Title: In Re: Amendments To The Florida Family Law Rules Of Procedure (Out Of Cycle)
Citation: N/A
Docket Number: SC06-344
State: Florida
Issuer: Florida Supreme Court
Date: September 28, 2006

Supreme Court of Florida 
 
 
____________ 
 
No. SC06-344 
____________ 
 
 
IN RE:  AMENDMENTS TO THE FLORIDA FAMILY LAW RULES OF 
PROCEDURE (OUT OF CYCLE). 
 
[September 28, 2006] 
CORRECTED OPINION 
 
PER CURIAM. 
 
The Family Law Rules Committee of The Florida Bar (committee) has filed 
an out of cycle report proposing amendments to family law forms 12.902(b) and 
(c) (Family Law Financial Affidavits), and 12.902(i) (Affidavit of Corroborating 
Witness).  We have jurisdiction.  See art. V, § 2(a), Fla. Const.  The proposed 
amendments were published for comment in the March 1, 2006, edition of The 
Florida Bar News.  No comments were received. 
 
Upon consideration, we adopt the amendments proposed by the committee1 
with one modification.  The committee recommends that form 12.902(i) (Affidavit 
of Corroborating Witness) be amended in order to reflect that the affiant has 
                                                 
 
1.  Other minor editorial changes, in addition to the amendments proposed 
by the committee, have also been made to the subject forms.  
knowledge that a petitioner for dissolution of marriage has resided in Florida for at 
least six months immediately prior to the filing of the petition for dissolution of 
marriage, rather than, as it now states, six months prior to the date of the affidavit.  
However, we recognize that an affiant may not personally have knowledge of the 
date a petition for dissolution of marriage is filed, and we modify the committee’s 
proposal accordingly.   
 
Family law forms 12.902(b) and (c) (Family Law Financial Affidavits), and 
12.902(i) (Affidavit of Corroborating Witness) are hereby amended as reflected in 
the appendix to this opinion, fully engrossed.  The amendments shall become 
effective immediately. The forms discussed herein may be accessed and 
downloaded from the Florida State Courts website at www.flcourts.org.  
 
It is so ordered. 
 
LEWIS, C.J., and WELLS, ANSTEAD, PARIENTE, QUINCE, CANTERO, and 
BELL, JJ., concur. 
 
THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE 
EFFECTIVE DATE OF THESE AMENDMENTS. 
 
 
Original Proceeding – Florida Family Law Rules of Procedure 
 
John Fraser Himes, Chair, Family Law Rules Committee, Tampa, Florida, 
Honorable John M. Alexander, Past-Chair, St. Augustine, Florida, and John F. 
Harkness, Jr., Executive Director, the Florida Bar, Tallahassee, Florida, 
 
 
for Petitioner 
 
 
 
2
APPENDIX 
 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(b), 
FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) 
 
When should this form be used? 
 
This form should be used when you are involved in a family law case which requires a financial affidavit 
and your individual gross income is UNDER $50,000 per year. 
 
This form should be typed or printed in black ink.  After completing this form, you should sign the form 
before a notary public or deputy clerk.  You should file the original with the clerk of the circuit court 
in the county where the petition was filed and keep a copy for your records.  
 
What should I do next? 
 
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on 
him or her with your initial papers.  This must be accomplished within 45 days of service of the petition. 
 
Where can I look for more information? 
 
Before proceeding, you should read “General Information for Self-Represented Litigants” found at 
the beginning of these forms.  The words that are in “bold underline” in these instructions are defined 
there.  For further information, see rule 12.285, Florida Family Law Rules of Procedure. 
 
Special notes... 
 
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do 
not enter the address, telephone, and fax information at the bottom of this form.  Instead, file Petitioner’s 
Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 
12.980(h). 
 
The affidavit must be completed using monthly income and expense amounts.  If you are paid or your 
bills are due on a schedule which is not monthly, you must convert those amounts.  Hints are provided 
below for making these conversions. 
 
Hourly - If you are paid by the hour, you may convert your income to monthly as follows: 
Hourly amount 
 
x 
Hours worked per week 
= 
Weekly amount 
Weekly amount 
 
x 
52 Weeks per year  
= 
Yearly amount 
Yearly amount 
 
÷ 
12 Months per year  
= 
Monthly Amount 
Daily - If you are paid by the day, you may convert your income to monthly as follows: 
Daily amount 
 
x 
Days worked per week 
= 
Weekly amount 
Weekly amount 
 
x 
52 Weeks per year  
= 
Yearly amount 
Yearly amount 
 
÷ 
12 Months per year  
= 
Monthly Amount 
Weekly - If you are paid by the week, you may convert your income to monthly as follows: 
Weekly amount 
 
x 
52 Weeks per year  
= 
Yearly amount 
Yearly amount 
 
÷ 
12 Months per year  
= 
Monthly Amount 
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as follows: 
Bi-weekly amount  
x 
 
26 
 
= 
Yearly amount 
Yearly amount 
 
÷ 
12 Months per year  
= 
Monthly Amount 
Semi-monthly - If you are paid twice per month, you may convert your income to monthly as follows: 
Semi-monthly amount 
x 
 
2 
 
= 
Monthly Amount 
 
Expenses may be converted in the same manner. 
Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (09/06) 
 
Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (09/06) 
 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out these 
forms also must put his or her name, address, and telephone number on the bottom of the last page of 
every form he or she helps you complete. 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial  Affidavit (Short Form) (09/06) 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                        COUNTY, FLORIDA 
 
Case No.:  
 
Division:  
 
                                                                      , 
Petitioner, 
and 
 
                                                                       , 
Respondent. 
 
FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) 
(Under $50,000 Individual Gross Annual Income) 
 
I, {full legal name}  
  
 
 
, being sworn, certify that the following information 
is true: 
My Occupation:   
   
 Employed by:  
 
Business Address:  
 
 
 
 
Pay rate: $                    (    ) every week (    ) every other week (    ) twice a month (    ) monthly (    ) other:  
 
□ Check here if unemployed and explain on a separate sheet your efforts to find employment. 
 
SECTION I.  PRESENT MONTHLY GROSS INCOME: 
All amounts must be MONTHLY.  See the instructions with this form to figure out money amounts for anything that is NOT 
paid monthly.  Attach more paper, if needed.  Items included under “other” should be listed separately with separate dollar 
amounts. 
1. Monthly gross salary or wages 
2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments
3. Monthly business income from sources such as self-employment, partnerships, 
close corporations, and/or independent contracts (gross receipts minus ordinary
and necessary expenses required to produce income)  (□ Attach sheet itemizing 
such income and expenses.) 
4. Monthly disability benefits/SSI 
5. Monthly Workers’ Compensation 
6. Monthly Unemployment Compensation 
7. Monthly pension, retirement, or annuity payments 
8. Monthly Social Security benefits 
9. Monthly alimony actually received 
9a.  From this case:       
$                 
9b.  From other case(s): 
                         
  
Add 9a and 9b 
10. Monthly interest and dividends 
11. Monthly rental income (gross receipts minus ordinary and necessary expenses 
 
required to produce income) (□ Attach sheet itemizing such income and
 
expense  items.) 
12. Monthly income from royalties, trusts, or estates 
13. Monthly reimbursed expenses and in-kind payments to the extent that they 
reduce personal living expenses 
14. Monthly gains derived from dealing in property (not including nonrecurring
gains) 
15. Any other income of a recurring nature (list source)  
 
 
16.  
 
 
 
 
 
 
 
1. $ 
 
 
2.    
 
 
 
 
 
 
3.  
 
 
4.  
 
 
5.  
 
 
6.  
 
 
7.  
 
 
8.  
 
 
 
9.  
 
 
10.  
 
 
 
 
11.  
 
 
12.  
 
 
 
13.  
 
 
 
14.  
 
 
15.  
 
 
16.  
 
 
 
17.  PRESENT MONTHLY GROSS INCOME (Add lines 1–16) 
TOTAL:               17. $  
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial  Affidavit (Short Form) (09/06) 
 
PRESENT MONTHLY DEDUCTIONS: 
18. Monthly federal, state, and local income tax (corrected for filing status and
allowable dependents and income tax liabilities) 
a.  Filing Status ____________ 
b.  Number of dependents claimed _______ 
19. Monthly FICA or self-employment taxes 
20. Monthly Medicare payments 
21. Monthly mandatory union dues 
22. Monthly mandatory retirement payments 
23. Monthly health insurance payments (including dental insurance), excluding 
portion paid for any minor children of this relationship 
24. Monthly court-ordered child support actually paid for children from another
 
relationship 
25. Monthly court-ordered alimony actually paid 
25a.  from this case:       
$                 
25b.  from other case(s):                            
  Add 25a and 25b 
  
 
 
18. $ 
 
 
19.  
 
 
20.  
 
 
21.  
 
 
22.  
 
 
 
23.  
 
 
 
24.  
 
 
 
 
25.  
 
 
 
26.  TOTAL  DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, 
FLORIDA STATUTES (Add lines 18 through 25) 
 
         TOTAL:   26. $  
 
PRESENT NET MONTHLY INCOME  (Subtract line 26 from line 17)                        27. $    
 
 
SECTION II.  AVERAGE MONTHLY EXPENSES 
A.  HOUSEHOLD: 
      Mortgage or rent  
   
$    
 
 
      Property taxes  
   
$   
 
 
      Utilities   
 
    $   
 
 
      Telephone  
 
   
$   
 
 
      Food  
 
 
   
$   
 
 
      Meals outside home  
   
$   
 
 
      Maintenance/Repairs    
$   
 
      Other:                                
$   
 
 
B.  AUTOMOBILE 
      Gasoline  
 
 
   
$   
 
      Repairs   
 
   
$   
 
 
      Insurance  
 
   
$   
 
 
C.  CHILD(REN)’S EXPENSES 
      Day care  
 
 
   
$   
 
      Lunch money  
   
$   
 
      Clothing   
 
   
$   
 
      Grooming  
 
   
$   
 
      Gifts for holidays  
   
$   
 
      Medical/Dental (uninsured)  $   
 
      Other:                              
$   
 
 
D.  INSURANCE 
      Medical/Dental 
    
$   
 
      Child(ren)’s medical/dental $   
 
      Life   
 
  
   
$   
 
      Other:                                 
$   
 
E.  OTHER EXPENSES NOT LISTED ABOVE 
      Clothing  
 
   
$   
 
      Medical/Dental (uninsured) $   
 
      Grooming 
 
   
$   
 
      Entertainment 
 
   
$   
 
      Gifts  
 
 
   
$   
 
      Religious organizations  
$   
 
      Miscellaneous 
   
$   
 
      Other:                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
 
F.  PAYMENTS TO CREDITORS 
  
 
 
 
 
 
 
 
MONTHLY 
CREDITOR:       
   
 
PAYMENT 
                                                    $  
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
                                                    $   
 
 
28.  TOTAL MONTHLY EXPENSES (add ALL monthly amounts in 
A through F above)    
  
 
 
 
 
