The Arizona Financial form is a critical document used in family law cases to provide a comprehensive overview of an individual's financial situation. It requires detailed information about income, expenses, and financial obligations, ensuring transparency in legal proceedings. Completing this form accurately is essential, as it can impact decisions regarding child support, spousal maintenance, and other financial matters.
The Arizona Financial form serves as a crucial document in various legal proceedings, particularly in family law cases. It requires detailed financial disclosures from both parties involved, ensuring transparency and fairness in matters such as child support and spousal maintenance. The form collects essential information, including personal details like names, addresses, and contact numbers, as well as specifics about income, employment, and monthly expenses. Individuals must provide accurate data about their financial status, including gross monthly income from all sources, any additional support obligations, and expenses related to children. This form also emphasizes the importance of honesty, warning that providing false information can lead to serious legal consequences. Furthermore, it outlines specific instructions on how to complete the affidavit, including the necessity of attaching relevant financial documents, such as pay stubs and tax returns. By filling out this form correctly, parties can facilitate a smoother legal process and help the court make informed decisions.
Name:
Mailing Address:
City, State, Zip Code:
Daytime Phone Number:
Evening Phone Number:
Representing: Self
State Bar Number:
Petitioner
Respondent
FOR CLERK’S USE ONLY
SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY
Case No.
Petitioner/Plaintiff
ATLAS No.
AFFIDAVIT OF FINANCIAL INFORMATION
Affidavit of
(Name of Person Whose Information is on this
Affidavit)
IMPORTANT INFORMATION ABOUT THIS DOCUMENT
WARNING TO BOTH PARTIES: This Affidavit is an important document. You must fill out this Affidavit completely, and provide accurate information. You must provide copies of this Affidavit and all other required documents to the other party and to the judge. If you do not do this, the court may order you to pay a fine.
I have read the following document and know of my own knowledge that the facts and financial information stated below are true and correct, and that any false information may constitute perjury by me. I also understand that, if I fail to provide the required information or give misinformation, the judge may order sanctions against me, including assessment of fees for fines under Rule 31, Arizona Rules of Family Law Procedure.
Date
Signature of Person Making Affidavit
INSTRUCTIONS
1.Complete the entire Affidavit in black ink. If the spaces provided on this form are inadequate, use separate sheets of paper to complete the answers and attach them to the Affidavit. Answer every question completely! You must complete every blank. If you do not
know the answer to a question or are guessing, please state that. If a question does not apply, write “NA” for “not applicable” to indicate you read the question. Round all amounts of money to the nearest dollar.
2.Answer the following statements YES or NO. If you mark NO, explain your answer on a separate piece of paper and attach the explanation to the Affidavit.
[
] YES [
] NO
1.
I listed all sources of my income.
2.
I attached copies of my two (2) most recent pay stubs.
3.
I attached copies of my federal income tax return for the last three (3)
years, and I attached my W-2 and 1099 forms from all sources of
income.
©SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY
DROSC13f-091511
ALL RIGHTS RESERVED
Page 1 of 7
AFI
1. GENERAL INFORMATION:
A. Name:
Date of Birth:
B. Current Address:
C. Date of Marriage:
Date of Divorce:
D.Last date when you and the other party lived together:
E.Full names of child(ren) common to the parties (in this case), their dates of birth:
Name
Date of Birth
F.The name, date of birth, relationship to you, and gross monthly income for each individual who lives in your household:
Relationship to you
Income
G. Any other person for whom you contribute support:
Age Relationship
Reside With
Court Order to
to You
You (Y/N)
Support (Y/N)
H. Attorney’s Fees paid in this matter $
. Source of funds
2.EMPLOYMENT INFORMATION:
A.Your job/occupation/profession/title: Name and address of current employer:
Date employment began:
How often are you paid: [ ] Weekly [ ] Every other week [ ] Monthly [ ] Twice a month
[] Other
B.If you are not working, why not?
C.Previous employer name and address: Previous job/occupation/profession/title:
Date previous job began:
Date previous job ended:
Reason you left job:
Gross monthly pay at previous job: $
D.Total gross income from last three (3) years’ tax returns (attach copies of pages 1 and 2 of your federal income tax returns for the last three (3) years):
Year
$
E.Your total gross income from January 1 of this year to the date of this Affidavit (year-to-date income): $
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3.YOUR EDUCATION/TRAINING: List name of school, length of time there, year of last attendance, and degree earned:
A.High School:
B.College:
C.Post-Graduate:
D.Occupational Training:
4.YOUR GROSS MONTHLY INCOME:
List all income you receive from any source, whether private or governmental, taxable or not.
List all income payable to you individually or payable jointly to you and your spouse.
Use a monthly average for items that vary from month to month.
Multiply weekly income and deductions by 4.33. Multiply biweekly income by 2.165 to arrive at
the total amount for the month.
A. Gross salary/wages per month
Attach copies of your two most recent pay stubs.
Rate of Pay $
per [ ] hour [ ] week [ ] month [ ] year
B. Expenses paid for by your employer:
Automobile
Auto expenses, such as gas, repairs, insurance
Lodging
4.
