Legal Affidavit and Financial Statement

LEGAL AFFIDAVIT AND FINANCIAL STATEMENT

Affiant Name:    Affiant Address:

Age:    Occupation:    Telephone:

RECITALS

WHEREAS, Affiant affirms under oath that the information contained in this Affidavit and Financial Statement is true, complete, and presented to the requesting party, court, or authorized recipient for the purposes of financial disclosure, support determinations, and/or litigation-related financial assessment;

WHEREAS, the requesting party or entity requires a sworn statement of Affiant's assets, liabilities, income, and expenses to evaluate financial status and to verify the availability of funds and resources relevant to the above-referenced matter;

WHEREAS, Affiant acknowledges that knowingly making a false statement under oath is punishable as perjury under applicable law and that verification of the information provided may be made through third parties and public or private records;

NOW, THEREFORE

Affiant hereby declares and states under penalty of perjury as follows:

1. DECLARATION AND OATH

Affiant affirms that the statements in this document are based upon personal knowledge, information and belief, and are true and correct. Affiant understands that false statements made knowingly are subject to penalties for perjury.

2. ASSETS

Affiant lists the following assets. For each category, indicate value as of the date of this affidavit and attach supporting documentation where available.

3. LIABILITIES

Provide a complete statement of all outstanding debts, including creditor name, current balance, monthly payment, and whether secured or unsecured.

4. INCOME

Current monthly gross income: $    Monthly net income: $

5. MONTHLY EXPENSES

Housing (rent/mortgage): $    Utilities: $

Transportation: $    Childcare/Support: $

6. ATTACHMENTS AND SUPPORTING DOCUMENTS

Affiant certifies that the following supporting documents are attached or will be provided upon request (check all that apply):

Pay stubs (most recent)
Federal/state tax returns (most recent year)
Bank statements (most recent 3 months)
Loan/credit card statements
Deeds, titles, or property appraisals

7. AUTHORIZATION TO VERIFY

Affiant authorizes any employer, bank, financial institution, government agency, or other third party to release information necessary to verify the accuracy of the statements herein. This authorization is limited to verification of the matters expressly disclosed in this Affidavit and Financial Statement.

8. REPRESENTATIONS AND WARRANTIES

Affiant represents that all material facts known to Affiant that would affect the accuracy of this statement have been disclosed. Affiant further warrants that Affiant will promptly notify the requesting party of any material change in financial circumstances.

9. NOTICES

Any notices required under this document shall be sent to the following addresses:

10. GOVERNING LAW; MISCELLANEOUS

This Affidavit and Financial Statement shall be governed by and construed in accordance with the laws of the jurisdiction specified by the requesting party. Any disputes arising from or related to this document shall be subject to the exclusive jurisdiction of the courts located in that jurisdiction.

Entire Agreement: This document constitutes the entire understanding between the parties with respect to the matters contained herein and supersedes all prior written or oral understandings relating thereto.

Severability: If any provision of this Affidavit is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments and Waiver: No amendment, waiver, or modification of this Affidavit shall be binding unless made in writing and signed by both parties.

11. OATH AND CERTIFICATION

I, the undersigned Affiant, declare under penalty of perjury under the laws of the governing jurisdiction that the foregoing is true and correct to the best of my knowledge, information and belief.

Sworn and subscribed before me this Day:   of Month:   Year:

Signature of Affiant:

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