[{"id":"a75e9eef-25ca-48a2-912e-ce0dd2d9b902","order":1,"text":"IN THE [Name of Court]","fontSize":"16","textAlign":"center","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"aed12af9-8b08-4f72-b02a-61c1ca36b52b","order":2,"text":"IN AND FOR [County, State]","fontSize":"16","textAlign":"center","bold":true,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"e4f54910-5c82-4d42-8f01-5242c966bdfe","order":3,"text":"[Petitioner's Full Name],","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"9ac31b56-2832-4a9d-8beb-178ae5568a99","order":4,"text":"Petitioner,","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"30f14c88-288b-4a0a-9dea-a7630026567b","order":5,"text":"and","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"12aa5ac4-2d22-458e-8ec9-37e7e7f18ffa","order":6,"text":"[Respondent's Full Name],","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"37a5c3bc-4b02-41c7-8788-84374889fd22","order":7,"text":"Respondent.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"53611fec-9384-4589-9558-38a4e284af93","order":8,"text":"Case No.: [Case / Docket Number]","fontSize":"14","textAlign":"right","bold":true,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"f211a0bc-7026-4ad3-b645-b937d85b0c89","order":9,"text":"FINANCIAL AFFIDAVIT","fontSize":"20","textAlign":"center","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"1ccdfd52-0b33-4c02-8324-58fc4b82ca3a","order":10,"text":"(SWORN FINANCIAL DISCLOSURE STATEMENT)","fontSize":"16","textAlign":"center","bold":true,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"20388ab6-4ce1-4f19-8e89-47e30c426231","order":11,"text":"STATE OF [State] )
) ss.:
COUNTY OF [County] )","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"f90014b8-8023-4433-b9c8-dd7eed2c1695","order":12,"text":"I, [Affiant's Full Legal Name], being first duly sworn upon oath, and being competent to testify to the matters stated herein, do hereby depose and state under penalty of perjury that the following is a true, accurate, complete and current statement of my financial circumstances as of [Date of Statement]:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"4746ec45-f4ac-43c4-83ae-520e75ad9497","order":13,"text":"1. GENERAL INFORMATION","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S01"},{"id":"5a15d3a4-af94-41de-9c48-2e24b9c95bff","order":14,"text":"My full legal name is [Affiant's Full Legal Name], and I am the [Petitioner / Respondent] in the above-captioned action. My date of birth is [Date of Birth], and the last four digits of my Social Security Number are [Last 4 digits]. My current residential address is [Street Address, City, State, ZIP].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"e97ea064-7a65-41ec-a045-b19747ae60f7","order":15,"text":"The parties were lawfully married on [Date of Marriage] in [City, State of Marriage], and [separated on (date) / continue to reside together as of the date hereof].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"4976988c-85c3-4bd7-918f-d2acd4825d3a","order":16,"text":"There [is / are] [Number] minor child(ren) born of or adopted during the marriage who remain dependent upon the parties, as more particularly described in the schedule of dependents maintained by the parties. The custodial and support arrangements concerning the said child(ren) are addressed in the pleadings filed herein.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"8080d890-f528-459e-94a2-62ea43cfbd1e","value":"1","type":"add","operator":"="}]},{"id":"8535cc00-b7ed-4ad0-805e-8e2a2309fc14","order":17,"text":"There are no minor or dependent children born of or adopted during the marriage.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"8080d890-f528-459e-94a2-62ea43cfbd1e","value":"1","type":"remove","operator":"="}]},{"id":"ea03f2f8-192b-4492-858f-ddc059195aa4","order":18,"text":"Unless otherwise expressly stated, all income and expense figures set forth in this Affidavit are expressed as monthly amounts, and all asset and liability figures are stated at their fair market value or outstanding balance as of the date of this Affidavit.