Other (Explain)
C. Commissions/Bonuses
D. Tips
E. Self-employment Income (See below)
F.
Social Security benefits
G.
Worker's compensation and/or disability income
H.
Unemployment compensation
I.
Gifts/Prizes
J.
Payments from prior spouse
K.
Rental income (net after expenses)
L.
Contributions to household living expense by others
M. Other (Explain:)
(Include dividends, pensions, interest, trust income, annuities
or royalties.)
TOTAL:
5.SELF-EMPLOYMENT INCOME (if applicable):
If you are self-employed, attach of a copy of the Schedule C for your business from your last tax return and the most recent income/expense statement from your business.
If self employed, provide the following information: Name, address and telephone no. of business:
Type of business entity:
State and Date of incorporation: Nature of your interest:
Nature of business: Percent ownership: Number of shares of stock:
Page 3 of 7
Total issued and outstanding shares:
Gross sales/revenue last 12 months:
Both parties must answer item 6 if either party asks for child support. These expenses include only those expenses for children who are common to the parties, which means one party is the birth/adoptive mother and
the other is the birth/adoptive father of the children.
6.SCHEDULE OF ALL MONTHLY EXPENSES FOR CHILDREN:
DO NOT LIST any expenses for the other party, or child(ren) who live(s) with the other party, unless you are paying those expenses.
If you are listing anticipated expenses, indicate this by putting an asterisk (*) next to the estimated amount.
A.HEALTH INSURANCE:
Do you have health insurance available? Yes
No
Are you enrolled?
Total monthly cost
Premium cost to insure you alone
Premium cost to insure child(ren) common to the parties
4.List all people covered by your insurance coverage:
5.Name of insurance company and Policy/Group Number:
B. DENTAL/VISION INSURANCE:
C.UNREIMBURSED MEDICAL AND DENTAL EXPENSES:
(Cost to you after, or in addition to, any insurance reimbursement)
Drugs and medical supplies
Other
D. CHILD CARE COSTS:
Total monthly child care costs
(Do not include amounts paid by D.E.S.)
Name(s) of child(ren) cared for and amount per child:
Page 4 of 7
3. Name(s) and address(es) of child care provider(s):
E.EMPLOYER PRETAX PROGRAM:
Do you participate in an employer program for pretax payment of child care expenses? (Cafeteria Plan)? [ ] YES [ ] NO
F.COURT ORDERED CHILD SUPPORT:
Court ordered current child support for child(ren)
not common to the parties
Court ordered cash medical support for child(ren)
Amount of any arrears payment
Amount per month actually paid in last 12 mos.
Attach proof that you are paying
5.Name(s) and relationship of minor child(ren) who you support or who live with you, but are not common to the parties.
G. COURT ORDERED SPOUSAL MAINTENANCE/SUPPORT (Alimony):
1.Court ordered spousal maintenance/support you actually
pay to previous spouse:
H. EXTRAORDINARY EXPENSES :
1. For Children (Educational Expense/Special Needs/Other): $ Explain:
2. For Self:
Explain:
Both parties must answer items 7 and 8 if either party is requesting:
Spousal maintenance
Division of expenses
Attorneys’ fees and costs
Adjustment or deviation from the child support amount
Enforcement
7.SCHEDULE OF ALL MONTHLY EXPENSES:
Do NOT list any expenses for the other party, or children who live with the other party unless you are paying those expenses.
Page 5 of 7
A. HOUSING EXPENSES:
House payment:
a.
First Mortgage
b.
Second Mortgage
c.
Homeowners Association Fee
d.
Rent
Repair & upkeep
Yard work/Pool/Pest Control
Insurance & taxes not included in house payment
5.
B. UTILITIES:
Water, sewer, and garbage
Electricity
Gas
Telephone
Mobile phone/pager
6.
Internet Provider
7.
Cable/Satellite television
8.
Other (Explain:)
C. FOOD:
Food, milk, and household supplies
School lunches
Meals outside home
D. CLOTHING:
Clothing for you
Uniforms or special work clothes
Clothing for children living with you
Laundry and cleaning
E. TRANSPORTATION OR AUTOMOBILE EXPENSES:
Car insurance
List all cars and individuals covered:
Car payment, if any
Car repair and maintenance
Gas and oil
Bus fare/parking fees
Other (explain):
F. MISCELLANEOUS:
School and school supplies
School activities or fees
3. Extracurricular activities of child(ren)
Page 6 of 7
Church/contributions
Newspapers, magazines and books
Barber and beauty shop
Life insurance (beneficiary:
)
Disability insurance
9.
Recreation/entertainment
10.
Child(ren)'s allowance(s)
11.
Union/Professional dues
12.
Voluntary retirement contributions and savings deductions
13.
Family gifts
14. Pet Expenses
15.
Cigarettes
16.
Alcohol
17.
8.OUTSTANDING DEBTS AND ACCOUNTS: List all debts and installment payments you currently owe, but do not include items listed in Item 7 “Monthly Schedule of Expenses”. Follow the format below. Use additional paper if necessary.
Creditor Name
Purpose of Debt
Unpaid
Balance
Min.
Monthly
Payment
Date of
Your Last
Amount of
Your
Page 7 of 7
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