 
28. $  
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial  Affidavit (Short Form) (09/06) 
 
SUMMARY 
29.  TOTAL PRESENT MONTHLY NET INCOME 
 (from line 27 of SECTION I.  INCOME) 
30.  TOTAL MONTHLY EXPENSES  (from line 28 above)  
 
31.  SURPLUS  (If line 29 is more than line 30, subtract line 30 from line 29. 
This is the amount of your surplus.  Enter that amount here.) 
32.  (DEFICIT)  (If line 30 is more than line 29, subtract line 29 from line 30. 
This is the amount of your deficit.  Enter that amount here.) 
 29.  $ 
 
 
30.  $ 
 
 
 
31.  $ 
 
 
 
32.  ($                        )
 
  
SECTION III.  ASSETS AND LIABILITIES 
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item is “nonmarital,” 
meaning it belongs to only one of you and should not be divided.  You should indicate to whom you believe the item(s) or 
debt belongs.  (Typically, you will only use this column if property/debt was owned/owed by one spouse before the marriage.  
See the “General Information for Self-Represented Litigants” found at the beginning of these forms and section 61.075(1), 
Florida Statutes, for definitions of  “marital” and “nonmarital” assets and liabilities.) 
 
A.  ASSETS: 
 
Nonmarital 
(√ correct column) 
 
DESCRIPTION OF ITEM(S).  List a description of each separate item owned by 
you (and/or your spouse, if this is a petition for dissolution of marriage).  
DO NOT LIST ACCOUNT NUMBERS. √ the box next to any asset(s) which you  
are requesting the judge award to you. 
 
 
Current Fair 
Market Value 
 
husband 
 
wife 
 
□ Cash (on hand) 
 
$ 
 
 
 
 
 
□ Cash (in banks or credit unions) 
 
 
 
 
 
 
 
□ Stocks, Bonds, Notes 
 
 
 
 
 
 
 
□ Real estate: (Home) 
 
 
 
 
 
 
 
□ (Other) 
 
 
 
 
 
 
 
□ Automobiles 
 
 
 
 
 
 
 
□ Other personal property 
 
 
 
 
 
 
 
□ Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 
 
 
 
 
 
 
 
□ Other 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□   √ here if additional pages are attached. 
 
 
 
 
 
 
 
Total Assets  (add next column) 
 
$  
 
  
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial  Affidavit (Short Form) (09/06) 
 
B.  LIABILITIES: 
 
Nonmarital 
(√ correct column) 
 
DESCRIPTION OF ITEM(S).  List a description of each separate debt owed by 
you (and/or your spouse, if this is a petition for dissolution of marriage). DO NOT 
LIST ACCOUNT NUMBERS. √ the box next to any debt(s) for which you believe 
you should be responsible. 
 
 
Current 
Amount Owed 
 
husband 
wife 
 
□ Mortgages on real estate: First mortgage on home 
 
$ 
 
 
 
 
 
□ Second mortgage on home 
 
 
 
 
 
 
 
□ Other mortgages 
 
 
 
 
 
 
 
□  
 
 
 
 
 
 
 
□ Auto loans 
 
 
 
 
 
 
 
□  
 
 
 
 
□ Charge/credit card accounts 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□  
 
 
 
 
 
 
 
□ Other   
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□  
 
 
 
 
 
 
 
□ √ here if additional pages are attached. 
 
 
 
 
 
 
 
Total Debts   (add next column) 
 
$   
  
   
 
 
 
 
 
C.   CONTINGENT ASSETS AND LIABILITIES: 
INSTRUCTIONS:  If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) 
or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts assumed by another), you must 
list them here. 
 
Nonmarital 
(√ correct column) 
 
Contingent Assets 
 
√ the box next to any contingent asset(s) which you are requesting the judge award to you. 
 
 
Possible Value 
 
husband 
wife
 
□ 
 
$ 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
Total Contingent Assets 
 
$   
 
    
 
 
 
 
 
 
Nonmarital 
(√ correct column) 
 
Contingent Liabilities 
 
√ the box next to any contingent debt(s) for which you believe you should be responsible. 
 
Possible Amount 
Owed 
 
husband 
wife
 
□ 
 
$ 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
Total Contingent Liabilities 
 
$  
 
    
 
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial  Affidavit (Short Form) (09/06) 
 
SECTION IV.  CHILD SUPPORT GUIDELINES WORKSHEET 
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be filed with 
the court at or prior to a hearing to establish or modify child support. This requirement cannot be waived by the 
parties.) 
 
[ √ one only] 
        
A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the 
establishment or modification of child support. 
        
A Child Support Guidelines Worksheet IS NOT being filed in this case.  The establishment or 
modification of child support is not an issue in this case. 
 
I certify that a copy of this document was [ √ one only] (    ) mailed (    ) faxed and mailed (    ) hand 
delivered to the person(s) listed below on {date}  
. 
 
Other party or his/her attorney: 
Name:   
 
 
   
 
 
 
Address:  
 
 
   
 
 
 
City, State, Zip:   
   
 
 
 
Fax Number:  
 
   
 
 
 
 
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in 
this affidavit and that the punishment for knowingly making a false statement includes fines and/or 
imprisonment. 
 
Dated:                                                     
 
 
 
 
 
 
 
 
Signature of Party 
Printed Name:  
 
Address:  
 
City, State, Zip:  
 
Telephone Number:  
 
Fax Number:  
 
STATE OF FLORIDA 
COUNTY OF  
 
   
                                         
 
Sworn to or affirmed and signed before me on  
 
 
 by  
. 
 
