Financial Affidavit - Template, Sample Form to Complete Pro · US-law
✓ Valid in United States · drafted to comply with local law
Create your Financial Affidavit - Template, Sample Form to Complete for use in United States. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.
- Answer 32 simple questions — the document fills in as you go
- Live preview: watch your document update in real time
- Download as Word (.docx) and PDF
- Edit your answers and re-download anytime
Fill in the details
0/32Type below — the document on the right updates as you go.
FINANCIAL AFFIDAVIT
State of ________
County of ________
I, the undersigned affiant, being first duly sworn upon oath, do hereby depose, swear, and affirm that the following statements are true and correct to the best of my knowledge, information, and belief:
§ 1. Identity of Affiant. My full legal name is ________ (the “Affiant”). My date of birth is ________, and the last four digits of my Social Security Number are ________.
§ 2. Residence. My present residential address is as follows:
________
§ 3. Employment. I am presently employed in the following position: ________. The name and address of my employer are as follows:
________
I have been so employed since ________.
§ 4. Gross Monthly Income. My gross monthly income is derived from the following source(s) and in the following amount(s):
________
Monthly Gross Income From This Source: $________
Additional or Supplemental Sources of Income (if any) and Amounts: ________
Total Gross Monthly Income From All Sources: $________
________
Total Monthly Deductions: $________
§ 6. Monthly Living and Household Expenses. My recurring monthly living and household expenses are as follows:
________
Total Monthly Living and Household Expenses: $________
§ 7. Monthly Debts and Liabilities. My recurring monthly debt obligations and liabilities (including, without limitation, mortgages, automobile loans, student loans, credit card minimum payments, and any court-ordered support obligations) are as follows:
________
Total Monthly Debt Payments: $________
§ 8. Assets. The assets owned by me, individually or jointly, including real property, personal property, bank and deposit accounts, retirement and investment accounts, and other property of value, are as follows:
________
Total Estimated Value of Assets: $________
§ 9. Financial Summary. A summary of my financial circumstances is as follows:
Total Net Monthly Income (gross income less deductions): $________
Total Monthly Expenses and Debts: $________
Total Current Assets: $________
Total Current Liabilities: $________
§ 10. Proof of Identity. I have provided the following form of identification to the Notary Public to establish my identity:
________
§ 11. Purpose of Affidavit. This Financial Affidavit is made and sworn for the following purpose:
________
§ 13. Oath and Penalty of Perjury. I understand that this Financial Affidavit is made under oath and that any false, fictitious, or fraudulent statement contained herein may subject me to civil and criminal penalties for perjury under the laws of the United States and of the State of ________.
§ 14. Duty to Update. I agree to promptly notify the appropriate party, agency, or court of any material change in the financial information set forth in this Financial Affidavit occurring after the date hereof.
§ 15. Affirmation. I declare and swear, under penalty of perjury, that I am the party described above and that all statements made in this Financial Affidavit are true and correct to the best of my knowledge, information, and belief.
Printed Name of Affiant: ________
Signature of Affiant: _____________________________
Date: ________
ACKNOWLEDGMENT / JURAT
State of ________
County of ________
Subscribed and sworn to (or affirmed) before me on this ________ by ________, who personally appeared before me and who is personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the foregoing instrument, and who acknowledged to me that he, she, or they executed the same for the purposes therein contained.
WITNESS my hand and official seal.
Seal:
Name of Notary Public: ________
Signature of Notary Public: _______________________________
My commission expires: ________
Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.