South Carolina Financial Declaration Form

Use this form to complete and trade with your spouse in order to view each others financial status.Download

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SCCA 430 (1	2/2009)	 	1 of 5 	 	
STATE OF SOUTH CAROLINA	 	) 	 IN THE FAMILY COURT	 OF THE 	 	
 	) 	            	     	_____	 JUDICIAL CIRCUIT	 	
COUNTY OF	 ______________________________	 	) 	 	
 	) 	                 	 	
 	) 	FINANCIAL DECLARATION	 	
                                                   	                  	Plaintiff	, 	) 	                   	OF 	______________________________	 	
vs.	 	) 	 	
 	) 	 	
          	                         	                               	Defendant	. 	) 	Docket No	. ___________________________________	 	
 
 	
Gross Monthly Income	 	Husband/Father	 	Wife/Mother	 	
Principal Earnings from Employment	 1 	 	 	
Overtime, Tips, Commission, Bonuses	 2 	 	 	
Pensions, 	Retirement, and Annuities income	 	 	 	
Additional Employment income	 	 	 	
Social Security Benefits (SSA) and VA Benefits	 	 	 	
Disability and Worker’s Compensation Benefits	 	 	 	
Unemployment and AFDC	 	 	 	
Spousal or Child Support (from other marriage/relationship)	 	 	 	
Dividends, Interest,	 Trust Income	, and 	Capital Gains	 	 	 	
Rental Income and Business Profits	 	 	 	
Other (Specify):	  	 	 	
TOTAL GROSS MONTHLY INCOME	 	 	 	
 	
Payroll Deductions from Monthly Income	 	Husband/Father	 	Wife/Mother	 	
Federal Income Tax	 3 	 	 	
State Income Tax	 	 	 	
Social Security and Medicare Tax (FICA)	 	 	 	
Self	-Employment Tax	 	 	 	
Health	 and Dental	 Insurance (Adult)	 	 	 	
Health 	and Dental 	Insurance (Child)	 	 	 	
Union Dues	 	 	 	
Voluntary Retirement Contribution (401(k), 457, IRA)	 	 	 	
Mandatory Retirement Contribution	 	 	 	
Savings Plan	 	 	 	
Other (Specify):	  	 	 	
TOTAL MONTHLY DEDUCTIONS	 	 	 	
NET MONTHLY INCOME	 4 	 	 	
 	
HUSBAND/FATHER	 	WIFE/MOTHER	 	
Address	 	 	Address	 	 	
Age	 	 	Age	 	 	
Occupation	 	 	Occupation	 	 	
Employer	 	 	Employer	 	 	
Employer 
Address	 	 	Employer 
Address

SCCA 430 (1	2/2009)	 	2 of 5 	 	
Estimate monthly expenses: (Specify which party is the custodial parent and list name and relationship of all members of hous	ehold 	
whose expenses are included.	 _________________________________________________________________________________	 	
 	
MONTHLY EXPENSES	 5 	Husband/Father	 	Wife/Mother	 	
Residential Rent Payment	 	 	 	
Note o	r Mortgage Payment on Residence	(s) 	 	 	
Food and Household Supplies	 6 	 	 	
Utilities, Water, and	 Garbage Collection	 	 	 	
Telephone and Cellular Phone	 	 	 	
Medical, Dental and Disability Insurance Premiums	 (not 	
deducted from paycheck	) 	 	 	
Life Insurance Premiums (not deducted from paycheck)	 	 	 	
Child Support (from other relationship)	 	 	 	
Work 	Related 	Day C	are	 	 	 	
Spousal Support (from prior marriage)	 	 	 	
Auto Payment	 	 	 	
Auto Insurance, taxes, gasoline, and maintenance	 7 	 	 	
SUBTOTAL	:    	
                             	 	 	
 	
Real Property Tax on Residence	(s) 	 	 	
Maintenance for household	 8 	 	 	
Adult Clothing	 	 	 	
Children’s Clothing	 9 	 	 	
Cable Television, Satellite, and 	Internet/Online Services	 	 	 	
Laundry and Dry Cleaning	 10 	 	 	
Medical	 and Dental	 Expenses 	(not paid by i	nsurance	) 	 	 	
Prescriptions	, Glasses, and Contacts (	not paid by insurance	) 	 	 	
Children’s incidental	 expenses	 11 	 	 	
School lunches, supplies, field trips, and fees	 12 	 	 	
Entertainment	 13 	 	 	
Adult 	Incidental expenses	 14 	 	 	
All I	nstallment payments	 15 	 	 	
Other (Specify):	  	 	 	
SUBTOTAL:   	 	
                             	 	 	
 	
TOTAL MONTHLY EXPENSES	 	 	 	
 	
Installment 	Loan Payments Section	 	
Creditor	 	For	 	Monthly Payment	 	Balance	 	Owed by	 16

SCCA 430 (1	2/2009)	 	3 of 5 	 	
Other Debts and Obligations 	not	 payable in monthly installments	 	
Creditor	 	For	 	Date Payable	 	Balance	 	Owed by 	16 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	
Are you currently in Bankruptcy? 	 YES 	 NO	 	
Are any obligations listed above, including mortgage and note p	ayments, in arrears?  	 YES 	 NO	 	
If yes, please list the obligations in arrears.	 	
________________________________________________________________________________________________________________________
_________________________	_______________________________________________________________________________________________	 	
 	
All Marital Property Known to Parties	 	
Assets	 	Husband/Father	 	Wife/Mother	 	Joint	 	Cash and Money in Checking Account(s)	  	 	 	 	
Money in Savings Accou	nt(s), Credit 	Union, Money M	arket, 	or Cert. of Dep.	 	 	 	 	
Value of Voluntary Retirement Account(s)	 	 	 	 	
Value of Pension Account	 	 	 	 	
Value of Publicly Held Stocks, Bonds, Securities, Mutual Funds	  	 	 	 	
Value of Privately Held Stocks and Other Business	 	 	 	 	
Value of Real 	Estate 	– Net of Mortgage Balance	s 	 	 	 	
Value of All Other Property	17 	 	 	 	
TOTAL ASSETS	 	 	 	 	
 	
 Any 	Non Marital Property	 Known to Parties	 	
Description of Asset	 	Title Owner	 	Date of 
Acquisition	 	
Source of Funds to 	
Acquirer	 	
Estimate Present market 	
Value	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 
If total assets are less than $300,000.00, sign and have notarized.	 	
 
