WPC j 1 %ou[Ŋg@b̨80@~Bg0z)qq.e2BğwQNjH>8U`;\n9>IE<" VUnZ^C}>O,t?&novj 3 $ƎSiu2L3J]^{g+&'->9)[iM Gz:m콖Jc\&;"T#J5Lsb}V$# da1Qy9n}lo}J0@ _*Qr30`E?@ABCDE0dddZ[\]^_`abcdefghi(3$ !  (;3$2)e  0  .3  0  8@HPPCL5E0oG]waȌ /eʟ] d$ERS\ ) )  OXXFloridaFamilyLawForm12.901(e),FamilyLawFinancialAffidavit#XXO# @XXԀ(2/98)#XX @#OXX#XXO# 3|xHX"Udd+ X`"T1, 2, 3,Level 1Level 2Level 3Level 4Level 5'dxd d8888'dxd ')e37=CIQYag1.a.i.(1)(a)(i)1)a)&0 d d)Hairline dTable_BTABLE ETABLE F TABLE B )  !XXInstructionsforFloridaFamilyLawForm12.901(e),FamilyLawFinancialAffidavit#XX!# .XXԀ(2/98)#XX .# !  %u%XX  %  %  INSTRUCTIONSFORFLORIDAFAMILYLAWFORM12.901(e),  FAMILYLAWFINANCIALAFFIDAVIT Whenshouldthisformbeused?  >   Thisformshouldbeusedwhenyouareinvolvedinafamilylawcasewhichrequiresa financialaffidavit  B  andyourindividualgrossincomeis$50,000ORMOREperyear. Readtheinstructionsatthe   beginningofeachsectionbecauseyoumaynotberequiredtocompleteeverysectionoftheaffidavit.    Thisformshouldbetypedorprintedinblackink.Aftercompletingthisform,youshouldsigntheformbeforea notarypublic .Youshouldthen file theoriginalwiththe clerkofthecircuitcourt inthecounty 4   wherethe petition wasfiledandkeepacopyforyourrecords. ^   WhatshouldIdonext?    Acopyofthisformmustbemailedorhanddeliveredtotheother party inyourcase,ifitisnotservedon  Y  himorherwithyourinitialpapers.Thismustbeaccomplishedwithin45daysofserviceofthepetition.  WherecanIlookformoreinformation?  *z   Beforeproceeding,youshouldread GeneralInformationforProSeLitigantsfoundatthebeginning q oftheseforms. Thewordsthatarein boldunderline intheseinstructionsaredefinedthere.Forfurther K information,seerule12.285,FloridaFamilyLawRulesofProcedure.   Specialnotes...  l  (  Ifthisisadomesticviolencecaseandyouwanttokeepyouraddressconfidentialforsafetyreasons,donotentertheaddress,telephone,andfaxinformationatthebottomofthisform.Instead,file Petitioners  RequestforConfidentialFilingofAddress ,.pFloridaFamilyLawForm12.980(i). g Theaffidavitmustbecompletedusing monthly incomeandexpenseamounts.Ifyouarepaidoryourbills k aredueonaschedulewhichisnotmonthly,youmustconvertthoseamounts.Hintsareprovidedbelowformakingtheseconversions.-XXX5%'XX-0  0` (#(##XX%%u#XX Hourly 󀄀Ifyouarepaidbythehour,youmayconvertyourincometomonthlyasfollows:!` (#` (# 0  0` (#(#0 ` (#` (#Hourlyamount  ' #XXI #XXԀ  Hoursworkedperweek  = x Weeklyamount]" (# (# 0  0` (#(#0 ` (#` (#Weeklyamount  '   52Weeksperyear    = x Yearlyamount a# (# (# 0  0` (#(#0 ` (#` (#Yearlyamount     12Monthsperyear  =  x MonthlyAmount  $ (# (#  0  0` (#(#Daily 󀄀Ifyouarepaidbytheday,youmayconvertyourincometomonthlyasfollows:y!