STATE OF NORTH CAROLINA File No. __________________ COUNTY OF __________________ IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION AFFIDAVIT OF FINANCIAL STANDING Plaintiff OF PARTY SEEKING SUPPORT vs. AND/OR Defendant AFFIDAVIT OF FINANCIAL NEEDS OR MINOR CHILD(REN) The undersigned affiant, having been first duly sworn as to the truthfulness and completeness of this Affidavit, deposes and says: 1. That my average monthly financial needs (the monthly total should be fairly allocated among those living in the household unless otherwise specifically ascertainable) while living separate and apart from the opposing party are as follows: *ADULT CHILDREN *( ) NO. OF AND OTHERS NATURE OF EXPENSE PAID OR MINOR LIVING IN *MONTHLY PAYABLE BY AFFIANT *SELF CHILDREN HOUSEHOLD TOTAL * Round off to nearest dollar. Rent (or house payment) Household maintenance or repairs Household supplies Utilities Heating (fuel oil) Water Electricity Telephone Gas for home Automobile payment Automobile maintenance Automobile gasoline Other transportation costs Food at home Food away from home (including school lunches) District 1 Page 1 of 4 FDCVD-3 Affidavit of Financial Standing of Party Seeking Support and/or Affidavit of Financial Needs of Minor Child(ren) >>>> 2 *ADULT CHILDREN *( ) NO. OF AND OTHERS NATURE OF EXPENSE PAID OR MINOR LIVING IN *MONTHLY PAYABLE BY AFFIANT *SELF CHILDREN HOUSEHOLD TOTAL * Round off to nearest dollar. Clothing (purchase) Personal care (grooming, laundry, dry cleaning, etc.) Extracurricular activities (recreation, entertainment, sports) Medical expenses (including doctors, hospital, dentist, drugs) not paid by insurance Educational expenses (including school supplies, fees, tuition) Reading materials Tobacco and alcohol Club dues and expenses Cable TV Insurance: Hospitalization and medical Automobile Life Other (itemize) _______________________ _______________________ _______________________ Church pledge (including Sunday School) Gifts **TOTAL BALANCE DUE (DEBTS) Debt payment MasterCard VISA Checkloan Credit Union Reserve District 1 Page 2 of 4 FDCVD-3 Affidavit of Financial Standing of Party Seeking Support and/or Affidavit of Financial Needs of Minor Child(ren) >>>> 3 *ADULT CHILDREN *( ) NO. OF AND OTHERS NATURE OF EXPENSE PAID OR MINOR LIVING IN *MONTHLY PAYABL E BY AFFIANT *SELF CHILDREN HOUSEHOLD TOTAL * Round off to nearest dollar. Debt payment continued Other (Finance companies, banks, department stores) ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ TOTAL MONTHLY (Self) ........................................................................ $ TOTAL MONTHLY (Minor Child(ren) ..................................................... $ (A total for adult children et al column is not required.) TOTAL BALANCE DUE (Debts) ............................................................. $ (A total for Monthly Total column is not required.) 2. That the minor children for which expenses and needs are shown are are not residing with this affiant. 3. That the names and ages of the minor child(ren) are:. Name Age Name Age Name Age Name Agee Name Age 4. That the affiant needs from the opposing party for the support of the minor child(ren) the sum of $______________ monthly allocated on a pro rata basis of $ _________________ weekly. (Based on 52 weeks rather than just four-week months.) (Applicable in alimony cases) District 1 Page 3 of 4 FDCVD-3 Affidavit of Financial Standing of Party Seeking Support and/or Affidavit of Financial Needs of Minor Child(ren) >>>> 45. That the affiant needs for her own support from the opposing party the sum of $______________ monthly allocated on a pro rata basis of $ _________________ weekly. (Based on 52 weeks rather than just four-week months.) (Applicable in alimony cases) This the ________________ day of _______________________ , 2______ . Affiant Subscribed and sworn to before me This ___________ day of ________________, 2____ . Notary Public My commission expires: _______________________ District 1 Page 4 of 4 FDCVD-3 Affidavit of Financial Standing of Party Seeking Support and/or Affidavit of Financial Needs of Minor Child(ren)