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Affidavit Of Financial Disclosure

Affidavit Of Financial Disclosure — a 4-page PDF form with 125 fill-in fields for the employer and affiant and sections covering income, health insurance, child care and 3 more sections.

  • 4 pages
  • 6 sections
  • 125 fill-in fields
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Not yet rated1 downloadsUpdated Aug 21, 2026
First-page preview of Affidavit Of Financial Disclosure
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How to fill out the Affidavit Of Financial Disclosure

Work through the form section by section in your browser, then download the completed PDF.

  1. Income
  2. Health Insurance
  3. Child Care
  4. Assets
  5. Expenses
  6. Loans And Debts

Information you will need

  • What’s the affiant’s name?
  • What’s the affiant’s employment status?
  • What’s the third source of income?
  • What’s the amount of the third income source?
  • Is the affiant paying child support?
  • Who’s the support order for?
  • What’s the amount of the child support order?
  • What’s the policy number?
  • How are the affiant’s children covered?
  • What’s the cost of childcare?
  • What’s the other account balance?
  • What’s the value of the second additional asset?
  • What’s the cost of the family insurance plan?
  • What’s the cost of the individual insurance plan?
  • What’s the other type of coverage?
  • Who’s the childcare provider?
  • How many hours of childcare?
  • What’s the savings account balance?
  • What’s the type of account?
  • What’s the vehicle make?
  • What’s the vehicle model?
  • What’s the vehicle’s value?
  • What’s the make of the second vehicle?
  • What’s the model of the second vehicle?

…and 101 more fields in the PDF.

Completed by the employer and the affiant.

The form includes 2 signature lines, a witness section.

PDF facts

Format
PDF
File size
882 KB
Pages
4
Version
1