 
 
 
NOTARY PUBLIC or DEPUTY CLERK  
 
 
[Print, type, or stamp commissioned name of notary 
or deputy clerk.] 
        
Personally known 
        
Produced identification 
Type of identification produced   
 
 
                                              
 
 
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS 
BELOW: [fill in all blanks] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street}   
 
 
 
 
, {city}  
, 
{state}   
 
, {phone}   
 
, helped {name}  
 
, 
who is the [ √ one only]       petitioner or       respondent, fill out this form.
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 12.902(c), 
FAMILY LAW FINANCIAL AFFIDAVIT 
 
When should this form be used? 
This form should be used when you are involved in a family law case which requires a financial affidavit 
and your individual gross income is $50,000 OR MORE per year. 
 
This form should be typed or printed in black ink.  After completing this form, you should sign the form 
before a notary public or deputy clerk.  You should then file the original with the clerk of the circuit 
court in the county where the petition was filed and keep a copy for your records. 
 
What should I do next? 
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on 
him or her with your initial papers.  This must be accomplished within 45 days of service of the petition. 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self-Represented Litigants” found at 
the beginning of these forms.  The words that are in “bold underline” in these instructions are defined 
there.  For further information, see rule 12.285, Florida Family Law Rules of Procedure. 
Special notes... 
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do 
not enter the address, telephone, and fax information at the bottom of this form.  Instead, file Petitioner’s 
Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 
12.980(h). 
 
The affidavit must be completed using monthly income and expense amounts.  If you are paid or your 
bills are due on a schedule which is not monthly, you must convert those amounts.  Hints are provided 
below for making these conversions. 
 
Hourly - If you are paid by the hour, you may convert your income to monthly as follows: 
Hourly amount  
x 
Hours worked per week 
 = 
 Weekly amount 
Weekly amount  
x  
52 Weeks per year   
 =  
 Yearly amount 
Yearly amount  
÷ 
12 Months per year  
 =  
 Monthly Amount 
Daily - If you are paid by the day, you may convert your income to monthly as follows: 
Daily amount 
x 
Days worked per week  
 =  
Weekly amount 
Weekly amount 
x 
52 Weeks per year   
 = 
Yearly amount 
Yearly amount  
÷ 
12 Months per year   
 = 
Monthly Amount 
Weekly - If you are paid by the week, you may convert your income to monthly as follows: 
Weekly amount 
x 
52 Weeks per year  
 = 
Yearly amount 
Yearly amount 
÷ 
12 Months per year  
 = 
Monthly Amount 
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as follows: 
Bi-weekly amount  
x  
 
26 
 
 = 
Yearly amount 
Yearly amount 
÷ 
12 Months per year   
 = 
Monthly Amount 
Semi-monthly - If you are paid twice per month, you may convert your income to monthly as follows: 
Semi-monthly amount 
x 
 
2 
 
 = 
Monthly Amount 
 
Expenses may be converted in the same manner. 
 
Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out these 
forms also must put his or her name, address, and telephone number on the bottom of the last page of 
every form he or she helps you complete. 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                       COUNTY, FLORIDA 
 
Case No.:  
 
Division:  
 
                                                                      , 
              Petitioner, 
 
and 
 
                                                                       , 
           Respondent. 
 
FAMILY LAW FINANCIAL AFFIDAVIT 
($50,000 or more Individual Gross Annual Income) 
 
I, {full legal name}                               
                                                                           , being  
sworn, certify that the following information is true: 
 
SECTION I.  INCOME 
 
1. 
Date of Birth:  
 
  
 
 
 
                                      
2. 
My occupation is:  
 
 
3. 
I am currently 
[ √ all that apply] 
          a.  Unemployed 
Describe your efforts to find employment, how soon you expect to be employed, and the pay you 
expect to receive:  
 
 
 
 
 
 
 
 
 
 
        
b.  Employed by:   
 
 
Address:  
 
 
 
 
City, State, Zip code:   
 
Telephone Number:   
 
Pay rate: $  
 
 (    ) every week (    ) every other week (    ) twice a month  
(    ) monthly (    ) other:  
 
If you are expecting to become unemployed or change jobs soon, describe the change you expect 
and why and how it will affect your income:  
 
 
 
 
 
 
 
 
□ Check here if you currently have more than one job.  List the information above for the second 
job(s) on a separate sheet and attach it to this affidavit. 
        
c.  Retired.  Date of retirement:   
 
 
 
                                                                              
Employer from whom retired:  
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
Address:  
 
 
 
 
City, State, Zip code:    
 
 
 
 Telephone Number:  
 
 
LAST YEAR=S GROSS INCOME: 
Your Income 
 
Other Party’s Income (if known) 
YEAR   
 
 
 
$  
 
 
 
 
$  
 
 
 
PRESENT MONTHLY GROSS INCOME: 
All amounts must be MONTHLY.  See the instructions with this form to figure out money amounts for anything that is NOT 
paid monthly.  Attach more paper, if needed.  Items included under “other” should be listed separately with separate dollar 
amounts. 
 
1. Monthly gross salary or wages 
2. Monthly bonuses, commissions, allowances, overtime, tips, and similar  
       payments 
3. Monthly business income from sources such as self-employment, 
partnerships, close corporations, and/or independent contracts (Gross receipts 
minus ordinary and necessary expenses required to produce income.) 
(□ Attach sheet itemizing such income and expenses.) 
4. Monthly disability benefits/SSI 
5. Monthly Workers’ Compensation 
6. Monthly Unemployment Compensation 
7. Monthly pension, retirement, or annuity payments 
8. Monthly Social Security benefits 
9. Monthly alimony actually received 
9a.  From this case:       $                 
9b.  From other case(s):                            
Add 9a and 9b 
10. Monthly interest and dividends 
11. Monthly rental income (gross receipts minus ordinary and necessary expenses 
required to produce income) (□ Attach sheet itemizing such income and 
expense items.) 
12. Monthly income from royalties, trusts, or estates 
13. Monthly reimbursed expenses and in-kind payments to the extent that they 
reduce personal living expenses (□ Attach sheet itemizing each item and 
amount.) 
14. Monthly gains derived from dealing in property (not including nonrecurring 
gains) 
Any other income of a recurring nature (identify source) 
15.  
 
