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Mississippi Financial Statement

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Rule 8.05 Financial Statement

EXHIBIT “A”

IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI

PLAINTIFF
V.
CAUSE NUMBER:
DEFENDANT

I. General Information

Name:

Address:

City, State and Zip Code:

Home Telephone:

Date of Birth:

Occupation:

Employer:

Employer’s Address:

Employer’s Telephone:

Minor Children

Name Date of Birth

II. Income Statement

GROSS MONTHLY INCOME

Item Amount
1. Salary and Wages, including commissions bonuses, allowance and overtime$
2. Pensions and retirements$
3. Social Security$
4. Disability and unemployment insurance$
5. Public Assistance (welfare, AFDC payments, etc.)$
6. Dividends and interest$
7. Rental Income$
8. Other Income$
9. TOTAL MONTHLY INCOME$
ITEMIZED MONTHLY DEDUCTIONS:
1. State Income Tax$
2. Federal Income Tax$
3. Social Security$
4. Mandatory Insurance$
5. Mandatory Retirement$
6. Union or other dues$
7. Other: (Specify)$
8. Other:$
9. TOTAL MONTHLY DEDUCTIONS$
10. NUMBER OF EXEMPTIONS
11. NET MONTHLY PAY$

III. Expenses Statement

A. LIVING EXPENSES

Expense Self Children
1. Rent/Mortgage (Residence)
2. Real Property Taxes
3. Real Property Insurance
4. Maintenance (Residence)
5. Food/household Supplies
6. Water, Sewer, Etc.
7. Electricity
8. Gas (Residence)
9. Telephone
10. Laundry and Cleaning
11. Clothing
12. Insurance (Not Payroll Deducted)
13. Medical
14. Dental
15. Child Care
16. Children’s Allowance
17. Payment of Child Support/alimony (Prior Marriage)
18. School Expenses
19. Entertainment
20. Incidentals & Misc.
21. Transportation Other than Vehicle
22. Gasoline & Oil (Auto)
23. Repair (Auto)
24. Insurance (Auto)
25. Auto Payments
26. Church Donations
27. Charitable Donations
28. Newspaper/magazine
29. Cable tv
30. Pet Expenses
31. Yard Expenses
32. Maid
33. Retirement (Ira, Etc.)
34. Pest Control
B. TOTAL LIVING EXPENSES
35. INSTALLMENT PAYMENTS
Notes, Loans, Charge Accounts, Etc.
36.
37.
38.
39. Other Expenses
40.
41.
42.
43.
Total Installments Payments:
Combined Total Expenses: Total Line 1-43

EXHIBIT “B”

IV. STATEMENT OF ASSETS

A. REAL ESTATE

1. Title in the name of:

Address:

Who paid cost:

How cost paid:

Value:

Mortgage Balance:

Equity:

2. Title in the name of:

Address:

Who paid cost:

How cost paid:

Value:

Mortgage Balance:

Equity:

3. Title in the name of:

Address:

Who paid cost:

How cost paid:

Value:

B. MOTOR VEHICLES

1. Registered in the name of:

Year: Model: Mileage:

Who paid cost: How cost paid:

Value:

Loan Balance:

Equity:

2. Registered in the name of:

Year: Model: Mileage:

Who paid cost: How cost paid:

Value:

Loan Balance:

Equity:

3. Registered in the name of:

Year: Model: Mileage:

Who paid cost: How cost paid:

Value:

Loan Balance:

C. OTHER PERSONAL PROPERTY

(Such as home computers, guns, lawnmowers, TVs, jewelry, household furnishings, etc.)

Property Listing Estimated Value Property Listing Estimated Value
TOTAL$ TOTAL$

D. CHECKING/SAVINGS

Names on Account Bank Name Account Number Type of Account Balance
$
$
$
TOTAL$

E. OTHER INVESTMENTS (IRA’S, STOCK(S), MUTUAL FUNDS, PENSION PLANS, ETC.)

Bank/Account No: Type of Investment Balance
$
$
$
TOTAL VALUE$

F. LIFE INSURANCE (EXCLUDE CHILDREN)

Insured Company Face Amount Less Any Loans Cash Beneficiary
$ $
TOTAL$ $

G. ALL OTHER ASSETS

Item Date Purchased Value (Assets) Liens Equity
TOTAL$

V. STATEMENT OF LIABILITIES

I. LIABILITIES

(Include mortgages, car loans, credit cards, personal loans.)

Creditor Whose Name Due Current Balance Monthly Who Pays
$ $
$ $
$ $
TOTAL LIABILITIES$ $

ACKNOWLEDGMENT OF TRUTHFULNESS

I declare to the Court that the foregoing financial information, including attachments, is true and correct and that this declaration was executed on the day of , 20.

(Plaintiff or Defendant)

EXHIBIT “C”

IN THE CHANCERY COURT OF , COUNTY, MISSISSIPPI

PLAINTIFF
V.
CIVIL ACTION NUMBER:
DEFENDANT

CERTIFICATE OF COMPLIANCE

I, , do hereby certify that I have this date complied with Rule 8.05 of the Uniform Chancery Court Rules and that I have mailed and/or delivered a copy of a detailed written statement of actual income and expenses and assets and liabilities to the attorney for the opposing party or the opposing party.

SO CERTIFIED on this the day of , 20.

