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Affidavit Of Income And Property (One Page) Form. This is a Tennessee form and can be use in Trial And General Sessions Courts Statewide.
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Tags: Affidavit Of Income And Property (One Page), Tennessee Statewide, Trial And General Sessions Courts
_____________ Court
____________ County
____________ Tennessee
AFFIDAVIT OF INCOME
AND PROPERTY
Case Number
_____________________________________________ vs. _______________________________________________
Comes now the Defendant(s) and, subject to the penalty of perjury, makes oath and says that the following facts are true and that there
is NO OTHER source of income or property other than that described below:
7. List all land/house/real estate/property you own:
1. Full name:
DESCRIBE
VALUE
Address:
$
Phone #
$
Soc. Sec. No.
$
Employer:
$
Phone #
8. List all personal property/cars/trucks/
2. List all dependents:
furniture/stocks/bonds/tools/equipment you own and its total
Name
Age
Relationship
value:
DESCRIBE
VALUE
Cars
$
Trucks
$
Other
$
$
3. List all income from any source:
$
$
per/wk /mo ,
$
from
:
$
from
$
from
per/wk
/mo
,
:
per/wk
/mo
,
:
I receive CHILD SUPPORT in the sum of
$
per
4. List all bank accounts:
ACCOUNT BANK/SOURCE
Checking
Savings
Other:
Other:
5. List all debts:
CREDITOR/ADDRESS
6. List all monthly household expenses:
Rent/Mortgage:
Utilities:
Health Insurance:
Transportation Cost:
Food:
Clothing:
Other:
TOTAL
.
BALANCE
$
$
$
$
BALANCE
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
9. List all assets/property sold or transferred in the last six
months:
DESCRIBE
VALUE
$
$
$
$
$
10. The last income tax I filed was for
and it reflected
an income of $
and I attach a copy hereto or will
file the same within seven days.
LIST ALL PROPERTY YOU CLAIM TO BE EXEMPT
PURSUANT TO LAW:
All clothing for myself and my family; all receptacles for said
clothing; family portraits; family Bible; school books; and
VERIFICATION AND OATH: Comes now the
Petitioner(s) / Defendant(s) and makes oath, subject to the
penalty of perjury, that the information in this Motion for
Installment Payment is true to the best of Petitioner's
knowledge, information and belief.
Defendant(s)
Sworn to and subscribed before me
on ____________________
Clerk/Deputy Clerk/Notary Public
Commission Expires:
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