner’s or Rental Insurance

Other mortgage, contract, or debt payments based on equity in your home

Homeowner’s Association dues or fees

Total Housing Expenses

F. Transportation Expenses

Automobile payment (loan or lease)

Auto insurance, license, registration

Gas and auto maintenance

Parking, tolls, public transportation

Other transportation expenses

Total Transportation Expenses

B. Utilities Expenses

Electricity and heating (gas and oil)

Water, sewer, garbage

Telephone(s)

Cable, Internet

Other (specify):

Total Utilities Expenses

G. Personal Expenses (not children’s)

Clothes

Hair care, personal care

Recreation, clubs, gifts

Education, books, magazines

Other Personal Expenses

Total Personal Expenses

C. Food and Household Expenses

Groceries for (number of people):

Household supplies (cleaning, paper, pets)

Eating out

Other (specify):

Total Food and Household Expenses

H. Other Expenses

Life insurance (not deducted from pay)

Other (specify):

Other (specify):

Other (specify):

Total Other Expenses

D. Children’s Expenses

Childcare, babysitting

Clothes, diapers

Tuition, after-school programs, lessons

Other expenses for children

Total Children’s Expenses

E. Health Care Expenses

Insurance premium (health, vision, dental)

Health, vision, dental, orthodontia, mental health expenses not covered by insurance

Other health expenses not covered by insurance

Total Health Care Expenses

List all Total Expenses from above:

A. Total Housing Expenses

B. Total Utilities Expenses

C. Total Food and Household Expenses

D. Total Children’s Expenses

E. Total Health Care Expenses

F. Total Transportation Expenses

G. Total Personal Expenses

H. Total Other Expenses

I. All Total Expenses (add A - H above)

8. Debts included in Monthly Expenses listed in section 7 above

Debt for what expense (mortgage, car loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment made Date:

Debt for what expense (mortgage, car loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment made Date:

Debt for what expense (mortgage, car loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment made Date:

Debt for what expense (mortgage, car loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment made Date:

9. Monthly payments for other debts (not included in expenses listed in section 7)

Describe Debt (credit card, loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment (Date and Amount) Date: $

Describe Debt (credit card, loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment (Date and Amount) Date: $

Describe Debt (credit card, loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment (Date and Amount) Date: $

Describe Debt (credit card, loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment (Date and Amount) Date: $

Describe Debt (credit card, loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment (Date and Amount) Date: $

Describe Debt (credit card, loan, etc.) | Who do you owe (Name of creditor) | Amount you owe this creditor now $ | Last Monthly Payment (Date and Amount) Date: $

Total Monthly Payments for Debts

10. Explanation of expenses or debts (if any needed):

11. Lawyer Fees

List your total lawyer fees and costs for this case as of today.

Amount paid $

Amount still owed $

Total Fees/Costs $

Source of the money you used to pay these fees and costs:

Describe your agreement with your lawyer to pay your fees and costs:

I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true.

Signed at (city and state):

Date:

Sign here

Print name

Financial Records

You must provide financial records as required by statute and state and local court rules. These records may include:

• Personal Income Tax Returns

• Pay stubs

• Partnership or Corporate Income Tax Returns

• Other financial records

Important! Do not attach financial records to this form. Financial records should be served on the other party and filed with the court separately using the Sealed Financial Source Documents cover sheet (FL All Family 011). If filed separately using the cover sheet, the records will be sealed to protect your privacy (although they will be available to all parties and lawyers in this case, court personnel and certain state agencies and boards.) See GR 22(c)(2).

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What the Financial Declaration Form Is

A Financial Declaration Form is a formal statement of an individual’s or entity’s financial position used in legal, lending, and administrative contexts. It typically lists income, assets, liabilities, monthly expenses, and supporting account details, and often requires certification under penalty of perjury. Courts, lenders, government agencies, and employers use the form to verify capacity to pay, determine eligibility for relief, or resolve disputes. The form can be submitted on paper or electronically, and must contain accurate, current figures and accompanying documentation where requested.

Why a Clear Financial Declaration Matters

A complete and accurate Financial Declaration Form establishes transparency, supports legal or administrative decisions, and reduces the risk of delays or sanctions. It provides a single source of truth for income and asset verification and helps ensure consistent treatment across parties.

Why a Clear Financial Declaration Matters

Who Typically Prepares and Reviews These Forms

The Financial Declaration Form is used by several practitioner and institutional groups depending on context.

  • Individuals and households — preparing personal financial statements for family court, loan underwriting, or government benefit applications.
  • Attorneys and paralegals — drafting, reviewing, and filing declarations in litigation, divorce, or bankruptcy matters.
  • Lenders and underwriters — verifying borrower income, assets, and liabilities during credit decisions.

Accuracy matters for all users because downstream legal or financial decisions depend on the declared information.

Essential Sections in a Professional Financial Declaration Form

A well-structured form organizes financial facts clearly, supports verification, and reduces ambiguity for reviewers and auditors.

Income Summary

Itemize all income sources separately (wages, self-employment, rental, investment). Include gross and net amounts and specify pay periods for each entry.

Assets

List bank accounts, investment accounts, real estate, vehicles, and other valuable property with current values and account identifiers where applicable.

