Fill and Sign the Sc Financial Declaration Form

STATE OF SOUTH CAROLINA ) IN THE FAMILY COURT OF THE )       JUDICIAL CIRCUIT COUNTY OF       ) )       ) FINANCIAL DECLARATION Plaintiff, ) OF       vs. )       ) Defendant. ) Docket No.       HUSBAND/FATHER WIFE/MOTHER Address       Address       Age       Age       Occupation       Occupation       Employer       Employer       Employer Address       Employer Address       Gross Monthly Income Husband/Father Wife/Mother Principal Earnings from Employment 1             Overtime, Tips, Commission, Bonuses 2             Pensions, Retirement, and Annuities income             Additional Employment income             Social Security Benefits (SSA) and VA Benefits             Disability and Worker’s Compensation Benefits             Unemployment and AFDC             Spousal or Child Support (from other marriage/relationship)             Dividends, Interest, Trust Income, and Capital Gains             Rental Income and Business Profits             Other (Specify):                   TOTAL GROSS MONTHLY INCOME             Payroll Deductions from Monthly Income Husband/Father Wife/Mother Federal Income Tax 3             State Income Tax             Social Security and Medicare Tax (FICA)             Self-Employment Tax             Health and Dental Insurance (Adult)             Health and Dental Insurance (Child)             Union Dues             Voluntary Retirement Contribution (401(k), 457, IRA)             Mandatory Retirement Contribution             Savings Plan             Other (Specify):                   TOTAL MONTHLY DEDUCTIONS             NET MONTHLY INCOME 4             Estimate monthly expenses: (Specify which party is the custodial parent and list name and relationship of all members of household whose expenses are included.       MONTHLY EXPENSES 5 Husband/Father Wife/Mother Residential Rent Payment             Note or Mortgage Payment on Residence(s)             Food and Household Supplies 6             Utilities, Water, and Garbage Collection             Telephone and Cellular Phone             Medical, Dental and Disability Insurance Premiums (not deducted from paycheck)             Life Insurance Premiums (not deducted from paycheck)             Child Support (from other relationship)             Work Related Day Care             SCCA 430 (12/2009) 1 of 5 Spousal Support (from prior marriage)             Auto Payment             Auto Insurance, taxes, gasoline, and maintenance 7             SUBTOTAL: Real Property Tax on Residence(s)             Maintenance for household 8             Adult Clothing             Children’s Clothing 9             Cable Television, Satellite, and Internet/Online Services             Laundry and Dry Cleaning 10             Medical and Dental Expenses (not paid by insurance)             Prescriptions, Glasses, and Contacts (not paid by insurance)             Children’s incidental expenses 11             School lunches, supplies, field trips, and fees 12             Entertainment 13             Adult Incidental expenses 14             All Installment payments 15             Other (Specify):                   SUBTOTAL: TOTAL MONTHLY EXPENSES             Installment Loan Payments Section Creditor For Monthly Payment Balance Owed by 16                                                                                                                                                                                                                   Other Debts and Obligations not payable in monthly installments Creditor For Date Payable Balance Owed by 16                                                                                                                                                       Are you currently in Bankruptcy? YES NO Are any obligations listed above, including mortgage and note payments, in arrears? YES NO If yes, please list the obligations in arrears.       All Marital Property Known to Parties Assets Husband/Father Wife/Mother Joint Cash and Money in Checking Account(s)                   Money in Savings Account(s), Credit Union, Money Market, or Cert. of Dep.                   