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Financial Affidavit Form. This is a Florida form and can be use in Manatee Local County.
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Tags: Financial Affidavit, Florida Local County, Manatee
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
:
Conversion Chart for Completing the Financial Affidavit
Plaintiff(s)
Index No.
Calendar No.
JUDICIAL SUBPOENA
-againstTo convert wages (always use gross income) or expenses to: monthly amounts:
:
Weekly amount x 52, then divide by 12
Bi-weekly amount (every other week) x 26, then divide by 12
:
Bi-monthly amount (every other month) x 6, then divide by 12
Semi-monthly amount (twice a month) xDefendant(s)
24, then divide by :12
. .Semi-annual. amount. (twice. a .year) .x . . .then .divide .by . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . 2, . . . . . . . . . . 12
Quarterly amount (four times a year) x 4, then divide by 12
Yearly amount divided by 12
THE PEOPLE OF THE STATE OF NEW YORK
TO
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT IN AND FOR
:
JUDICIAL SUBPOENA
Plaintiff(s)
MANATEE COUNTY
CIVIL ACTION
-against-
:
THE STATE OF FLORIDA
DEPARTMENT OF REVENUE,
ON BEHALF OF:
:
:
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. . . . . . . . . .
Petitioner/Plaintiff,
THE PEOPLE OF THE STATE OF NEW YORK
and
CASE NO.
TO
,
GREETINGS:
Respondent/Defendant.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
dayFINANCIAL AFFIDAVIo'clock in the
of
, 20
, at
noon, and at any recessed
T
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Name:
Occupation: failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Your
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Name your failure to
result of of Employer: comply.
AddressWitness, Honorable
of Employer:
Court in
Rate of Pay:
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
PART I -MONTHLY INCOME
Attorney(s) for
INCOME FROM EMPLOYMENT:
Average Monthly Gross Salary or Wages
Bonuses, Commissions, Allowances, Overtime, Tips, Etc.
Total Monthly Gross Income from employment
Office and P.O. Address
Less Deductions:
Federal Income Tax
Social Security
Telephone No.:
Mandatory Retirement/Pension
Facsimile No.:
Health Insurance
E-Mail Address:
Mandatory Union Dues
Mobile Tel. No.:
Court Ordered Child Support being paid
$
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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:
:
Index No.
Calendar No.
Total Deductions
$
:
JUDICIAL SUBPOENA
Plaintiff(s)
TOTAL MONTHLY NET INCOME FROM EMPLOYMENT
$
-against:
OTHER MONTHLY INCOME:
Pension/Retirement/Annuity
:
Social Security Benefits
Disability Benefits
:
Unemployment Compensation
Defendant(s)
Workers Compensation
:
......................................................
Alimony from prior marriage
Interest and Dividends
Business Income
THE PEOPLE OF THE STATE OF NEW YORK
Rental Income
Income from Royalties, Trusts or Estates
TO
Reimbursed Expenses
Recurring Gains
Other:
GREETINGS:
Total Other Monthly Income
$
WE COMMAND YOU, that all business
of
TOTAL MONTHLY NET INCOME and excuses being laid aside, you and each $ you attend before
,
the Honorable
at the
Court
located at
County of
PART II - MONTHLY EXPEo'clockSin the
NSE
in room
, on the
day of
, 20
, at
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
HOUSEHOLD EXPENSES:
Rent/Mortgage Payment
Property Taxes not included in mortgage payment
Your failure to comply with
Homeowners Insurance notthis subpoena is punishable as a contempt of court and will make you liable to
included in mortgage payment
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Flood Insurance not included in mortgage payment
result of your failure to comply.
Electricity
Fuel Oil/Natural Gas
Witness, Honorable
, one of the Justices of the
Water, Garbage, Sewer day of
Court in
County,
, 20
Telephone
Pest Control
Cable TV
(Attorney must sign above and type name below)
Repairs & Maintenance
Food & Household Supplies
Other:
Attorney(s) for
Sub-Total Household Expenses
$
TRANSPORTATION EXPENSES
Car Payment
Office and P.O. Address
Operating Expenses (gas, Maintenance, Etc.)
Parking
Public Transportation
Telephone No.:
Other:
Facsimile No.:
Sub-Total Transportation Expenses
E-Mail Address:
$
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
CHILDREN'S EXPENSES:
Child Care
:
School Tuition
Defendant(s)
School Supplies
:
......................................................
School Lunches
Allowances
Clothing
THE PEOPLE OF& Dental
Medical THE STATE OF NEW YORK
Medications & Drugstore Items
TO
Barber, Beauty, etc.
Gifts
Other:
GREETINGS:
Sub-Total Children's Expenses
$
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable EXPENSES:
at the
Court
PERSONAL
located at
County of
Meals Outside Home
in room Medical &on the
, Dental
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Medications & Drugstore Items
Barber, Beauty, Etc.
Laundry/Dry Cleaning
Your failure
Clothing to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party Publications
on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Vacations
Recreation
Witness, Honorable
, one of the Justices of the
Professional/Social Dues
Court in
County,
day of
, 20
Contributions
Gifts:
(Attorney must sign above and type name below)
Insurance (Not Thru Employment):
Medical
Dental
Disability
Life
Child Support/Alimony
Other:
Attorney(s) for
Office and P.O. Address
Sub-Total Personal Expenses
INSTALLMENT PAYMENTS:
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
$
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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:
Index No.
:
Plaintiff(s)
Calendar No.
