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Affidavit of Current Income and Expenses

An individual can officially submit a financial statement of his/her assets and liabilities plus the details of his/her current income and expenses to the Court through execution of this affidavit.

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IN THE IOWA DISTRICT COURT FOR	COUNTY	
IN RE THE MARRIAGE OF	
EQUITY No.
AFFIDAVIT OF FINANCIAL STATUS	
, Petitioner 	-	
and concerning	
, Respondent. 	
, the                                            in the above-entitled matter, being first duly	I,
state the following is a true and complete statement of my assets and liabilities, under Division I (and my present	
income under Division II, if applicable) as of the	day of	
DIVISION I - NET WORTH STATEMENT	
(Required in all dissolution of marriage cases except when waived upon application of both parties and approval by
 the Court, Section 598.13, the Code, as amended 1987 G.A.)	Assets	
OWNERSHIP DESCRIPTION	MARKET VALUE (H) (W) (J)	ENCUMBRANCENET VALUE	
()	(a) Homestead
$	$$	
()	(b) Other 	$$$	
   Vehicles (make, year)	
()	(a)	$$$	
()	(b)	$	$	$	
Life Insurance (cash value)	
()	(a)	$	$	$	
()	(b)	$ $$	
Securities	
()	(a)	$$$	
()	(b)	$	$	$	
    Cash & Bank Accounts	
()	(a)	$ $$	
()	(b)	$ $$	
Household Contents	
()	(a) Furniture	$ $$	
(	)	(b) Appliances	$	$$	
Other:	()	(c)	$	$ $	
      	Other Assets - Itemize:	
(	)	(a)	$	$$	
()	(b)	$ $$	
()	(c)	$ $$	
Totals	$ $
$	Other debts:	
TOTAL Other Debt: 	
$	
,	
$
$
$
$ $	$
NET
WORTH:	
$ $ $	
()	(d)$ $$	
()	(e)$ $$	
()	(c)	$	$	$	
()	(d)	$	$	$	
()	(f)	$ $$	
Real Property:	
and

DIVISION 11 - CURRENT INCOME AND EXPENSE INFORMATION	
(To be completed by all parties seeking or resisting alimony or support allowances)	
A.	Income Source	Gross	Deduction(s)
Net Income	
(a)	per	$
$
$	
(b)
per	$
$$	
(c)	per	$$$	TOTAL	$	
Insert the total deductions for each source of income and identify the deduction items:	
for per	$	
for per	$	
per
for	$	
B. Affiant's estimate of the other spouse's income	Gross	Deduction(s)
Net Income	
(a)
per	$$
$	
(b)	per	$$$	
(c)	per	$$$	
TOTAL	$	
C. Residential Arrangements	-	
Are both spouses living in the same dwelling?
If there are children, which spouse or other person has physical care of the children?
Do the children reside in the family dwelling or elsewhere?	
children)	D. Personal Expenses For Support of Affiant (and	.	(Note: All expenses default uniformly - either weekly or monthly	)	
per House payment or rent	
Meals or food	per	
Clothing per	--	per	Car expense, transportation	
-	per	Medical, dental	
per	Utilities & telephone	
per
Other expenses:
per
per
Installment Payments and Other Debt Payments - pay periods default for uniformity: 
per
per
per
per	
Total of Division D:  $	
per
as child support	Affiant requests:	as temporary alimony	per
peras temporary attorneys fees	
day of
Subscribed and Sworn to before me this	
Notary Public State of Iowa	
Income Source (a) Total Deductions
Income Source (b) Total Deductions
Income Source (c) Total Deductions	
for
per
for
per	
per
for	
Income Source (a) Total Deductions
Income Source (b) Total Deductions
Income Source (c) Total Deductions	
$
$ $	
Insert the total deductions for each source of income and identify the deduction items:	
Electronic Form Courtesy Alft & Wilson Publishing - Iowa Support Master - 1-800-735-9426
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