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"466122be-c5e6-4b78-8fa6-188fa2cd8e22","order":19,"text":"2. EMPLOYMENT AND OCCUPATION","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S02"},{"id":"f8411b3d-0ce8-42ef-8630-1255042e9a2a","order":20,"text":"My present occupation is [Occupation / Title]. I am currently [employed / self-employed / unemployed / retired]. My present employer (or business) is [Employer / Business Name and Address], where I have been engaged since [Date]. My highest level of education completed is [Highest Education].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"2f2212b7-07b9-48e6-8db0-2f7e87120c62","order":21,"text":"3. GROSS MONTHLY INCOME","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S03"},{"id":"16a8ab59-621c-4fb4-bd69-6f32419ff718","order":22,"text":"I disclose all sources of income, whether earned or unearned, and regardless of frequency, reduced to a monthly equivalent. My gross monthly income from all sources is as follows:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"3d9705ea-75c5-4a8e-9e43-e7b35484a376","order":23,"text":"Gross wages, salary and commissions (before deductions): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"4e11a607-523d-4c65-92b1-89fdcea6c617","order":24,"text":"Bonuses, overtime, tips and other incentive compensation: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"bb0ee46f-b544-4131-b812-97574fa65df1","order":25,"text":"Net income from self-employment or business (after ordinary and necessary business expenses): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"37467fa2-cabc-4c3c-a185-4156d66a7a6b","order":26,"text":"Income from interest, dividends, capital gains and other investments: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"1a0a1db2-4874-4ea7-930e-1e64445c36a7","order":27,"text":"Rental and royalty income (net of expenses): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"4998e55a-3163-45a6-b88e-e12644db462c","order":28,"text":"Pension, retirement, annuity and Social Security benefits: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"b94f09cf-d876-48ce-bbe0-7fe3fbb5259f","order":29,"text":"Spousal support, child support or maintenance actually received: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"8a437748-a786-44e0-b589-d679ad9715e7","order":30,"text":"Unemployment, disability, workers' compensation and other public benefits: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"5fe3f382-057f-4aa9-8344-e68f7381dd96","order":31,"text":"All other income (described as follows): [Description] — $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"ca3abea2-3462-410a-8efa-1cec485309e4","order":32,"text":"TOTAL GROSS MONTHLY INCOME FROM ALL SOURCES: $[Total] per month.","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"cedc1523-20eb-477c-b1b5-29dc91e92df0","order":33,"text":"4. MANDATORY DEDUCTIONS AND NET INCOME","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S04"},{"id":"eeab4768-5cf3-45aa-8fb1-71859c1a8e36","order":34,"text":"The following recurring deductions are withheld from my gross income, expressed as monthly amounts:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"5cf2013d-0fc1-43db-b394-4bdc24598c6b","order":35,"text":"Federal, state and local income taxes: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"f71595b5-ed78-436f-baed-b700544b4d8d","order":36,"text":"Social Security (FICA) and Medicare contributions: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"d2f3ebd4-e2f5-4732-9f79-7e2d1a2cb700","order":37,"text":"Mandatory retirement, pension or union contributions: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"d2f7a1cd-5b7b-4f74-a77e-2a127d43b4f1","order":38,"text":"Health, dental and life insurance premiums withheld: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"90ee379c-8b9d-4146-aee6-540cd6f75703","order":39,"text":"Court-ordered support or wage garnishments: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"79cb1d52-3415-4902-a485-fc3a20d30955","order":40,"text":"TOTAL MONTHLY DEDUCTIONS: $[Total] per month, yielding a NET MONTHLY INCOME of $[Net] per month.","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"16fca35e-12c6-47b5-84a6-7874c6e24e2d","order":41,"text":"5. MONTHLY LIVING EXPENSES","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S05"},{"id":"355c889b-b218-4fee-b7d2-349d6cd8ff11","order":42,"text":"My reasonable and necessary monthly living