Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY ______________________________________ Petitioner and Case No. _________________ ______________________________________ Respondent AFFIDAVIT OF FINANCIAL INFORMATION Affidavit of ____________________ (Name of Person Whose Information is on this Affidavit.) IMPORTANT INFORMATION ABOUT THIS DOCUMENT WARNING TO 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. 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 and expenses under Rule 31. _____________________________ Date ______________________________________________________ Signature of Person Making Affidavit 1 to-financial affidavit.form Revised 02.24.12 American LegalNet, Inc. www.FormsWorkFlow.com Case No. __________________________ 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. You must provide the other party with copies of the following: A. Proof of your year to date income from all sources, including your two most recent pay stubs. B. Complete copies of your federal income tax returns for the last three years with all schedules and attachements. C. All W-2 and 1099 forms from all sources of income for the last three years. D. If self-employed, a member of a partnership, or a shareholder of a closely held corporation, complete copies of the business federal income tax returns for the last three years with all schedules and attachments. { } YES [ ] NO I have provided the other party with copies of the documents described above. If no explain your answer: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 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 parities (in this case), their dates of birth, and Social Security Number(s) (last four digits only): Name ___________________________________ ___________________________________ ___________________________________ ___________________________________ Date of Birth ________________ ________________ ________________ ________________ Social Security Number ____________________ ____________________ ____________________ ____________________ 2 to-financial affidavit.form Revised 02.24.12 American LegalNet, Inc. www.FormsWorkFlow.com F. The name, date of birth, relationship to you, and gross monthly income for each individual who lives in your household: Name ___________________________________ ___________________________________ G. Any other person for whom you contribute support: Name Age Relationship to You Reside With You (Y/N) Court Order to Support (Y/N) Date of Birth ____________ ____________ Relationship to You _________________ _________________ Income _______ _______ _____________________________________________________________________________________ _____________________________________________________________________________________ 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: _____________________________________________________ _____________________________________________________________________________________ D. Total gross income from last three (3) years' tax returns. Year _______ $____________ Year _______ $____________ Year _______ $___________ E. Your total gross income from January 1 of this year to the date of this Affidavit (year-to-date income): $_________________ 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: __________________________________________________________________ 3 to-financial affidavit.form Revised 02.24.12 American LegalNet, Inc. www.FormsWorkFlow.com 4. YOUR GROSS MONTHLY INCOME: x List all income you receive from any source, whether private or governmental, taxable or not. x List all income payable to you individually and all non-wage income payable jointly to you and your s