Attorney for Opposing Party

Attorney for Opposing Party

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What the Mississippi Financial Statement Is and When It’s Used

A Mississippi Financial Statement is a standardized document that summarizes an individual’s or entity’s financial position for lenders, courts, or administrative agencies. It collects assets, liabilities, income, expenses, and contingent obligations to support credit decisions, support determinations in family law or probate, or meet regulatory reporting requests. The form is typically completed under penalty of perjury and may be required as part of loan underwriting, divorce proceedings, child support calculations, or enforcement actions. Accuracy and supporting documentation are essential because third parties rely on its assertions for legal and financial decisions.

Why a Clear, Complete Statement Matters

A professionally prepared Mississippi Financial Statement provides a transparent snapshot of financial status, reduces follow-up requests, and supports faster underwriting or court resolution. It helps avoid disputes by documenting sources of income and liabilities.

Why a Clear, Complete Statement Matters

Who Typically Prepares or Requests This Statement

The exact recipient and required level of documentation depend on the requester’s rules; always confirm which attachments and notarization steps are required before submission.

  • Individual filers seeking loans, credit, or child support determinations.
  • Banks and mortgage underwriters verifying ability to repay.
  • Attorneys and courts during divorce, custody, or probate proceedings.

Primary Signers and Responsible Parties

Primary Signer

The person whose finances are reported. They must provide truthful, complete data and sign under penalty of perjury. In joint filings, both parties supply separate asset and income disclosures if requested.

Authorized Representative

A legal guardian, power-of-attorney, or attorney-in-fact may complete the statement when authorized. Proof of authority such as a POA must accompany the submission and match the document dates.

Step-by-Step: Completing a Mississippi Financial Statement

Follow this order to reduce mistakes and speed review: assemble documents, populate fields, verify totals, and obtain required authentication.

  • 01
    Gather Documents: Collect bank statements, pay stubs, tax returns, and loan statements first.
  • 02
    Enter Data: Populate asset, liability, and income fields using exact amounts.
  • 03
    Attach Proof: Add copies of statements and schedules referenced on the form.
  • 04
    Authenticate: Sign, date, and notarize if required by the requester.

Typical Submission Flow for the Statement

A clear submission pathway helps ensure the statement is accepted and processed promptly by the receiving organization.

  • Prepare Document: Complete the statement and attach supporting files.
  • Verify Identity: Confirm signer identity per requester authentication requirements.
  • Submit to Requester: Send via certified upload, portal, or accepted email address.
  • Record Retention: Keep a signed copy and related proofs in secure storage.

Digital Workflow Settings to Use for E-Submission

When completing and sending electronically, configure fields and authentication to match the requester’s requirements to avoid rejections.

Field Configuration
Signature Field Require signer initials + full signature
Date Field Auto-fill using MM/DD/YYYY format
Attachment Field Require PDF upload for supporting documents
Authentication Email + SMS code for signer verification

Technical Options for Sharing and Signing Electronically

Confirm the recipient accepts the chosen e-delivery method and retains an audit trail for verification and retention purposes.

  • File Formats: PDF, DOCX, XLSX
  • Authentication: Email, SMS code, or KBA
  • Integrations: Common CRMs and cloud storage

Common Timing and Response Expectations

Deadlines for providing a Mississippi Financial Statement vary by requester; lenders and courts typically specify a turnaround window when they request the document.

Lender Requests:

Response windows usually range from 5 to 15 business days.

Court Orders:

Follow the court’s deadline in the order; extensions require court permission.

Divorce Filings:

Often due within 14–30 days of discovery requests.

Underwriting Reviews:

Underwriters may request additional documentation within 3–7 business days.

Follow-Up:

Respond promptly to reduce risk of denial or sanctions.

Key Milestones from Request to Completion

A sequential timeline helps track progress and ensure each milestone is met before the next action.

01

Request Received

Document request issued by court, lender, or agency; deadline provided.

02

Records Collected

Gather bank statements, tax returns, and creditor statements.

03

Statement Prepared

Populate form, reconcile totals, and attach proofs.

04

Submission Completed

Sign, notarize if required, and deliver via accepted channel.

Essential Data Points to Include

Legal Name: Full printed name
Contact Information: Address and phone number
Income: Gross monthly income
Assets: Cash and investments
Liabilities: Loans and balances
Signature: Signed and dated

Common Pitfalls to Avoid

  • Using outdated statements or inconsistent valuation dates that create reconciliation errors and trigger additional verification requests.
  • Omitting contingent liabilities such as co-signed loans or pending litigation, which can cause material misstatements.
  • Submitting unsigned or incorrectly dated forms that will be returned or rejected by lenders or courts.
  • Failing to attach required proof (bank statements, tax returns) that substantiates entries and shortens review time.

Consequences of Errors or Misrepresentation

Civil Penalties: Fines or sanctions by courts or agencies
Loan Denial: Underwriters may decline credit
Perjury Risk: False statements can carry legal exposure
Credit Impact: Incorrect reporting may affect credit decisions
Delays: Processing time may increase significantly
Document Rejection: Requester may require resubmission

eSignature Vendor Pricing Snapshot for Document Signing

Compare common vendor starting prices and feature differences relevant for securely signing and submitting Mississippi Financial Statements.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Available (Business Premium) Available Available Available Limited
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA available) Yes Yes No No

Frequently Asked Questions About the Mississippi Financial Statement

Answers to common questions about completion, authentication, and electronic submission for Mississippi Financial Statements.


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