Liabilities

Detail outstanding debts: mortgages, auto loans, student loans, credit cards, and judgments including creditor names and outstanding balances.

Monthly Expenses

Provide recurring living costs such as housing, utilities, insurance, transportation, and child care with typical monthly amounts.

Supporting Documents

Attach recent pay stubs, bank statements, tax returns, loan statements, and appraisal or bill of sale documents to substantiate line items.

Declaration and Signature

Include a signed certification under penalty of perjury and a signature block with date, printed name, and notarization or witness fields if required.

Required Identifying and Contact Details

Name: Full legal name
Date of Birth: MM/DD/YYYY
SSN / TIN: Digits only
Primary Address: Street, city, state, ZIP
Phone: Best contact number
Email: Current email address

Step-by-Step: Filling Out the Form

Follow these steps in order to create a complete, verifiable financial statement suitable for legal or administrative submission.

  • 01
    Gather Documents: Collect pay stubs, bank statements, tax returns, and loan statements before you begin.
  • 02
    Enter Identifying Info: Fill name, DOB, address, and TIN exactly; double-check for typos.
  • 03
    Complete Schedules: Itemize income, assets, liabilities, and monthly expenses with dates and amounts.
  • 04
    Sign and Certify: Sign in MM/DD/YYYY format and obtain notarization if required by the recipient.

How to Customize the Form for Online Completion

Configure a digital template to guide signers, collect evidence, and enforce required fields for accurate submissions.

Template Create a reusable PDF or DOCX template with fixed sections and required fields
Conditional Fields Use conditional logic to show relevant fields for self-employed, retired, or jointly filing individuals
Authentication Set signer authentication (email/SMS/KBA) depending on verification needs
Reminders Enable automatic reminders for incomplete submissions or missing attachments
Archive Define automatic export to secure storage in PDF/A or encrypted format

Where to Send or Submit a Completed Financial Declaration

Submission channels depend on the receiver’s requirements; choose the method that preserves signature evidence and attachments.

  • Court Filing: File per local court rules, often via electronic court filing systems or clerk’s office.
  • Lender Submission: Upload through lender portal or deliver to underwriting email address as directed.
  • Attorney or Counsel: Send to opposing counsel or your attorney with cover note and supporting documents.
  • Government Agency: Submit via the agency’s secure portal or as the agency instructs in the request.

Digital Delivery and System Integrations

Choose platforms that support secure storage, audit trails, and required integrations for your workflow.

  • Integrations: Salesforce, Microsoft 365, NetSuite, Google Workspace
  • File Formats: PDF, DOCX, HTML, Excel supported
  • Security: TLS 1.2/1.3 and AES-256 at rest

Ensure the chosen platform preserves an audit trail and supports stronger signer authentication when required.

Typical Timelines and Response Expectations

Timing depends on the requesting authority; meet indicated deadlines to avoid processing delays or enforcement actions.

Upon Request:

Provide within 7–14 days unless the requester sets a different deadline

Court Proceedings:

File by the schedule in court orders or local rules; deadlines vary by jurisdiction

Lender Reviews:

Expect underwriting follow-up within 3–10 business days after submission

Bankruptcy Filings:

Submit with schedules per bankruptcy rules and trustee timelines

Government Audits:

Respond within the timeframe specified in the audit notice to avoid penalties

Common Mistakes to Avoid

  • Rounding or omitting cents on account balances, which can cause reconciliation questions and requests for clarification.
  • Using outdated supporting documents; attach the most recent statements within the prior 30 to 90 days where possible.
  • Failing to list contingent liabilities such as cosigned loans or pending lawsuits that affect net worth.
  • Signing before required witness or notary presence when the recipient mandates notarization, invalidating the filing.

Key Risks and Potential Consequences

Perjury Exposure: Civil and criminal penalties
Tax Penalties: Backup withholding 24% for incorrect TIN
Filing Fines: Late or incorrect reports may trigger IRS §6721 penalties
Delay Risk: Application or case delays
Credit Impact: Incorrect debt reporting affects credit decisions
Reputational Harm: Professional or court credibility loss

Real-World Examples of Financial Declaration Use

Practical examples show how different organizations apply the form in routine workflows and complex matters.

Optica Ventures LLC

A small investment firm standardized declarations for investor KYC and underwriting.

  • Resulted in faster verification for new deals.
  • The firm used templates and attached bank statements to reduce follow-up questions and improve audit readiness across investments.

Tech Data

A large distributor centralized financial declarations for vendor onboarding.

  • Streamlined supplier due diligence.
  • Centralization cut processing time, ensured consistent documentation, and simplified internal audits and compliance reviews.

Practical Tips for Accurate, Efficient Completion

Follow these operational tips to reduce rework and support reliable verification.

Use Recent Statements
Attach bank and investment statements from the last 30–90 days to substantiate balances and transactions.
Double-Check Identifiers
Verify account number suffixes, TIN digits, and account holder names against supporting documents.
Lock Required Fields
When using digital templates, make critical fields mandatory to avoid incomplete submissions.
Preserve Audit Trail
Ensure the platform records timestamps, IP addresses, and signer authentication for evidentiary purposes.

Frequently Asked Questions About the Financial Declaration Form

Answers to common questions about completion, signatures, notarization, and digital submission for Financial Declaration Forms.


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