%` (#` (# 0  0` (#(#0 ` (#` (#Dailyamount  '   Daysworkedperweek  =  x Weeklyamount-"}& (# (# 0  0` (#(#0 ` (#` (#Weeklyamount  '   52Weeksperyear    = x Yearlyamount"1' (# (# 0  0` (#(#0 ` (#` (#Yearlyamount     12Monthsperyear  = x MonthlyAmount #( (# (#  0  0` (#(#Weekly 󀄀Ifyouarepaidbytheweek,youmayconvertyourincometomonthlyasfollows:I$)` (#` (# 0  0` (#(#0 ` (#` (#Weeklyamount  '#XX` #XX   52Weeksperyear    = x Yearlyamount$M * (# (# 0  0` (#(#0 ` (#` (#Yearlyamount     12Monthsperyear  =  x MonthlyAmount %!+ (# (#  0  0` (#(#Biweekly 󀄀Ifyouarepaideverytwoweeks,youmayconvertyourincometomonthlyasfollows:e&!,` (#` (# 0  0` (#(#0 ` (#` (#Biweeklyamount  '    p 26    = x Yearlyamount'i"- (# (# 0  0` (#(#0 ` (#` (#Yearlyamount     12Monthsperyear  =  x MonthlyAmount#XX#XX '#. (# (# #XX3#XX 0  0` (#(#Bimonthly 󀄀Ifyouarepaidtwicepermonth,youmayconvertyourincometomonthlyasfollows:(#/` (#` (# 0  0` (#(#0 ` (#` (#Bimonthlyamount   '   p 2    =  x MonthlyAmount#XX#%u%XX 5)$0 (# (# 1 XXXX5%'X 1Expensesmaybeconvertedinthesamemanner.#XX%%u7#XX )9%1 #XX#%u%XXRemember,apersonwhoisNOTanattorneyiscalledanonlawyer.Ifanonlawyerhelpsyoufillouttheseforms,thatpersonmustgiveyouacopyofa DisclosurefromNonlawyer ,.oFloridaFamilyLawForm w,'4 12.900,beforeheorshehelpsyou.Anonlawyerhelpingyoufillouttheseformsalso must puthisorher  name,address,andtelephonenumberonthebottomofthelastpageofeveryformheorshehelpsyoucomplete.  d    I  %  NTHECIRCUITCOURTOFTHE򀀀JUDICIALCIRCUIT,  INANDFOR򀀀COUNTY,FLORIDA  ~0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#CaseNo.:(#(#K(#(#(# > 0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#Division:(#(#K(#(#(# h 򀀀, B 0  0` (#(# 0` (#` (#Petitioner, (#(# 0  0` (#(#and ` (#` (# 򀀀, 4   0  0` (#(# 0` (#` (#Respondent. (#(#    FAMILYLAWFINANCIALAFFIDAVIT    #XX%%E#\2 XX($50,000ormoreIndividualGrossAnnualIncome)#XX \2b#%%XX     I,{fulllegalname}2!2!D(#,being >  sworn,certifythatthefollowinginformationistrue: K52(XKSECTIONI.INCOME  d  #XX%%# ފ XXReadtheinstructionswiththisform;iftheyindicatethatyoumustfilethisfinancialaffidavit,starthere.#XX  ފL!#%%XX  V @nHHHH @  @1.0  DateofBirth:򀀀H(#(# 2.  SocialSecurityNumber:򀀀 X 3.  Myoccupationis:(#(#K(# h  @4.  Iamcurrently (x [ all thatapply] R  @Ӏ0  a.Unemployed,(#(# 0  Describeyoureffortstofindemployment,howsoonyouexpecttobeemployed,andthepayyouexpecttoreceive:(#(#K(#(#(#   @0  (#(#K(#(#(# &  @Ӏ0  b.Employedby:(#(#K(#(#(#   0  Address:(#(#K(#(#(# !    City,State,Zipcode:(#(#K(# " !   TelephoneNumber:(#(#K(# #0"     Payrate:$   everyweek()everyotherweek()twiceamonth()monthly $@ #   ()other:(#(#K(# &P!