 
 
 
 
 
 
16.  
 
 
 
 
 
 
 
 
  1. $ 
 
 
 
2.  
 
 
 
 
 
3.  
 
 
4.  
 
 
5.  
 
 
6.  
 
 
7.  
 
 
8.  
 
 
 
 
9.  
 
 
10.  
 
 
 
 
11.  
 
 
12.  
 
 
 
 
13.  
 
 
 
14.  
 
 
 
15.  
 
 
16.  
 
 
 
 
17.  PRESENT MONTHLY GROSS INCOME  (Add lines 1B16)   TOTAL: 17. $  
 
 
 
 
 
 
 
PRESENT MONTHLY DEDUCTIONS: 
All amounts must be MONTHLY.  See the instructions with this form to figure out money amounts for anything that is NOT 
paid monthly. 
 
18. Monthly federal, state, and local income tax (corrected for filing status and 
allowable dependents and income tax liabilities) 
a.  Filing Status   
  
 
 
 
b.  Number of dependents claimed  
 
 
19. Monthly FICA or self-employment taxes 
20. Monthly Medicare payments 
21. Monthly mandatory union dues 
  
 
 
 
18. $ 
 
 
19.  
 
 
20.  
 
 
21.  
 
 
22. Monthly mandatory retirement payments 
23. Monthly health insurance payments (including dental insurance), excluding 
portion paid for any minor children of this relationship 
24. Monthly court-ordered child support actually paid for children from another 
relationship 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
 
26.  TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, 
       FLORIDA STATUTES  (Add lines 18 through 25)    TOTAL: 
26. $   
 
 
27.  PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17) 
27. $  
 
 
SECTION II.  AVERAGE MONTHLY EXPENSES 
Proposed/Estimated Expenses.  If this is a dissolution of marriage case and your expenses as listed 
below do not reflect what you actually pay currently, you should write “estimate” next to each amount 
that is estimated. 
HOUSEHOLD: 
1. Monthly mortgage or rent payments 
2. Monthly property taxes (if not included in mortgage) 
3. Monthly insurance on residence (if not included in mortgage) 
4. Monthly condominium maintenance fees and homeowner’s association fees
5. Monthly electricity 
6. Monthly water, garbage, and sewer 
7. Monthly telephone 
8. Monthly fuel oil or natural gas 
9. Monthly repairs and maintenance 
10. Monthly lawn care 
11. Monthly pool maintenance 
12. Monthly pest control 
13. Monthly misc. household 
14. Monthly food and home supplies 
15. Monthly meals outside home 
16. Monthly cable t.v. 
17. Monthly alarm service contract 
18. Monthly service contracts on appliances 
 1. $ 
 
 
2.  
 
 
3.  
 
 
4.  
 
 
5.  
 
 
22.  
 
 
 
23.  
 
 
 
24.  
 
 
 
 
25.  
 
 
25. Monthly court-ordered alimony actually paid 
25a.  from this case: 
$    
                  
25b.  from other case(s):                       
 Add 25a and 25b 
6.  
 
 
7.  
 
 
8.  
 
 
9.  
 
 
10.  
 
 
11.  
 
 
12.  
 
 
13.  
 
 
14.  
 
 
15.  
 
 
16.  
 
 
17.  
 
 
18.  
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
19. Monthly maid service 
Other: 
20.  
 
 
 
 
 
 
 
21.  
 
 
 
 
 
 
 
22.  
 
 
 
 
 
 
 
23.  
 
 
 
 
 
 
 
24.  
 
 
 
 
 
 
 
19.  
 
 
 
20.  
 
 
21.  
 
 
22.  
 
 
23.  
 
 
24.  
 
 
 
  
25. 
                                               SUBTOTAL (add lines 1 through 24)  
25.  $   
 
 
 
 
AUTOMOBILE: 
26. Monthly gasoline and oil  
27. Monthly repairs 
28. Monthly auto tags and emission testing 
29. Monthly insurance 
30. Monthly payments (lease or financing)           
31. Monthly rental/replacements 
32. Monthly alternative transportation (bus, rail, car pool, etc.) 
33. Monthly tolls and parking 
34. Other:   
 
   
 
 
  
  
26. $ 
 
 
27.  
 
 
28.  
 
 
29.  
 
 
30.  
 
 
31.  
 
 
32.  
 
 
33.  
 
 
34.  
 
 
 
  
35.  
                                              SUBTOTAL (add lines 26 through 34) 
35. $ 
 
 
 
 
 
MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH
PARTIES: 
36. Monthly nursery, babysitting, or day care 
37. Monthly school tuition 
38. Monthly school supplies, books, and fees 
39. Monthly after school activities 
40. Monthly lunch money 
41. Monthly private lessons or tutoring 
42. Monthly allowances 
43. Monthly clothing and uniforms 
44. Monthly entertainment (movies, parties, etc.) 
45. Monthly health insurance 
46. Monthly medical, dental, prescriptions (nonreimbursed only) 
47. Monthly psychiatric/psychological/counselor 
48. Monthly orthodontic 
49. Monthly vitamins 
50. Monthly beauty parlor/barber shop 
51. Monthly nonprescription medication 
52. Monthly cosmetics, toiletries, and sundries 
53. Monthly gifts from child(ren) to others (other children, relatives, teachers, 
etc.) 
54. Monthly camp or summer activities 
55. Monthly clubs (Boy/Girl Scouts, etc.) 
56. Monthly access expenses (for nonresidential parent) 
57. Monthly miscellaneous 
  
 
36. $   
 
37.  
 