:
JUDICIAL SUBPOENA
-against-
:
Sub-Total Installment Payments
TOTAL MONTHLY EXPENSES
:
$
$
:
PART III - SUMMARY
Defendant(s)
:
......................................................
TOTAL MONTHLY NET INCOME
$
TOTAL MONTHLY EXPENSES
$
THE PEOPLE OF THE STATE OF NEW YORK
TO
NET
$
PART IV - ASSETS
GREETINGS:
CASH ON HAND OR IN BANKS:
Cash
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Checking
,
the Honorable
at the
Court
Savings
located at
County of
Certificates of Depositday of
in room
, on the
, 20
, at
o'clock in the
noon, and at any recessed
Credit Union Account
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Sub-Total Cash on Hand or in Bank
$
INVESTMENTS:
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Stocks
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Bonds
result of your failure to comply.
Mutual Funds
Other: Honorable
Witness,
, one of the Justices of the
Sub-Total Investments
$
Court in
County,
day of
, 20
CASH VALUE OF LIFE INSURANCE
REAL ESTATE:
Home
Other:
$
(Attorney must sign above and type name below)
Attorney(s) for
Sub-Total Real Estate
MOTOR VEHICLES:
Automobiles
Motor Homes
Boats
Other:
Office and P.O. Address
Telephone No.:
Sub-Total Motor Vehicles
Facsimile No.:
OTHER PERSONAL PROPERTY:
$
$
E-Mail Address:
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
Sub-Total Other Personal :Property
$
:
TOTAL ASSETS
$
:
Defendant(s)
:
......................................................
PART V - LIABILITIES
THE PEOPLE OF THE STATE OF NEW YORK
MORTGAGES:
TO
Home Mortgage
Other Mortgages:
Sub-Total Mortgages
GREETINGS:
$
WE COMMAND YOU,
MOTOR VEHICLE LOANS: that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
Automobiles
located at
County of
Motor Homes
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
Boats
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Other:
Sub-Total Motor Vehicle Loans
$
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
LOANS, DEBTS AND CREDIT CARDS:
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
Sub-Total Loans, Debts, & Credit Cards
day of
, one of the Justices of the
, 20
TOTAL LIABILITIES
$
$
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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:
Index No.
Calendar No.
If you are employed, but expecting soon to become unemployed or change jobs, describe the change you expect and
:
why and how it will affect your income. If currently unemployed, describe your efforts to find employment, how soon
JUDICIAL SUBPOENA
Plaintiff(s)
you expect to be employed, and -against-you expect to receive.
the pay
:
:
:
ALL OF THE FOLLOWING MUST BE ATTACHED TO THE COPY OF THIS FINANCIAL AFFIDAVIT
Defendant(s)
:
SERVED. ON .THE. OPPOSING. PARTY.. .THE ATTACHMENTS .SHALL NOT BE FILED WITH THE COURT.
... ... ... .......... ....... .................... .
(1)
All federal and state income tax returns filed by your or on your behalf for the past three (3) years;
THE PEOPLEATTACHED; OF NEW YORK
OF THE STATE
NONE FILED OR IN MY POSSESSION;
TO
(2)
prepared;
IRS forms W-2, 1099, and K-1 for the past year, if the income tax return for that year has not been
GREETINGS:ATTACHED;
NONE;
WE COMMAND YOU, that (3) business prior to delivery of theaside, you and each of you attend before
(3)
Pay stubs for the past three all months and excuses being laid financial affidavit;
,
the Honorable
at the
Court
located at NONE. If none, complete the following;
County of
ATTACHED;
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
MONTH/YEAR
GROSS INCOME
SOURCE OF INCOME/EMPLOYER
(1)
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
(3) result of your failure to comply.
(2)
(4)
Court in
Loan applications for the last three (3) years;
Witness, Honorable
County,
day of
ATTACHED;
, one of the Justices of the
, 20
NONE;
I AM AWARE THAT ANY MATERIALLY FALSE STATEMENT KNOWINGLY MADE WITH THE INTENT
(Attorney must sign above and type name below)
TO DEFRAUD OR MISLEAD SHALL SUBJECT ME TO THE PENALTY FOR PERJURY AND MAY BE
CONSIDERED A FRAUD UPON THE COURT.
Attorney(s) for
STATE OF FLORIDA
COUNTY OF MANATEE
BEFORE ME, the undersigned authority, personally appeared
was sworn and says that the foregoing statements are true:
Office and P.O. Address
, who
PETITIONER/PLAINTIFF
SWORN TO AND SUBSCRIBED before me on
who is personally known to me or presented
SEAL
Telephone No.: by the above named Petitioner/Plaintiff,
Facsimile No.:
as identification.
E-Mail Address:
Mobile Tel. No.:
NOTARY PUBLIC
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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:
:
Index No.
Calendar No.
Printed or Typed Notary Name
:
Plaintiff(s)
JUDICIAL SUBPOENA
-against- CERTIFICATE OF SERVICE
:
:
I HEREBY CERTIFY that a true copy of the foregoing has been furnished by (mail), (hand delivery) (service of
process
together
:
with
attached
pleadings)
to:
Defendant(s)
:
......................................................
THE PEOPLE OF THE STATE OF NEW YORK
on this
day of
,
.
TO
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as aProgramin this action on the part of the
witness Attorney
Child Support Enforcement
Post Office Box 25400
Bradenton, Florida contempt of court and will make you liable to
34206
Your failure to comply with this subpoena is punishable as a
(941) a maximum
the party on whose behalf this subpoena was issued for 741-4039 penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
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