IN THE COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION SUMMIT COUNTY, OHIO ___________________________________ Plaintiff vs. ___________________________________ Defendant ) ) ) ) ) ) ) ) CASE NO. _________________________________ JUDGE ____________________________________ MAGISTRATE _____________________________ FINANCIAL AFFIDAVIT RE: ADVANCE ATTORNEY’S FEES AND COSTS OF:_______________________________________ 1. I am requesting attorney’s fees of $______________________ and costs of $____________________. 2. I anticipate the following discovery/litigation expenses: Real estate appraisal $__________ Guardian ad litem $__________ Process server $__________ Court reporter $__________ Pension appraisal $__________ Subpoenas $__________ Business evaluation $__________ Vocational Eval. $__________ Accountant/Tax advisor $__________ Personal property appraisal $__________ Document production $__________ Other:__________________ $__________ 3. List all bank, brokerage, or other financial accounts in your name alone or jointly with another: Highest Balance Account No. Titled In Last 6 Mos. Present Balance Bank/Financial Institution _______________________ _____________ _____________ $___________ $____________ _______________________ _____________ _____________ $___________ $____________ _______________________ _____________ _____________ $___________ $____________ 4. List all Certificates of Deposit held in your name alone or jointly with another: Institution Co-owner Maturity Date ______________________ ________________ _______________ ______________________ ________________ _______________ CD Amount $__________________ $__________________ 5. List all open credit cards or credit lines (including equity) in your name alone or jointly with another: Creditor Co-owner Present Balance Credit Limit ______________________ ________________ $_______________ $__________________ ______________________ ________________ $_______________ $__________________ ______________________ ________________ $_______________ $__________________ 6. List all life insurance with cash surrender value, pension plans, profit sharing accounts, stocks, bonds, money markets, or any other asset which can be borrowed against or surrendered for cash: Asset Present Value Amount Available for Loan/Surrender ______________________ ________________ $______________________________ ______________________ ________________ $______________________________ 7. The following total amount of attorney’s fees and costs in this case have been paid by me/on my behalf: $_______________. The source of this payment was __________________________________. _______________________________________ Signed SWORN TO before me and subscribed in my presence this _____ day of ________________, ________. _______________________________________ Notary Public Revised June, 2001 American LegalNet, Inc. www.FormsWorkflow.com