expenses, including my share of any expenses attributable to the dependent child(ren), are as follows:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"77682ac0-701e-4e91-a763-fd976d9c9279","order":43,"text":"Housing — rent or mortgage payment (principal and interest): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"90955e50-bbcc-47c2-9b43-7727bbca14ff","order":44,"text":"Real estate taxes and homeowner's or renter's insurance: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"058fa911-1a70-4dad-929b-3d89887a8ef8","order":45,"text":"Utilities (gas, electricity, water, sewer, trash, telephone, internet): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"1c7e129d-4f30-466a-a840-bf800586db10","order":46,"text":"Food, groceries and household supplies: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"18f78413-0e1c-4f6c-aa28-c506cf7d2a93","order":47,"text":"Transportation (vehicle payments, fuel, insurance, maintenance, transit): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"b983df67-abf1-4ec8-bcff-dbd938f96a1b","order":48,"text":"Health care (insurance premiums, medical, dental, prescriptions): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"1cefe56e-822c-45f1-a2d3-1b68bc75bc59","order":49,"text":"Child care, education, tuition and child-related expenses: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"8080d890-f528-459e-94a2-62ea43cfbd1e","value":"1","type":"add","operator":"="}]},{"id":"44283304-a8de-427a-a263-3d0076034ab9","order":50,"text":"Clothing, personal care and incidentals: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"df8dca09-f1ff-4e12-9d9f-3108a48e9d7b","order":51,"text":"Debt service (credit cards, loans, other obligations): $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"ceda6d6c-9c3b-4e80-8e3f-82ce434aba49","order":52,"text":"Insurance (life and other), savings and miscellaneous: $[Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"4d2f22c5-fb56-43ba-8290-a4f76c79e9ae","order":53,"text":"TOTAL MONTHLY LIVING EXPENSES: $[Total] per month.","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"162f6499-8620-4bfa-9330-5f2ea51ecbe4","order":54,"text":"6. REAL PROPERTY","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3f2daaa1-2901-4bae-897d-1a2d4123417e","value":"1","type":"add","operator":"="}],"sectionNum":"S06"},{"id":"a83ad899-c647-4c70-b819-a59f3c841537","order":55,"text":"I hold the following interest(s) in real property, whether held as separate property, marital property or jointly with any other person:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3f2daaa1-2901-4bae-897d-1a2d4123417e","value":"1","type":"add","operator":"="}]},{"id":"fe2742df-8d8c-4aba-8886-c61f71dad367","order":56,"text":"The real property located at [Property Address], titled in the name of [Title Holder(s)], has an estimated fair market value of $[Value], is encumbered by a mortgage or lien with an outstanding balance of $[Balance] held by [Lienholder], resulting in an approximate net equity of $[Net Equity]. This property is characterized as [marital / separate / mixed] property.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3f2daaa1-2901-4bae-897d-1a2d4123417e","value":"1","type":"add","operator":"="}]},{"id":"d29ff5f9-ffa8-400f-9d14-2c032add829f","order":57,"text":"Additional real property interests, if any, are described as follows: [Additional Property Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"3f2daaa1-2901-4bae-897d-1a2d4123417e","value":"1","type":"add","operator":"="}]},{"id":"e1eb7698-e150-40ac-a9a7-81ec8c62f649","order":58,"text":"7. MOTOR VEHICLES AND OTHER VEHICLES","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"465f0451-692b-478b-b380-79ad0f1d1e6d","value":"1","type":"add","operator":"="}],"sectionNum":"S07"},{"id":"6c987fec-83ca-4b57-9a42-893157d2988c","order":59,"text":"I hold an interest in the following motor vehicle(s), watercraft, trailers or other titled vehicles:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"465f0451-692b-478b-b380-79ad0f1d1e6d","value":"1","type":"add","operator":"="}]},{"id":"70a4da21-cf1f-4131-90e6-23dc3db19ff1","order":60,"text":"Vehicle: [Year, Make and Model], titled in the name of [Title Holder(s)], with an estimated fair market value of $[Value] and an outstanding loan or lease balance of $[Balance], resulting in an approximate net equity of $[Net Equity].