$ 0  Ifyouareexpectingtobecomeunemployedorchangejobssoon,describethechangeyouexpectandwhyandhowitwillaffectyourincome:(#(#K(#(#(# ':#&  @0  (#(#K(#(#(# (J$' 0  Checkhereifyoucurrentlyhavemorethanonejob.Listtheinformationaboveforthesecond )$%( job(s)onaseparatesheetandattachittothisaffidavit. (#(#  @Ӏ0  c.Retired.Dateofretirement:򀀀+&*(#(# 0  Employerfromwhomretired:(#(#K(#(#(# ,'+ 0  Address:(#(#K(#(#(#    City,State,Zipcode:   h      p TelephoneNumber:(#(#K(#   &  LASTYEAR'SGROSSINCOME:  h YourIncome  ,(#OtherPartysIncome(ifknown) 0   YEAR `    0 h $     p   $   x  '+@h(#h(#  PRESENTMONTHLYGROSSINCOME:   P  #X=X%%!#;XX= @AllamountsmustbeMONTHLY. SeetheinstructionswiththisformtofigureoutmoneyamountsforanythingthatisNOTpaid  ` monthly.Attachmorepaper,ifneeded.Itemsincludedunder othershouldbelistedseparatelywithseparatedollaramounts.#X=X;-#%%XX=   C 6 )e'# C((#(#(1.  Monthlygrosssalaryorwages R   2.0  Monthlybonuses,commissions,allowances,overtime,tips,andsimilar ,|  payments ?? 3.0  Monthlybusinessincomefromsourcessuchasselfemployment, 0  partnerships,closecorporations,and/orindependentcontracts(Grossreceiptsminusordinaryandnecessaryexpensesrequiredtoproduceincome.)(Attachsheetitemizingsuchincomeandexpenses.)n ?? 4.  Monthlydisabilitybenefits/SSI H 5.  MonthlyWorkers'Compensation "r 6.  MonthlyUnemploymentCompensation L 7.  Monthlypension,retirement,orannuitypayments & 8.  MonthlySocialSecuritybenefits  9.  Monthlyalimonyactuallyreceived     `  9a.Fromthiscase:  $򁁁 d    ` 0 9b.Fromothercase(s):򁁁  -? ? ?Add9aand9b > 10.  Monthlyinterestanddividends h 11.0  Monthlyrentalincome(grossreceiptsminusordinaryandnecessary B expensesrequiredtoproduceincome)(Attachsheetitemizingsuch  incomeandexpenseitems.) ?? 12.  Monthlyincomefromroyalties,trusts,orestates  13.0  Monthlyreimbursedexpensesandinkindpaymentstotheextentthat Z theyreducepersonallivingexpenses ?? 14.0  Monthlygainsderivedfromdealinginproperty(notincluding  ^ nonrecurringgains) ?? Anyotherincomeofarecurringnature(identifysource)15.  ??:? "" 16.  ??:? v## G  )e#'6 %/GC 6 )e'# C P$$ 3? ?kX;g>XX31.$!!F! R $ 2. L !!F! V & 3. L !!F! n * 4. L !!F! H+ 5. L !!F! "r, 6. L !!F! L- 7. L !!F! &. 8. L !!F! / 9. L !!F! >2 10. L !!F! h3 11. L !!F! 6 12. L !!F! 7 13. L !!F! 49 14. L !!F!  8; 15. L !!F! "= 16. L !!F!7 X? ?kX;g>XJ87ӈ v#> (??( 17.PRESENTMONTHLYGROSSINCOME (Addlines116) TOTAL:  17.$(#(#K(# *%z > PRESENTMONTHLYDEDUCTIONS:  &."@  #X=X%%.#;XX=AllamountsmustbeMONTHLY. SeetheinstructionswiththisformtofigureoutmoneyamountsforanythingthatisNOTpaid '#A monthly.