How to Fill Out the Financial Affidavit Form

How to Fill Out the Financial Affidavit Form

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August 2017

In divorce, separation, and custody cases, parents must give their financial information to the court. The court needs this information to make orders about child support, alimony, or legal fees.

How do I give my financial information to the court?

You will need to fill out a Financial Affidavit form. You can get the form from the court clerk or from the State of Connecticut Judicial Branch website. If you have very low income, you should use the short version of the Financial Affidavit (#JD-FM-6-SHORT) There is a long version of the form for people who have higher income and assets, but this booklet talks only about the short form.

Step 1:
It is highly recommended that you get the form at the Judicial Branch website and save it to your computer to work on it digitally. The form is a fillable PDF and it will do all of the math calculations for you. Make sure to save your work as you go.

If you have to fill out the form by hand, start with two or more blank copies of the form. You can use the extra copies to practice.

Step 2:
You will need your financial information to fill out the form, including

  • pay stubs,
  • recent bills you have paid,
  • recent bills you have not paid yet,
  • your checkbook, and
  • bank account statements.

Step 3:
Make sure to answer each question and fill out all of the pages. If a question does not apply to you, write "None" or "0." Fill out the form completely, but do not sign it. See below for instructions on how to fill out the form.

Step 4:
After you fill out the form, take it to a notary, a lawyer, or the court clerk. You will have to swear that the information you wrote on the form is true. Then you will sign it and that person will sign as your witness.

Step 5:
Make three copies of the completed and signed form.

  • Send a copy to your spouse or your spouse’s lawyer.
  • Keep a copy for your records.
  • Take a copy to your court hearing.

When should I give the court my financial information?

The court usually needs your financial information at the end of a case, but it may need it sooner sometimes in order to make temporary orders.

How to fill out the Financial Affidavit form

Get the Financial Affidavit online at and download it to your computer, making sure to save it as you go. You can fill it out by hand, but if you use a computer, the form will do the math for you.

Start by filling out the Instructions section at the top of the form.

You must list the

  • docket number,
  • Judicial district,
  • court address,
  • name of your case, and
  • your name (under “name off affiant”).

Look for this information on your other court papers and copy it here.

Then 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, then you are the defendant. If this is part of another case, the person who started that case is the plaintiff.

For a sample of a completed affidavit, see page below.

I. Income

1)      Gross Weekly Income/Monies and Benefits from all Sources

The 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.

If you are paid…

Here’s how to get your average weekly gross income:

Every other week – 26 paychecks per year.

Divide your gross pay in one paycheck by 2.

This is your weekly average pay.

Twice a month (for example, you are paid each month on the 15th and 30th) – 24 paychecks per year.

Multiply your gross pay in one paycheck by 2 to get your monthly pay.

Multiply that number by 12 months.

Divide the total by 52 weeks.

This is your weekly average pay.

One paycheck per month.

Multiply your gross pay in one paycheck by 12 months.

Divide the total by 52 weeks.
This is your average weekly pay.

You get an annual salary.

Divide the gross amount you are paid each year by 52.

This is your weekly average pay.

Your average must be based on at least 13 weeks. If the amounts you write in are based on fewer than 13 weeks, you must explain why in the lines provided.

Section (a) (Job 1, Job 2 and Job 3): Fill in your average weekly gross income, which is the amount you get paid before taxes and other deductions are taken out of your pay. To figure out the average, add your gross income for the past 13 weeks (see the chart above to get that amount) and divide the total by 13. If you are not working, put “none” or “0.”

  • Lines (b) through (p): If you get money from any other source (such as Social Security, disability, or unemployment), fill in the amounts in the spaces provided.
  • Line (q): Fill in your Total Gross Weekly Income/Monies and Benefits from All Sources.

If you’re filling out the form by hand, add up lines (b) through (p) and enter it here. In the second field, put your total income from all sources from the year before.

2)  Mandatory Deductions
Here you will write the weekly average amount of each deduction taken from your paycheck, including

  • Federal income tax,
  • Social Security,
  • State income tax,
  • Medicare, 
  • health insurance,
  • union dues, and
  • child support or alimony.

3)  Net Weekly Income
This amount is calculated by subtracting your Total Mandatory Deductions in part (2) from your Total Gross Weekly Income in part (1).

II. Weekly Expenses Not Deducted From Pay

In this section you must list each of your weekly expenses.

If a bill is one you pay monthly, multiply the monthly amount by 12 and divide the total by 52.

If a bill is one you pay yearly, divide the yearly amount by 52.

Tip: Under Other, you can list expenses such as laundry, haircuts, cigarettes, church donations, children's school expenses, school lunches, toys, recreation, movie rentals, toiletries (such as shampoo, contact lens solution, makeup), newspapers, stamps, union dues, etc.

Add all of your expenses in this section and put the total under Total Weekly Expenses Not Deducted From Pay.

Important: If you have more income than expenses, that means you have extra money after paying all of your bills. If this is not true for you, think about other expenses that you may have forgotten to write down. By listing all ofyour expenses, the court will know how much support is needed.

III. Liabilities (Debts)

Liabilitiesare debts that you owe. You must list the amount that you pay per week for each debt. List every person or company that you owe money to. Also include overdue items that you have not paid, such as utility and tax bills, credit cards, medical bills, and personal and student loans. Do not include any expenses that are listed in Section II. Weekly Expenses Not Deducted From Pay.

The creditor is the person or company you owe money to.

  • Check the box marked Sole if the bill is in your name alone.
  • Check the box marked Joint if someone else’s name is also on the bill (for example, your spouse).

Balance Due is the amount you still owe.

Date Debt Incurredis the date you took on the debt. If you don’t know, try to list the month and year. If the debt is a credit card, you don’t 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.

Tip: If your expense is monthly, multiply the monthly amount by 12 and divide the total by 52.If your expense is yearly, divide the yearly amount by 52.

Line (A): Total Liabilities (Total Balance Due on Debts)

Add all items in the Balance Due column here.

Line (B): Total Weekly Liabilities Expense
Add all items in the Weekly Payment column here.

IV. Assets

In this section, you will list valuable things that you own. If you do not know the exact value, you can guess. Assets include

  • real estate;
  • motor vehicles;
  • bank accounts;
  • stocks, bonds, and mutual funds;
  • insurance;
  • retirement plans;
  • business interest/self-employment; and
  • other things you own that are worth money.

I. Total Net Value of All Assets
Add all items in A-H above and write that number.

V. Child(ren)’s Assets.
Here you will list any of your kids' trust accounts.

VI. Health
Here you will list the name and address of your health and dental insurance companies and the names of the people your policies cover.

Write and add the totals from sections I through IV.

Do not sign yet!
You must sign the form in front of a court clerk, a notary public, or a lawyer. When you sign this form, you are swearing that the information is true.

Make 3 copies of the completed, signed form.

Remember to

  • send 1 copy to your spouse or your spouse’s lawyer,
  • keep one copy for your records, and
  • take one 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 form called the Application for Waiver of Fees. If you need help filling out this form, see the legal aid booklet called A Guide to Fee Waivers.

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Under age 60: Find legal help or apply online.
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