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"465f0451-692b-478b-b380-79ad0f1d1e6d","value":"1","type":"add","operator":"="}]},{"id":"22da0fd5-8fb3-419c-a1fd-09436ebe261f","order":61,"text":"Additional vehicles, if any, are described as follows: [Additional Vehicle Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"465f0451-692b-478b-b380-79ad0f1d1e6d","value":"1","type":"add","operator":"="}]},{"id":"153643fd-d9e7-44f3-b052-d976aefd218d","order":62,"text":"8. CASH AND DEPOSIT ACCOUNTS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S08"},{"id":"164ec8fe-8a04-403a-adab-373b33471a61","order":63,"text":"I disclose the following cash on hand and funds held in checking, savings, money market and similar deposit accounts:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"4aad6ccf-6384-41a0-87f8-98668b744874","order":64,"text":"Cash on hand: $[Amount].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"83b9e2dd-84d2-46f3-9c80-62f1fa49fb5d","order":65,"text":"Funds held at [Financial Institution(s)] in account(s) ending in [Last 4 digits], with an aggregate balance of $[Balance], characterized as [marital / separate / joint] property.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"b3c6ebe6-19a4-472b-8159-cd7de2c3fd02","order":66,"text":"Additional deposit accounts, if any, are described as follows: [Additional Account Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"69ccbd32-c196-4761-903d-e1a0eabb1efb","order":67,"text":"9. RETIREMENT AND INVESTMENT ACCOUNTS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9efc08d6-6c46-4d17-8072-af6562c53daa","value":"1","type":"add","operator":"="}],"sectionNum":"S09"},{"id":"372de4a4-0383-4339-ae0d-c38c740a6c37","order":68,"text":"I hold the following retirement, pension, brokerage and investment interests, including but not limited to 401(k), IRA, 403(b), pension, deferred compensation, stocks, bonds and mutual funds:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9efc08d6-6c46-4d17-8072-af6562c53daa","value":"1","type":"add","operator":"="}]},{"id":"8cb62a11-e1ad-4b8a-bb4d-11fa8c9380a5","order":69,"text":"Account or plan: [Type and Plan Administrator], held in the name of [Holder], with an approximate current value of $[Value], of which $[Marital Portion] is estimated to be attributable to the marital period.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9efc08d6-6c46-4d17-8072-af6562c53daa","value":"1","type":"add","operator":"="}]},{"id":"87729622-bbcf-48b9-ba91-cdaf5c68954e","order":70,"text":"Additional retirement or investment interests, if any, are described as follows: [Additional Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9efc08d6-6c46-4d17-8072-af6562c53daa","value":"1","type":"add","operator":"="}]},{"id":"1cd2eb54-a3a4-4d18-8bfc-9c53bca13b46","order":71,"text":"10. BUSINESS INTERESTS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"1537e59e-f99f-4a22-b344-0cae9c564f8b","value":"1","type":"add","operator":"="}],"sectionNum":"S10"},{"id":"f9895465-6e70-4a77-974a-b617e20ab04b","order":72,"text":"I hold the following ownership interest(s) in any business, partnership, professional practice, limited liability company or closely held entity:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"1537e59e-f99f-4a22-b344-0cae9c564f8b","value":"1","type":"add","operator":"="}]},{"id":"4ad2db8f-3381-44d9-803d-5bea6efb3767","order":73,"text":"Entity: [Business / Entity Name], organized as a [Legal Form], in which I hold a [Percentage] ownership interest, having an estimated fair market value (net of associated liabilities) of $[Value]. The basis of valuation is [basis: book value / appraisal / other].