Opinion ID: 2762444
Heading Depth: 2
Heading Rank: 1

Heading: ASSETS (This is where you list what you OWN.)

Text: 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 line 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.) 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 line 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. 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 SelfFlorida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15) - 38 - A B C ASSETS: DESCRIPTION OF ITEM(S) Current Nonmarital Fair (Check correct LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS. Market column) Check the line next to any asset(s) which you are requesting the judge award Value to you. 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 Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15) - 39 - Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 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) $ 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 (Long Form) (01/15) - 40 - A B C LIABILITIES: DESCRIPTION OF ITEM(S) Current Nonmarital Amount (Check correct LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS. Owed Check the line next to any debt(s) for which you believe you should be column) responsible. 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 (Long Form) (01/15) - 41 - 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. A B C Contingent Assets Nonmarital Possible (Check correct Check the line next to any contingent asset(s) which you are requesting the Value column) judge award to you. husband wife $ Total Contingent Assets $ A B C Contingent Liabilities Nonmarital Possible (Check correct Amount column) Check the line next to any contingent debt(s) for which you believe you Owed should be responsible. husband wife $ Total Contingent Liabilities $ 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. [Check one only] Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15) - 42 - ____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 [check all used]: ( ) e-mailed ( ) mailed, ( ) faxed ( ) hand delivered to the person(s) listed below on {date} ____________________. Other party or his/her attorney: Name: _____________________________ Address: ____________________________ City, State, Zip: _______________________ Fax Number: _________________________ E-mail Address(es): _____________________ 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: ______________________________ Fax Number: ________________________________ E-mail Address(es): ____________________________ 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 Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15) - 43 - IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent This form was completed with the assistance of: {name of individual} , {name of business} ______________________________________________________________ , {address} _____________________________ , {city} ________,{state}________, {telephone number} . Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15) - 44 -