If total assets are greater than $300,000.00, itemize assets by completing additional sections below and 
sign and have notarized.	 	
Financial Accounts Section	18 	
Owner	 	Name of Institution	 	Type of Account	 	Balance

SCCA 430 (1	2/2009)	 	4 of 5 	 	
Voluntary Retirement Accounts and Pension Accounts Section	 	
Type of Account	 	Value	 	
 	 	
 	 	
 	 	
 	 	
 
 	
Publicly Held Stocks, Bonds, Securities, Mutual Funds Section	 (Non	-Retirement)	19 	
Name of 	Company	 	Number of Shares/Type of Account	 	Value	 	
 	 	 	
 	 	 	
 	 	 	
 	 	 	
 	 	 	
 	
Real Estate Section	20 	
Owner	 	Address	 	Value	 	Mortgage Balance	 	Mortgage Equity	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	
Other Property Section	17 	
Owner	 	Description of Asset	 	Value	 	Loan 	Balance	 	Equity	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	
 	
 	 	 	 	 	 	 	 	___________________________________________	 	
 	 	 	 	 	 	 	 	Signature	 	
Sworn to before me this	_____	  day 	 	
of_____________________, 	20_____	. 	 	 	 	 	 	     	 	
 
_________________________________	 (SEAL)	 	
Notary Public for South Carolina	 	
My commission expires	: ____________	 	
 
 
Custodial Parent (if applicable): _______________________________________________________________

SCCA 430 (1	2/2009)	 	5 of 5 	 	
                                        	        	 	
1. 	A recent paystub should be attached to the Financial Declaration.  To compute Principal Earnings from Employment, first 
determine whether you are paid semi	-monthly, biweekly, or weekly.  If you are paid semi	-monthly, multiply the gross 	
amount of your pay 	check by two.  If you are paid biweekly, multiply the gross amount of your pay check by 26 and then 	
divide by 12.  If you are paid weekly, multiply the amount of your paycheck by 52 and divide by twelve.  Round to the 
nearest 	whole 	dollar.	 	
 	
2. 	To compute Over	time, Tips, Commission, and/or Bonuses, take an average of your monthly earnings from overtime, tips, 	
commission, bonuses, etc. from the past three years or the length of employment if employed less than three years (including 
this year).	 	
 
3. 	To compute State	, Local, and Social Security Tax deductions, use the same formula used to compute principal earnings in 	
endnote 1 above, or consult or have your attorney consult an accountant.	 	
 
4. 	Net monthly Income is equal to Total Gross Monthly Income minus Total Monthly 	Deductions.	 	
 
5. 	Do not include any expense in the Monthly Expenses section that has already been included in the Deductions from Gross 
Monthly Income on page one of 	the Declaration.	 	
 	
6. 	Food Expense is to include the cost of groceries, toiletries, cleaning 	supplies, and casual eating out.	 	
 
7. 	Auto Expenses are to include gasoline, oil changes, tune	-ups, tire replacement, maintenance, and related items.	 	
 
8. 	Maintenance for Household is to include appliance and household repairs, landscaping, house cleaning, pest co	ntrol, pool 	
service, alarm service, and other related items.	 	
 
9. 	Clothing Expense is to include shoes and clothing purchases, clothing repair and alterations, and related items.	 	
 
10.	 Laundry Expense is to include the cost of laundry service, dry cleaning, and rel	ated items.	 	
 
11.	 Children’s Incidental Expenses are to include allowance, summer camp, baby sitters, lessons, activities, participatory sports	, 	
and related items.	 	
 
12.	 School Expense is to include tuition, supplies, field trips, dues, tutors, locker rentals, schoo	l lunches, and other related items.	 	
 
13.	 Entertainment is to include movies, theater, vacations, sporting events, compact discs, digital video discs, and related item	s. 	
 	
14.	 Adult Incidental Expenses are to include cosmetics, hair and nail care, books, magazines, 	newspapers, business dues, 	
memberships, pets, charity, religious dues or tithes, gifts, bank charges, hobbies, and related items.	 	
 	
15.	 All Installment Loan Payments is the total amount itemized in Installment Loan Payments Section, which should include all 
loa	n payments not already listed as a monthly expense.  Examples: home equity loan, credit cards, etc.	 	
 
16.	 Indicate which spouse legally owes the payment (husband, wife, or joint).	 	
 
17.	 Other property is to include automobiles (minus loan balance), boats (minus loan	 balance), furniture, furnishings, china, 	
silver, jewelry, collectibles, and other personal property.	 	
 	
18. Itemize Financial Accounts such as checking, savings, credit union, money market, or certifi	cate of deposit accounts in the 	 	
      	Financial Accounts	 Section.                          	 	
 	
19. Itemize Publicly Held Stocks, Bonds, Securities, Stock Options and Mutual Funds (excluding retirement accounts) in the 	 	
      	Publicly Held Stocks, Bonds, Securities, Mutual Funds Section.	 	
 	
20. Itemize each parcel o	f Real Estate in the Real Estate Section.