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"1537e59e-f99f-4a22-b344-0cae9c564f8b","value":"1","type":"add","operator":"="}]},{"id":"7dfc625f-4c54-4d8f-9929-e00f791d4ab3","order":74,"text":"Additional business interests, if any, are described as follows: [Additional Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"1537e59e-f99f-4a22-b344-0cae9c564f8b","value":"1","type":"add","operator":"="}]},{"id":"56712df3-a21c-4f27-8b44-a2c37a5391a0","order":75,"text":"11. PERSONAL PROPERTY OF VALUE","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"0759b148-e83e-4661-81d2-b6494c3ff955","value":"1","type":"add","operator":"="}],"sectionNum":"S11"},{"id":"27e3d7c4-0e69-40b7-b028-8d309e8e5aa3","order":76,"text":"I hold the following items of personal property of significant value, including jewelry, art, collectibles, furnishings, equipment and other valuables:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"0759b148-e83e-4661-81d2-b6494c3ff955","value":"1","type":"add","operator":"="}]},{"id":"d1052074-4525-402f-ae5b-faf046c76684","order":77,"text":"Description and estimated value of personal property: [Itemized Description with Values], having an aggregate estimated fair market value of $[Total Value].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"0759b148-e83e-4661-81d2-b6494c3ff955","value":"1","type":"add","operator":"="}]},{"id":"afa5dcf9-ffec-4b8a-ae86-84700dad9e19","order":78,"text":"12. LIFE INSURANCE AND CASH VALUE","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"f200f798-d32f-4a94-b301-5e975f8a6cee","value":"1","type":"add","operator":"="}],"sectionNum":"S12"},{"id":"f8fe6bfe-c3ef-4bd7-b697-64946bc63668","order":79,"text":"I hold the following policy or policies of life insurance, whether term or permanent, together with any associated cash surrender value, which value constitutes an asset of the estate:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"f200f798-d32f-4a94-b301-5e975f8a6cee","value":"1","type":"add","operator":"="}]},{"id":"fc6d2e27-4052-4839-ad11-19887d563c0c","order":80,"text":"Policy: [Insurer and Policy Number], insuring the life of [Name of Insured], with a face (death) benefit of $[Face Amount] and a present cash surrender value of $[Cash Value]. The named beneficiary is [Beneficiary].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"f200f798-d32f-4a94-b301-5e975f8a6cee","value":"1","type":"add","operator":"="}]},{"id":"c51c6bea-2679-4196-b822-1a3f3964104d","order":81,"text":"Additional life insurance policies, if any, are described as follows: [Additional Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"f200f798-d32f-4a94-b301-5e975f8a6cee","value":"1","type":"add","operator":"="}]},{"id":"f455e975-ecce-4c6c-8b75-ef7eaa4c264e","order":82,"text":"13. LIABILITIES AND DEBTS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S13"},{"id":"4372ab2c-47fb-41dd-b84a-b08b55b2256b","order":83,"text":"I disclose the following liabilities and debts, whether incurred individually, jointly or on behalf of the marital estate, stated at their outstanding balance as of the date of this Affidavit:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"aced596c-5b6c-4ce1-9108-2b50d44c6ceb","order":84,"text":"Mortgages and real-estate-secured debt: $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"e06889b8-3a8f-4da5-ad43-909ffc804aa5","order":85,"text":"Vehicle loans and leases: $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"6fe23d0d-72d8-4bd9-9960-7bdb1b6a8738","order":86,"text":"Credit card and revolving account balances: $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"bd90dbae-de25-42dc-8e1c-33b42efb9d09","order":87,"text":"Student loans: $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"f4c49985-911e-477e-8932-1a3d7e63eb9c","order":88,"text":"Tax obligations owed to any taxing authority: $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"106f3dd0-86f0-4ac5-ac68-969eaf089a4c","order":89,"text":"Loans from family, friends or other persons: $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"30fd976e-e54e-4b80-a4b0-f6906c196481","order":90,"text":"All other liabilities (described as follows): [Description] — $[Balance].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"629bcf0b-1903-467d-a0a5-757ff458e1ba","order":91,"text":"TOTAL LIABILITIES: $[Total].","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"7dfffaa0-dcfb-41cc-ad57-b4fccacbee0f","order":92,"text":"14. CONTINGENT AND UNUSUAL ASSETS AND LIABILITIES","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S14"},{"id":"8993688f-2017-4e27-a6b2-b6295a9ee025","order":93,"text":"I disclose the following contingent, unliquidated or non-customary assets and liabilities, the value or existence of which may not be reflected in the foregoing schedules, including but not limited to: unvested stock options or restricted stock units; deferred or anticipated bonuses; expected tax refunds; accounts or notes receivable; inheritances or trust interests, whether vested or expectant; pending claims, lawsuits or settlements in which I have an interest; personal guarantees; and contingent or disputed tax or other obligations.