 
38.  
 
 
39.  
 
 
40.  
 
 
41.  
 
 
42.  
 
 
43.  
 
 
44.  
 
 
45.  
 
 
46.  
 
 
47.  
 
 
48.  
 
 
49.  
 
 
50.  
 
 
51.  
 
 
52.  
 
 
 
53.  
 
 
54.  
 
 
55.  
 
 
56.  
 
 
57.  
 
 
 
  
58. 
                                              SUBTOTAL (add lines 36 through 57) 
58. $ 
 
 
MONTHLY 
EXPENSES 
FOR 
CHILD(REN) 
FROM 
ANOTHER
RELATIONSHIP: (other than court-ordered child support) 
59.  
 
 
 
 
 
 
 
60.  
 
 
 
 
 
 
 
61.  
 
 
 
 
 
 
 
62.  
 
 
 
 
 
 
 
  
 
59. $ 
 
 
60.  
 
 
61.  
 
 
62.  
 
 
 
  
63. 
                                              SUBTOTAL (add lines 59 through 62) 
63. $ 
 
 
 
 
 
MONTHLY INSURANCE: 
64. Health insurance, excluding portion paid for any minor child(ren) of this
relationship 
65. Life insurance 
66. Dental insurance 
Other:  
67.  
 
 
 
 
 
 
 
68.  
 
 
 
 
 
 
 
  
 
64. $ 
 
 
65.  
 
 
66.  
 
 
 
67.  
 
 
68.  
 
 
 
  
69. 
                                              SUBTOTAL (add lines 64 through 68) 
69. $ 
 
 
 
 
 
OTHER MONTHLY EXPENSES NOT LISTED ABOVE: 
70. Monthly dry cleaning and laundry 
71. Monthly clothing 
72. Monthly medical, dental, and prescription (unreimbursed only) 
73. Monthly psychiatric, psychological, or counselor (unreimbursed only) 
74. Monthly non-prescription medications, cosmetics, toiletries, and sundries 
75. Monthly grooming 
76. Monthly gifts 
77. Monthly pet expenses 
78. Monthly club dues and membership 
79. Monthly sports and hobbies 
80. Monthly entertainment 
81. Monthly periodicals/books/tapes/CDs 
82. Monthly vacations 
83. Monthly religious organizations 
70. $ 
 
 
84. Monthly bank charges/credit card fees 
85. Monthly education expenses 
Other: (include any usual and customary expenses not otherwise mentioned in
the items listed above) 
86.  
 
 
 
 
 
 
 
87.  
 
 
 
 
 
 
 
88.  
 
 
 
 
 
 
 
89.  
 
 
 
 
 
 
 
 
71.  
 
 
72.  
 
 
73.  
 
 
74.  
 
 
75.  
 
 
76.  
 
 
77.  
 
 
78.  
 
 
79.  
 
 
80.  
 
 
81.  
 
 
82.  
 
 
83.  
 
 
84.  
 
 
85.  
 
 
 
 
86.  
 
 
87.  
 
 
88.  
 
 
89.  
 
 
 
  
90. 
                                              SUBTOTAL (add lines 70 through 89) 
90. $ 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
MONTHLY PAYMENTS TO CREDITORS:  (only when payments are currently made by you on 
outstanding balances) 
NAME OF CREDITOR(s): 
  
 
 
 
 
 
 
 
91. $ 
 
 
91.  
 
 
 
 
 
 
 
92.  
 
 
 
 
 
 
 
93.  
 
 
 
 
 
 
 
94.  
 
 
 
 
 
 
 
92.  
 
 
93.  
 
 
94.  
 
 
95.  
 
 
 
 
 
 
 
95.  
 
 
96.  
 
 
 
 
 
 
 
97.   
 
 
 
 
 
 
 
98.  
 
 
 
 
 
 
 
96.  
 
 
97.  
 
 
98.  
 
 
99.  
 
 
 
 
 
 
 
99.  
 
 
100.  
 
 
 
 
 
 
 
101.  
 
 
 
 
 
 
 
102.  
 
 
 
 
 
 
 
103.  
 
 
 
 
 
 
 
100.  
 
 
101.  
 
 
102.  
 
 
103.  
 
 
 
  
104. 
 
                                     SUBTOTAL (add lines 91 through 103)  
104. $  
 
 
 
 
105. 
TOTAL MONTHLY EXPENSES: 
(add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, Expenses) 
  105. $  
 
 
SUMMARY 
 
106. 
TOTAL PRESENT MONTHLY NET INCOME 
106.  $  
 
(from line 27 of SECTION I.  INCOME) 
 
 
  
107. 
TOTAL MONTHLY EXPENSES (from line 105 above) 
 
108. 
SURPLUS (If line 106 is more than line 107, subtract line 107 from
line 106.  This is the amount of your surplus.  Enter that amount here.) 
 107.  $  
 
 
108.  $   
 
 
 
  
109. 
(DEFICIT) (If line 107 is more than line 106, subtract line 106 from
line 107.  This is the amount of your deficit.  Enter that amount here.) 
  
