STATE OF NORTH CAROLINA File No. __________________ COUNTY OF __________________ IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION Plaintiff AFFIDAVIT OF FINANCIAL STANDING vs. OF PARTY SEEKING SUPPORT Defendant The undersigned affiant, having been first duly sworn as to the truthfulness and completeness of this Affidavit, deposes and says: 1. That I have monthly and/or weekly income from the following sources and none other: (Both columns are to be computed.) * WEEKLY (Prorate if paid SOURCE OF INCOME * MONTHLY monthly or semimonthly Gross wages Deductions: State withholding Federal withholding Social Security Retirement Loans Other (itemize) _________________________________ _________________________________ _________________________________ Net wages Business Profit Commissions Overtime Interest Dividends Trust Fund Social Security Pension/Retirement Rent Bonuses Medical Reimbursements Travel Expense Reimbursement Gifts Other (itemize) ________________________________ ________________________________ ________________________________ TOTAL INCOME * Round off to nearest dollar District 1 Page 1 of 3 FDCVD-2 Affidavit of Financial Standing of Party Seeking Support >>>> 2 2. That I have other assets as follows: IRA Account Yes No Stocks Yes No Bonds Yes No Savings Accounts Yes No Certificates of Deposit Yes No Real Estate Yes No Vehicles Yes No Boats Yes No (If answer is yes, list separately and specifically on a separate sheet to be attached.) 3. (a) Have you remarried? Yes No (b) Is your present spouse (spouse now living Yes No with) employed? (c) If employed, what is such spouses net monthly income? $ (d) Does this spouse receive support from a Yes No former spouse? (e) If so, how much per month for herself/himself? $ (f) How much per month for child(ren)? $ 4. That my pay period is: Weekly Twice Monthly Every other week Monthly Other (Explain) 5. That my total gross income from all sources for the previous calendar year was: $ _________ 6. That for tax purposes I claim _________ exemptions on my W-2 form (including myself). 7. That I am presently employed with (name of employer) ________________________________ at (place of employment) __________________________________________ , and I have been so employed since (date) ___________________________ . That I was employed with (name of employer) ________________________________________________________ at (place of employment) ______________________________________ prior to where I am now employed. District 1 Page 2 of 3 FDCVD-2 Affidavit of Financial Standing of Party Seeking Support >>>> 3 8. That I do do not have a second job. If yes, that second job is with (name of employer) ___________________________________________________ at (place of employment) ___________________________________________________ , and I have worked there since (date) ______________________ . 9. That I do not have any other income or employment other than as listed in this Affidavit 10. That I have have not received substantially the same income for the past 12 months. If not substantially the same, explain the reason for the change. 11. That true and accurate copies of all financial statements submitted by me to any lending institution in the past two years are attached to this Affidavit. 12. That since the date of separation from my spouse, I have provided support in the total sum of $ ____________________ for my minor dependent child(ren) living with me. This the ________________ day of _______________________ , 2______ . Affiant Subscribed and sworn to before me This ___________ day of ________________, 2____ . Notary Public My commission expires: _______________________ District 1 Page 3 of 3 FDCVD-2 Affidavit of Financial Standing of Party Seeking Support