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"7117cc51-7c02-4622-abd0-78d1dbffb813","order":94,"text":"Contingent or unusual assets: [Describe, with estimated values, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"c0f96241-7737-4227-8137-04db51e355a7","order":95,"text":"Contingent or unusual liabilities: [Describe, with estimated amounts, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"c4006bb8-e0fd-47a6-9191-bbfba80f3e08","order":96,"text":"15. HEALTH INSURANCE AND DEPENDENT COVERAGE","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S15"},{"id":"e7c7a855-d794-437b-bef9-a4ea84bd2aea","order":97,"text":"Health insurance coverage is presently maintained as follows. The coverage is provided through [employer / private plan / public program], with [Carrier and Plan Name]. The total monthly premium is $[Premium], of which the portion attributable to coverage of the dependent child(ren) is approximately $[Child Portion] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"aa58372e-7013-42a9-a0a9-c55914924b3f","order":98,"text":"The persons presently covered under the said policy are: [List of Covered Persons]. Unreimbursed or out-of-pocket medical, dental and vision expenses average approximately $[Monthly Amount] per month.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"71733917-35de-4e27-b19c-c9f7938dd6fc","order":99,"text":"16. EXISTING SUPPORT OBLIGATIONS AND PRIOR ORDERS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"99b82124-38b5-4767-b9e2-ec9bded54ba7","value":"1","type":"add","operator":"="}],"sectionNum":"S16"},{"id":"02374c91-d7ad-4e2a-b5c6-a88ea6b4e201","order":100,"text":"I am presently subject to the following pre-existing court orders or legal obligations for the support of any spouse, former spouse or child of another relationship, which affect my available income and resources:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"99b82124-38b5-4767-b9e2-ec9bded54ba7","value":"1","type":"add","operator":"="}]},{"id":"8d6d6c07-3a52-48bf-a9e4-bc97f612e0ed","order":101,"text":"Obligation: [child support / spousal support / other], payable to [Payee] in the amount of $[Amount] per month, pursuant to an order entered in [Court and Case Number]. The present arrearage, if any, is $[Arrears].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"99b82124-38b5-4767-b9e2-ec9bded54ba7","value":"1","type":"add","operator":"="}]},{"id":"4de00e15-b779-4652-bcc2-e826bcc472a7","order":102,"text":"Additional support obligations or prior orders, if any, are described as follows: [Additional Details, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"99b82124-38b5-4767-b9e2-ec9bded54ba7","value":"1","type":"add","operator":"="}]},{"id":"9eb9b0b3-dcbf-4926-8911-87950e82b345","order":103,"text":"17. ATTORNEY'S FEES AND COSTS OF LITIGATION","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S17"},{"id":"7d5a1f0d-c427-4226-b5a4-e86f1a203b66","order":104,"text":"In connection with this proceeding, I have incurred attorney's fees and costs in the approximate amount of $[Amount Incurred] to date, of which $[Amount Paid] has been paid and $[Amount Owed] remains outstanding. The source of funds used to pay such fees has been [Source of Funds].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"a1216df1-5b25-4fed-8d10-49266ba6c529","order":105,"text":"18. SUMMARY OF NET WORTH AND SUPPLEMENTARY DISCLOSURES","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S18"},{"id":"1d2e5d20-2aca-4446-b6db-23202fc1f4e6","order":106,"text":"Based upon the foregoing, the total estimated value of all assets disclosed herein is $[Total Assets], and the total of all liabilities disclosed herein is $[Total Liabilities], resulting in an estimated net worth of $[Net Worth] as of the date of this Affidavit.