109.  ($  
          )
 
  
SECTION III.  ASSETS AND LIABILITIES 
A. ASSETS  (This is where you list what you OWN.) 
INSTRUCTIONS: 
STEP 1:  In column A, list a description of each separate item owned by you (and/or your spouse, if this is a petition for 
dissolution of marriage).  Blank spaces are provided if you need to list more than one of an item.  
STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any item that you are requesting the 
judge award to you. 
STEP 3:  In column B, write what you believe to be the current fair market value of all items listed.   
STEP 4:  Use column C only if this is a petition for dissolution of marriage and you believe an item is “nonmarital,” 
meaning it belongs to only one of you and should not be divided.  You should indicate to whom you believe the item belongs.  
(Typically, you will only use Column C if property was owned by one spouse before the marriage.  See the “General 
Information for Self-Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for 
definitions of “marital” and “nonmarital” assets and liabilities.) 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
 
C 
Nonmarital 
(√ correct column) 
 
A 
ASSETS:  DESCRIPTION OF ITEM(S) 
DO NOT LIST ACCOUNT NUMBERS. 
√ the box next to any asset(s) which you are requesting the judge award to you. 
 
B 
Current Fair 
Market Value 
 
husband
wife
 
□
 
$ 
 
 
 
 
 Cash (on hand) 
 
□ Cash (in banks or credit unions) 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Stocks/Bonds 
 
 
 
 
 
 
 
□ 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Notes (money owed to you in writing) 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Money owed to you (not evidenced by a note) 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Real estate: (Home) 
 
 
 
 
 
 
 
□ (Other) 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Business interests 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Automobiles 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Boats 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Other vehicles 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
 
C 
Nonmarital 
(√ correct column) 
 
A 
ASSETS:  DESCRIPTION OF ITEM(S) 
DO NOT LIST ACCOUNT NUMBERS. 
√ the box next to any asset(s) which you are requesting the judge award to you. 
 
B 
Current Fair 
Market Value 
 
husband
wife
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Furniture & furnishings in home 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Furniture & furnishings elsewhere 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Collectibles 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Jewelry 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Life insurance (cash surrender value) 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Sporting and entertainment (T.V., stereo, etc.) equipment 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Other assets 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
□
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
Total Assets  (add column B) 
 
$  
 
 
 
 
 
 
 
B.  LIABILITIES/DEBTS  (This is where you list what you OWE.) 
INSTRUCTIONS: 
STEP 1:  In column A, list a description of each separate debt owed by you (and/or your spouse, if this is a petition for 
dissolution of marriage).  Blank spaces are provided if you need to list more than one of an item. 
STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any debt(s) for which you believe 
you should be responsible. 
STEP 3:  In column B, write what you believe to be the current amount owed for all items listed. 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
STEP 4:  Use column C only if this is a petition for dissolution of marriage and you believe an item is “nonmarital,” 
meaning the debt belongs to only one of you and should not be divided.  You should indicate to whom you believe the debt 
belongs. (Typically, you will only use Column C if the debt was owed by one spouse before the marriage.  See the “General 
Information for Self-Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for 
definitions of “marital” and “nonmarital” assets and liabilities.) 
 
 
C 
Nonmarital 
(√ correct column) 
 
A 
LIABILITIES:  DESCRIPTION OF ITEM(S) 
DO NOT LIST ACCOUNT NUMBERS. 
√ the box next to any debt(s) for which you believe you should be responsible. 
 
B 
Current 
Amount Owed 
 
husband 
wife
 
□
 
$ 
 
 
 
 Mortgages on real estate: First mortgage on home 
 
 
□ Second mortgage on home 
 
 
 
 
 
 
 
□ Other mortgages 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Charge/credit card accounts 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Auto loan 
 
 
 
 
 
 
 
□ Auto loan 
 
 
 
 
 
 
 
□ Bank/Credit Union loans 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Money you owe (not evidenced by a note) 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Judgments 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ Other 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□
 
 
 
 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
□ 
 
 
 
 
 
 
 
Total Debts  (add column B)  
 
$  
 
  
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
C.  NET WORTH  (excluding contingent assets and liabilities) 
 
Total Assets  (enter total of Column B in Asset Table; Section A) 
  $                                    
Total Liabilities (enter total of Column B in Liabilities Table; Section B)  $                       
 
TOTAL NET WORTH  (Total Assets minus Total Liabilities) 
(excluding contingent assets and liabilities)  
 
 
 
  
$  
 
 
D.  CONTINGENT ASSETS AND LIABILITIES 
INSTRUCTIONS: 
If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or POSSIBLE 
liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts assumed by another), you must list them here. 
 
 
C 
Nonmarital 
(√ correct column) 
 
A 
Contingent Assets 
 
√ the box next to any contingent asset(s) which you are requesting the judge award to you. 
 
B 
 
Possible Value 
 
husband 
wife 
 
□
 
$ 
 
 
 
 
 
 
 
 
 
 
 
□
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
Total Contingent Assets 
 
$  
 
 
 
 
 
 
 
 
 
C 
Nonmarital 
(√ correct column) 
 
A 
Contingent Liabilities 
 
√ the box next to any contingent debt(s) for which you believe you should be responsible.
B 
 
Possible Amount 
Owed 
 
husband 
wife 
 
□
 
$ 
 
 
 
 
 
 
 
 
 
 
 
□
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
 
 
 
□ 
 
 
 
 
$  
 
 
Total Contingent Liabilities 
 
 
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
E.  CHILD SUPPORT GUIDELINES WORKSHEET.  Florida Family Law Rules of Procedure Form 
12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to 
establish or modify child support. This requirement cannot be waived by the parties. 
[ √ one only] 
        
A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves 
the establishment or modification of child support. 
        
