Affidavit of Income and Property

Making an under-oath statement by an affiant regarding their income and property requires the execution of the following affidavit.

Extracted Text for Proper Search

_____________	Cour	t 	
____________	County 	
 	
Case Number	 	
____________ Tennessee	 	A	FFIDAVIT OF 	I	NCOME 
AND 	
P	ROPERTY	 	
  _____________________________________________  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:	
 	 
1.  Full name:      	 	
Address:        	 	
Phone #        	 	
Soc. Sec. No.       	  	
Employer:       	 	
Phone #        	 	 
2.    List all dependents: 
Name   Age   Relationship 
     	      	
     	     	    	
     	      	
     	      	 
3.   List all income from any source:	   	 	
$      	   per/wk  ‰ /mo   ‰,	 	
from               	: 	
$      	   per/wk  ‰ /mo   ‰,	 	
from               	: 	
$      	   per/wk  ‰ /mo   ‰,	 	
from               	: 	
 
I receive CHILD SUPPORT in the sum of  
$      	  per         	. 	 
4.    List all bank accounts: 
ACCOUNT     BANK/SOURCE          BALANCE 
Checking   	  $     	 	    	
Savings       	  $     	  	    	
Other:         	    $        	    	 	
Other:            	  $     	 	    	 
5.   List all debts: 
CREDITOR/ADDRESS                BALANCE 
      	    $      	 	
      	 $    	 	
      	 $    	 	
      	 $    	 	
      	   $      	 	 
6.   List all monthly household expenses: 
Rent/Mortgage:            $    	 	
Utilities:                  $    	 	
Health Insurance:          $    	 	
Transportation Cost:    $   	 	
Food:                     $    	 	
Clothing:                  $    	 	
Other:                     $    	 	
    	   $      	 	
    	   $      	 	
    	   $      	 	
 
  TOTAL      $      	 	  	 
 
 	
7.   List all land/house/real estate/property you own: 
DESCRIBE                          VALUE 
     	      $    	 	
     	   $    	 	
     	     $    	 	
     	     $    	 	
8.   List all personal property/cars/trucks/ 
furniture/stocks/bonds/tools/equipment you own and its total 
value: 	
DESCRIBE                           VALUE 
Cars        	 $  	 	
Trucks        	  $   	 	
Other        	  $   	 	
     	  $   	 	
     	  $   	 	
     	  $   	 	 
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 fa mily; 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	 	
 
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