#X=X;=#%%XX=((#(#(18.0  Monthlyfederal,state,andlocalincometax(correctedforfilingstatus  )p$C andallowabledependentsandincometaxliabilities) ??    ` a.FilingStatus h    *$&E    ` b.Numberofdependentsclaimed   p  +&F 19.  MonthlyFICAorselfemploymenttaxes ,'G 20.  MonthlyMedicarepayments  21.  Monthlymandatoryuniondues  22.  Monthlymandatoryretirementpayments d 23.0  Monthlyhealthinsurancepayments(includingdentalinsurance), > excludingportionpaidforanyminorchildrenofthisrelationship ?? 24.0  Monthlycourtorderedchildsupportactuallypaidforchildrenfrom B anotherrelationship ?? &  25.  Monthlycourtorderedalimonyactuallypaid     0 ` 25a.fromthiscase: h   $   p  ` ?` ?   0 ` 25b.fromothercase(s):     p QQ+?` ?` ?Add25aand25b' BԈ Z   'FXkXX'18. E $!!F! +&  19. E !!F! ,'  20. E !!F!  21. E !!F!  22. E !!F! d 23. E !!F! h 24. E !!F!   25. E !!F! Z   (??( 26.    TOTALDEDUCTIONSALLOWABLEUNDERSECTION61.30, ^      FLORIDASTATUTES (Addlines18through25) p TOTAL:  26.$(#(#K(#  8   * hXXFXkX*5/2 527.PRESENTNETMONTHLYINCOME (Subtractline26fromline17)   27.$ (#(#K(#    @QV !!!!!G@ 552 5SECTIONII.AVERAGEMONTHLYEXPENSES  3 @QV^QQQQ!H@ Proposed/EstimatedExpenses. Ifthisisadissolutionofmarriagecase and yourcurrentexpensesdonot ^ reflectwhatyouwillactuallyhavetopayafteryourmarriageends,youshouldwrite estimatenexttoeachamountthatisproposed/estimated. HOUSEHOLD:   Y ((#(#(1.  Monthlymortgageorrentpayments 3 2.  Monthlypropertytaxes(ifnotincludedinmortgage)   3.  Monthlyinsuranceonresidence(ifnotincludedinmortgage)  4.0  Monthlycondominiummaintenancefeesandhomeowner'sassociation q fees ?? 5.  Monthlyelectricity %u 6.  Monthlywater,garbage,andsewer O 7.  Monthlytelephone ) 8.  Monthlyfueloilornaturalgas  9.  Monthlyrepairsandmaintenance  10.  Monthlylawncare g  11.  Monthlypoolmaintenance A!  12.  Monthlypestcontrol "k! 13.  Monthlymisc.household "E" 14.  Monthlyfoodandgroceryitems ## 15.  Monthlymealsoutsidehome $$ 16.  Monthlycablet.v. % % 17.  Monthlyalarmservicecontract ]&!& 18.  Monthlyservicecontractsonappliances 7'"' 19.  Monthlymaidservice (a#( Other:20.  ??:? )%* 21.  ??:? *%+ 22.  ??:? y+&, 23.  ??:? S,'- 24.  ??:?  $ ?kXhXX$1. L $!!F! 3 2. L !!F!   3. L !!F!  4. L !!F! K 5. L !!F! %u 6. L !!F! O 7. L !!F! ) 8. L !!F!  9. L !!F!   10. L !!F! g   11. L !!F! A!  12. L !!F! "k  13. L !!F! "E  14. L !!F! # 15. L !!F! $ 16. L !!F! %  17. L !!F! ]&! 18. L !!F! 7'" 19. L !!F! (a# 20. L !!F! )% 21. L !!F! *% 22. L !!F! y+& 23. L !!F! S,' 24. L !!F!   1 ??125.  SUBTOTAL (addlines1through24)؈ d  25.  $(#(#K(#  d  1w 1AUTOMOBILE:  h 26.  