A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or 
modification of child support is not an issue in this case. 
 
I certify that a copy of this financial affidavit was: (    ) mailed, (    ) faxed and mailed, or (    ) hand 
delivered to the person(s) listed below on {date}  
. 
Other party or his/her attorney: 
Name:   
 
 
   
 
 
 
 
Address:  
 
 
   
 
 
 
 
City, State, Zip:  
   
 
 
 
 
Fax Number:   
   
 
 
 
 
 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this affidavit and that the punishment for knowingly making a false statement includes 
fines and/or imprisonment. 
 
Dated:   
 
 
   
 
 
 
 
 
 
 
 
 
 
Signature of Party 
Printed Name:  
 
Address:  
 
City, State, Zip:  
 
Telephone Number:  
 
Fax Number:  
 
 
STATE OF FLORIDA 
COUNTY OF   
   
 
                                         
 
Sworn to or affirmed and signed before me on   
 
 by  
. 
 
 
 
NOTARY PUBLIC or DEPUTY CLERK  
 
 
[Print, type, or stamp commissioned name of 
notary or deputy clerk .] 
        
Personally known 
        
Produced identification 
Type of identification produced 
 
 
 
 
 
 
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE 
BLANKS BELOW: [fill in all blanks] 
I, {full legal name and trade name of nonlawyer}  
, 
a nonlawyer, located at {street}  
 
 
 
 
, {city}  
, 
{state}   
 
, {phone}  
 
 
 
, helped {name}  
, 
who is the [√ one only]       petitioner or       respondent, fill out this form.
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (09/06) 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(i),  
AFFIDAVIT OF CORROBORATING WITNESS 
 
When should this form be used? 
 
This form may be used to prove residency in a dissolution of marriage proceeding.  To get a divorce in 
Florida, either the husband or the wife must have lived in Florida for at least 6 months before filing the 
petition.  Residency may be proved by a valid Florida’s driver’s license, Florida identification card, or 
voter’s registration card (issue date of document must be at least 6 months before the date the case is 
actually filed with the clerk of the circuit court), or the testimony or affidavit of someone other than you 
or your spouse.  This form is used to prove residency by affidavit.  The person signing this form must 
know that you have lived in the State of Florida for at least 6 months before the date you filed your 
petition for dissolution of marriage. 
 
This form should be typed or printed in black ink, and signed in the presence of a notary public or 
deputy clerk.  After completing this form, you should file the original with the clerk of the circuit court 
in the county where the petition was filed and keep a copy for you records. 
 
What should I do next? 
 
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on 
him or her with your initial papers. 
 
Where can I look for more information? 
 
Before proceeding, you should read “General Information for Self-Represented Litigants” found at 
the beginning of these forms.  The words that are in “bold underline” in these instructions are defined 
there. For further information, see section 61.021, Florida Statutes or section 61.052(2), Florida Statutes.  
 
Special notes… 
 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out these 
forms also must put his or her name, address, and telephone number on the bottom of the last page of 
every form he or she helps you complete. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(i), Affidavit of Corroborating Witness  (09/06) 
IN THE CIRCUIT COURT OF THE  
 
 
 
 
 JUDICIAL CIRCUIT, 
IN AND FOR   
 
 
  COUNTY, FLORIDA 
 
 
 
 
 
 
 
  
 
 
Case No.:  
 
 
 
 
 
 
 
 
 
 
  
 
 
Division:  
 
 
 
 
 
 
 
 
 
 
 
       , 
 
 
 
Petitioner,  
  
 
 
 
 
 
 
 
 
 
 
and 
 
 
 
 
 
 
 
       , 
 
 
 
Respondent. 
 
AFFIDAVIT OF CORROBORATING WITNESS 
 
 
 
I, {full legal name}  
  
 
 
            , being sworn, certify that the following 
statements are true: I have known {name}  
 
 
 
 
 
 since 
{approximate date} 
 
 
; to the best of my understanding the petition in this action was filed on 
{date}  
 
; and I know of my own personal knowledge that this person has resided in the State of 
Florida for at least 6 months immediately before {date}                 
      .   
 
 
 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this affidavit and that the punishment for knowingly making a false statement includes 
fines and/or imprisonment. 
 
Dated:   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
Signature of Corroborating Witness 
 
 
 
 
 
 
  
 
 
 
Printed Name: 
 
 
 
 
 
 
 
 
 
  
 
 
 
Address:   
 
 
 
 
 
 
 
 
 
  
 
 
 
City, State, Zip:  
 
 
 
 
 
 
 
 
 
  
 
 
 
Telephone Number:  
 
 
 
STATE OF FLORIDA 
COUNTY OF   
 
 
 
 
Sworn to or affirmed and signed before me on   
 
 
 by  
 
 
            . 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
NOTARY PUBLIC or DEPUTY CLERK 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
[Print, type, or stamp commissioned name of notary or clerk.] 
 
____ 
Personally known 
____ 
Produced identification 
 
Type of identification produced   
 
 
 
 
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE 
BLANKS BELOW:[fill in all blanks] 
I, {full legal name and trade name of nonlawyer}  
 
 
 
 
 
            , 
a nonlawyer, located at {street}   
 
 
 
, {city}   
 
 
            , 
{state}   
 
       , {phone}   
 
                    , helped {name}  
 
     
            , 
who is the affiant, fill out this form. 
Family Law Rules of Procedure Form 12.902(i), Affidavit of Corroborating Witness (09/06)