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"06b77829-7031-4c0a-9bfb-ec17cdb50a2f","order":107,"text":"I further state that, within the three (3) years immediately preceding the date of this Affidavit, I have not made any gift, transfer, conveyance or disposition of property of significant value outside the ordinary course of the parties' affairs, and I have not dissipated, concealed or transferred any asset in anticipation of these proceedings, except as follows: [Describe any such transfers, or 'None'].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"f8d7ee09-8ef2-4aac-b1f0-83e33fc9a6b3","order":108,"text":"In support of the disclosures made herein, and in accordance with the mandatory financial disclosure obligations applicable to this proceeding, I have produced or will produce upon request the following supporting documentation: federal and state income tax returns for the preceding three (3) years; pay stubs and proof of income for the preceding two (2) months; statements for all bank, retirement and investment accounts; loan and credit card statements; deeds, titles and the most recent valuation for each item of real and personal property; declarations pages for each insurance policy; and, where applicable, business financial statements and profit-and-loss statements for the preceding two (2) years.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"2da1e480-9bbf-4cd5-9d3a-1804791a0f53","order":109,"text":"Any schedules, statements or attachments annexed to this Affidavit are incorporated herein by reference and form an integral part hereof. I acknowledge and understand that I am under a continuing duty to supplement and amend this Affidavit promptly should my financial circumstances materially change, or should I discover that any information stated herein is incomplete or inaccurate. Nothing in this Affidavit shall be construed as a waiver of any right, claim or defense available to me at law or in equity, all of which are expressly reserved.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"40edf6db-ba3f-4e9f-b621-a06295caf68d","order":110,"text":"DECLARATION UNDER PENALTY OF PERJURY","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"20"},{"id":"24f5097e-b1e3-4911-a8c9-74ecad9489b5","order":111,"text":"I declare under penalty of perjury under the laws of the State of [State] that the foregoing is true, accurate and complete, and that I have not knowingly or willfully omitted, understated or concealed any asset, debt, income or expense. I understand that a substantial or willful failure to disclose fully my financial circumstances, or the falsification of this document, may subject me to monetary sanctions, an adverse distribution of property, a finding of contempt, and such other penalties as the Court may impose by law.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"71e95315-e19a-4aad-a8d6-6dc173dc739f","order":112,"text":"Executed at [City, State], on this [Day] day of [Month], [Year].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"40","cflou":false,"active":true},{"id":"9a539812-2a99-48da-87ec-9fb27c2945a9","order":113,"text":"______________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"f52783c6-353d-4f72-a7b5-66adf970ace6","order":114,"text":"[Affiant's Full Legal Name], Affiant","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"40","cflou":false,"active":true},{"id":"fa2d2971-2a09-40e9-a57d-300d3851a3c9","order":115,"text":"ACKNOWLEDGMENT AND JURAT","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true},{"id":"e77545a9-eefb-4e37-b4f1-17efa5898f18","order":116,"text":"Subscribed and sworn to (or affirmed) before me on this [Day] day of [Month], [Year], by [Affiant's Full Legal Name], who is personally known to me or who produced [form of identification] as identification and who executed the foregoing instrument and acknowledged that the statements contained therein are true.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"e22fea0c-b0b9-444a-9d69-ff94f0ae49f8","order":117,"text":"______________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"eeee45d4-b5da-4ffb-bb7f-c0cb83e349f9","order":118,"text":"Notary Public","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"f5de6d88-a349-429b-89cd-60a23d854123","order":119,"text":"My commission expires: [Date]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true}]