A Guide to Financial Affidavits
A Guide to Financial Affidavits
- How do I give my financial information to court?
- How to fill out your financial affidavit
- Weekly Income
- Liabilities (Debts)
- Health Insurance
- Summary & Certification
- Sample Forms
If you need help filling out the form, go to a Court Service Center.
Your Financial Information (Financial Affidavits)
In divorce, custody, and legal separation cases, the spouses (or parents) must give their financial information to the court.
The court needs your financial information to make orders about child support, alimony, or legal fees.
This booklet answers common questions about how to give your financial information to the court, and how to fill out a Financial Affidavit form.
You have to fill out a court form called Financial Affidavit (form #JD-FM-6-SHORT or JD-FM-6-LONG). You can get either of these forms from the court clerk or download from Connecticut’s court website: http://www.jud.ct.gov/webforms/forms/fm006-short.pdf.
To Fill Out Your Financial Affidavit, Follow These Steps:
Start with 2 or more blank copies of the Financial Affidavit form. You can use one as your draft.
You will need your financial information, including your:
- pay stubs,
- recent bills you have paid,
- recent bills you have not paid yet,
- checkbook, and
- bank account statements.
Fill out the form completely, but do not sign it yet!
Make sure you:
- Fill out all pages, and
- Answer each question. If a question does not apply to you, write "none" or "0."
Take your completed form to a notary, lawyer, or the court clerk. That person will ask you to swear that the information you gave is true. Then you will sign it, and that person will sign as your witness.
Make 3 copies
of the completed, signed form.
- Send 1 copy to your spouse or your spouse’s lawyer,
- Keep 1 copy for your records, and
- Take 1 copy to your court hearing.
What if I don’t earn much money and I need help to pay my court fees?
You will have to fill out a different form, called Application for Waiver of Fees.
If you need help filling out that form, see our article, A Guide to Fee Waivers.
When do I have to give the court my financial information?
The court usually needs your financial information at the end of a case. But in some cases, the court may need it sooner to make temporary orders.
You can fill out this form:
- By hand in blue or black ink, or
- Online at www.jud.ct.gov/webforms/forms/fm006-short.pdf. (If you fill out the form online, be sure to save as you go.)
Fill out the top of the form:
You must list the:
- Judicial district,
- Court address,
- Name of your case,
- Docket number, and
- Your name (under NAME OF AFFIANT).
Look for this information on your other court papers, and copy it here.
Check one of these boxes:
□ Plaintiff or □ Defendant
If you started this case, you are the plaintiff. If your spouse or the other parent started this case, you are the defendant. (If this is part of another case, the person who started that case is the plaintiff.)
To see a sample of a completed affidavit, Sample 1.
Fill out the rest of the form:
Your Financial Affidavit is based on your weekly income and expenses. If your income and expenses are not paid weekly, you will have to figure out your weekly average. Your average must be for at least 13 weeks.
a) Write your average weekly gross income (before taxes and other deductions) for the past 13 weeks or more. (Add your gross income for the past 13 weeks, then divide by 13.)
If you are not working, put “none” or “0.”
b-p) If you get money from any other source, include it here.
2) Under DEDUCTIONS, write weekly average of each deduction taken from your paycheck, including: federal tax, state tax, FICA, wage attachments, health insurance, union dues, etc.
3) Under NET WEEKLY INCOME, subtract your Total Deductions from Gross Weekly Wages. See Sample 1.
II. WEEKLY EXPENSES
You must list each expense on a weekly basis.
Tip! If your bills are monthly, divide the monthly amount by 4.3. If your bill is yearly, divide the yearly amount by 52.
- Rent or Mortgage.
- Utilities. Electricity, gas, water, telephone, etc.
- Food. Groceries only. Don’t list SNAP benefits, if any.
- Transportation. Gas, oil, car repairs, auto loan payments, public transportation.
- Insurance. Car, life, health, home. Exception: Do not include health insurance here if you listed it as a deduction from your paycheck above.
- Healthcare Expenses. Medical and dental bills, copays, and prescriptions. Do not include health insurance here.
- Child Support that you pay, if any.
- Childcare, including nursery school, babysitters, afterschool care, etc.
- Alimony that you pay, if any.
- Other personal and miscellaneous expenses, such as diapers, laundry, haircuts, cigarettes, church donations, children's school expenses, school and lunches, toys, recreation, movie rentals, toiletries (for example, shampoo, contact lens fluid, makeup), newspapers,
stamps, union dues etc.
TOTAL WEEKLY EXPENSES
Add all your expenses in this section.
Important! If you have more income than expenses, that means you have “extra” money after paying all your bills. If this is not your case, think about other expenses you may have, but forgot to write down. By listing ALL your expenses, the court will know how much support is needed.
Liabilities are debts you owe. List every person or company you owe money to. Also include overdue items, such as utility bills, tax bills, personal and student loans, credit cards, store credit cards, medical bills you have not paid, etc.
You must list each debt on a weekly basis.
Tip! If your expense is monthly, divide the monthly amount by 4.3. If your expense is yearly, divide the yearly amount by 52.
Creditor is the person or company you owe money to.
Balance Due is the amount you still owe.
Date Debt Incurred. List the date you took on the debt. If you do not know, list the month and/or the year. If it is a credit card, like MasterCard or Visa, you do not need to put a date.
Weekly Payment is the amount you pay per week. If you have not made payments, write “0” on this line. If you have already put your auto loan payments under Weekly Expenses, do not list them here.
A. TOTAL LIABILITIES (Total Balance Due on Debts)
Add all items in the BALANCE DUE column.
B. TOTAL WEEKLY LIABILITY EXPENSE
Add all items in the WEEKLY PAYMENT column.
List valuable property you own in this section. If you do not know the exact value, you may estimate.
I. Total. Total Cash Value of All Assets.
Add all items in A-H above, and write that number.
V. KIDS' ASSETS. List any kids' trust accounts here.
List the name and address of your health and dental insurance company, and the names of the people your policy covers.
Write the totals.
Do not sign yet! You must sign the form in front of a court clerk, notary public or lawyer. When you sign this form, you are swearing that the information is true.
Make 3 copies of the completed, signed form.
- Send 1 copy to your spouse or spouse's lawyer.
- Keep 1 copy for your records, and
- Take 1 copy to the court hearing.
This booklet was produced by the Legal Assistance Resource Center of Connecticut in cooperation with Connecticut Legal Services, Greater Hartford Legal Aid, New Haven Legal Assistance Association, and Statewide Legal Services.
The information in this booklet is based on laws in Connecticut as of 2/2014. We hope that the information is helpful. It is not intended as legal advice for an individual situation. Please call Statewide Legal Services or contact an attorney for additional help. © February 2014
Statewide Legal Services: 860-344-0380 (Central CT & Middletown) or 1-800-453-3320 (all other regions).
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