Value of Voluntary Retirement Account(s)                   Value of Pension Account                   Value of Publicly Held Stocks, Bonds, Securities, Mutual Funds                   Value of Privately Held Stocks and Other Business                   Value of Real Estate – Net of Mortgage Balances                   Value of All Other Property 1 7                   SCCA 430 (12/2009) 2 of 5             TOTAL ASSETS                   Any Non Marital Property Known to Parties Description of Asset Title Owner Date of Acquisition Source of Funds to Acquirer Estimate Present market Value                                                                                                                                                       If total assets are less than $300,000.00, sign and have notarized. If total assets are greater than $300,000.00, itemize assets by completing additional sections below and sign and have notarized. Financial Accounts Section 1 8 Owner Name of Institution Type of Account Balance                                                                                                                         Voluntary Retirement Accounts and Pension Accounts Section Type of Account Value                                                 Publicly Held Stocks, Bonds, Securities, Mutual Funds Section (Non-Retirement) 1 9 Name of Company Number of Shares/Type of Account Value                                                                                           Real Estate Section 2 0 Owner Address Value Mortgage Balance Mortgage Equity                                                                                                                                                       Other Property Section 1 7 Owner Description of Asset Value Loan Balance Equity SCCA 430 (12/2009) 3 of 5                                                                                                                                                       ___________________________________________ Signature Sworn to before me this       of       , 2       . _________________________________ (SEAL) Notary Public for South Carolina My commission expires: ____________ Custodial Parent (if applicable):       SCCA 430 (12/2009) 4 of 5 1 A recent paystub should be attached to the Financial Declaration. To compute Principal Earnings from Employment, first determine whether you are paid semi-monthly, biweekly, or weekly. If you are paid semi- monthly, multiply the gross amount of your pay check by two. If you are paid biweekly, multiply the gross amount of your pay check by 26 and then divide by 12. If you are paid weekly, multiply the amount of your paycheck by 52 and divide by twelve. Round to the nearest whole dollar. 2 To compute Overtime, Tips, Commission, and/or Bonuses, take an average of your monthly earnings from overtime, tips, commission, bonuses, etc. from the past three years or the length of employment if employed less than three years (including this year). 3 To compute State, Local, and Social Security Tax deductions, use the same formula used to compute principal earnings in endnote 1 above, or consult or have your attorney consult an accountant. 4 Net monthly Income is equal to Total Gross Monthly Income minus Total Monthly Deductions. 5 Do not include any expense in the Monthly Expenses section that has already been included in the Deductions from Gross Monthly Income on page one of the Declaration. 6 Food Expense is to include the cost of groceries, toiletries, cleaning supplies, and casual eating out. 7 Auto Expenses are to include gasoline, oil changes, tune-ups, tire replacement, maintenance, and related items. 8 Maintenance for Household is to include appliance and household repairs, landscaping, house cleaning, pest control, pool service, alarm service, and other related items. 9 Clothing Expense is to include shoes and clothing purchases, clothing repair and alterations, and related items. 10 Laundry Expense is to include the cost of laundry service, dry cleaning, and related items. 11 Children’s Incidental Expenses are to include allowance, summer camp, baby sitters, lessons, activities, participatory sports, and related items. 12 School Expense is to include tuition, supplies, field trips, dues, tutors, locker rentals, school lunches, and other related items. 13 Entertainment is to include movies, theater, vacations, sporting events, compact discs, digital video discs, and related items. 14 Adult Incidental Expenses are to include cosmetics, hair and nail care, books, magazines, newspapers, business dues, memberships, pets, charity, religious dues or tithes, gifts, bank charges, hobbies, and related items. 15 All Installment Loan Payments is the total amount itemized in Installment Loan Payments Section, which should include all loan payments not already listed as a monthly expense. Examples: home equity loan, credit cards, etc. 16 Indicate which spouse legally owes the payment (husband, wife, or joint). 17. Other property is to include automobiles (minus loan balance), boats (minus loan balance), furniture, furnishings, china, silver, jewelry, collectibles, and other personal property. 18. Itemize Financial Accounts such as checking, savings, credit union, money market, or certificate of deposit accounts in the Financial Accounts Section. 19. Itemize Publicly Held Stocks, Bonds, Securities, Stock Options and Mutual Funds (excluding retirement accounts) in the Publicly Held Stocks, Bonds, Securities, Mutual Funds Section. 20. Itemize each parcel of Real Estate in the Real Estate Section. 1 1 1 2 1