Monthlygasolineandoil B 27.  Monthlyrepairs   28.  Monthlyautotagsandemissiontesting   29.  Monthlyinsurance   30.  Monthlypayments(leaseorfinancing) Z  31.  Monthlyrental/replacements 4  32.  Monthlyalternativetransportation(bus,rail,carpool,etc.) ^  33.  Monthlytollsandparking 8  34.  Other:8   26. L $!!F! B  27. L !!F!    28. L !!F!    29. L !!F!    30. L !!F! Z  31. L !!F! 4  32. L !!F! ^  33. L !!F! 8  34. L !!F!   1w 1 35. KK SUBTOTAL (addlines26through34) v   35.  $(#(#K(#  v   &  1, 1MONTHLYEXPENSESFORCHILD(REN)FROMANOTHER *z RELATIONSHIP (otherthancourtorderedchildsupport) T 36.  8 . 37.  8  38.  8  39.  8'*]Ԉ l $36.  $ F  . 37.   F   38.   F   39.   F  l  1, 140.KKSUBTOTAL (addlines36through39)($؈  p  40.  $(#(#K(#   p  1w 1MONTHLYINSURANCE $  41.0  Healthinsurance,excludingportionpaidforanyminorchild(ren)ofthis  relationship  42.  Lifeinsurance b 43.  Dentalinsurance <  Other:44.  8 @" 45.  8  # )(41. L $ F  % 42. L  F  b& 43. L  F  <' 44. L  F  @) 45. L  F   *  1w 146.KKSUBTOTAL (addlines41through45).)؈ ~"*  46.  $(#(#K(#  ~"*  ((OTHERMONTHLYEXPENSESNOTLISTEDABOVE:  2$* (D,(#(#(47.  Monthlydrycleaningandlaundry  %\ + 48.  Monthlyclothing %6!, 49.  Monthlymedical,dental,andprescription(unreimbursedonly) &"- 50.  Monthlypsychiatric,psychological,andcounselor(unreimbursedonly) '". 51.0  Monthlynonprescriptionmedications,cosmetics,toiletries,andsundriest(#/ 52.  Monthlygrooming N)$0 53.  Monthlygifts (*x%1 54.  Monthlypetexpenses +R&2 55.  Monthlyclubduesandmembership +,'3 56.  Monthlysportsandhobbies  57.  Monthlyentertainment  58.  Monthlyperiodicals/books/tapes/CDs d 59.  Monthlyvacations > 60.  Monthlyreligiousorganizations h 61.  Monthlybankcharges/creditcardfees B 62.  Monthlyeducationexpenses   Other:(includeanyusualandcustomaryexpensesnototherwisementionedintheitemslistedabove)63.  9 Z   64.  9 4   65.  9 ^  66.  9/.؈ 8  47. L $ F   %\  48. L  F  %6!  49. L  F  &" 50. L  F  '" 51. L  F  t(# 52. L  F  N)$ 53. L  F  (*x% 54. L  F  +R& 55. L  F  +,' 56. L  F   57. L  F   58. L  F  d 59. L  F  > 60. L  F  h 61. L  F  B 62. L  F    63. L  F  Z   64. L  F  4   65. L  F  ^  66. L  F  8   1D, 167. KK SUBTOTAL (addlines47through66)C/؈    67.  $(#(#K(#     ((MONTHLYPAYMENTSTOCREDITORS: (onlywhenpaymentsarecurrentlymadebyyouon P  outstandingbalances)  ((#(#(NAMEOFCREDITOR(s):68.  8 . 69.  8  70.  8  71.  8 l 72.  8 F 73.  8  p 74.  8 J 75.  8 $ 76.  8  77.  8  78.  8 b 79.  8 < 80.  8 f DC68. k $: : D:  . 69. k : : D:   70. k : : D:   71. k : : D:  l 72. k : : D:  F  73. k : : D:   p! 74. k : : D:  J" 75. k : : D:  $# 76. k : : D:  $ 77. k : : D:  % 78. k : : D:  b& 79. k : : D:  <' 80. k : : D:  f(  1 181. KK SUBTOTAL (addlines68through80)KD؈  ( P 2)eP  81  .3  Ԁ$(#(#K(#   (  ((5/2~"52)eQ  82  .3  ԀTOTALMONTHLYEXPENSES:  "(   (addlines25,35,40,46,67,and81ofSectionII,Expenses)     82.$ (#(#K(#  #) @K $!!!!!.z@& h SUMMARY o% + MK2)eR  83  .3  ԀTOTALPRESENTMONTHLYNETINCOME(r(#(#(  (fromline27ofSECTIONI.INCOME)'ho%{ 'M#. RS 2)eR  83  .3  Ԁ$!!G!  'M#. MS 84.TOTALMONTHLYEXPENSES (fromline82above) )%.  85.0  SURPLUS (Ifline83ismorethanline84,subtractline84fromline83. e+&0 Thisistheamountofyoursurplus.Enterthatamounthere.)?,'1  84.$!!G!  )%1  85.$!!G!  e+&3  86.0  (DEFICIT) (Ifline84ismorethanline83,subtractline83fromline84.  Thisistheamountofyourdeficit.Enterthatamounthere.)  PM86.($s!s!F! )  (r( 552>5SECTIONIII:ASSETSANDLIABILITIES    @* QQQQ!`@ @A.0  ASSETS(ThisiswhereyoulistwhatyouOWN.) (#(# #X=X%%B>#;XX=INSTRUCTIONS:   STEP1:IncolumnA, listadescriptionofeachseparateitemownedbyyou(and/oryourspouse,ifthisisapetitionfordissolution   ofmarriage).Blankspacesareprovidedifyouneedtolistmorethanoneofanitem. STEP2: Ifthisisapetitionfordissolutionofmarriage,checkthebox inColumnA nexttoanyitemthatyouarerequestingthe @  judgeawardtoyou. STEP3:IncolumnB, writewhatyoubelievetobethecurrentfairmarketvalueofallitemslisted.  %   -hXXB''X?kX-STEP4:UsecolumnConlyifthisisapetitionfordissolutionofmarriageandyoubelieveanitemis nonmarital,meaning   itbelongstoonlyoneofyouandshouldnotbedivided. Youshouldindicatetowhomyoubelievetheitembelongs.(Typically, j  youwillonlyuseColumnCifpropertywasownedbyonespousebeforethemarriage.Seetheinstructionswiththisformandsection61.075(1),FloridaStatutes,fordefinitionsof maritaland nonmaritalassetsandliabilities.)#X=X;#%%XX= "   @*y9ddd Xdd Xdd X(#(#y,66 ,F6 ,"",FF"+  ;9992&   x;#X=X%%#cXX=A U ASSETS:DESCRIPTIONOFITEM(S)#X=Xc9#%%XX=  #X=X%%ﲈ#cXX=Ԁtheboxnexttoanyasset(s)whichyouarerequestingthejudgeawardtoyou.#X=Xc#%%XX= R9992=./ 9992 R#X=X%%#cXX=B U CurrentFairMarketValue R9992=.A" ))9992 RC U Nonmarital(correctcolumn)#X=Xc(#%%XX= \9992G+A" x  9992 <\ 799(/9992 7 99992$/99 9#X=X%%!#*lXX=husband#X=X*l/#%%XX= =99992(k"9992 =#X=X%%x#*lXX=wife#X=X*l#%%XX= O99@(k" <  99992 fFO#X=X%%=#XX=ԀCash(onhand) 799(k99 7$ 799(k99 7 ;999(k"99 ; J99;(k" F f 999 6J#X=Xҍ#%%XX=#X=X%%#XX=ԀCash(inbanksorcreditunions) 799(+{ 99 @7 799(+{!@99 @7 ;999(+{""@99 @; E996#+{#"@ 6 999 6E#X=X]#%%XX=#X=X%%ﮐ#XX= 799(;$99 @7 799(;%@99 @7 ;999(;&"@99 @; J99;#;'"@ 6 999 6J#X=X#%%XX=#X=X%%)#XX=ԀStocks/Bonds#X=Xo#%%XX= ;99,K(99 @; L99=.K)@999 @L P999=.K*"@999 @P [99L9K+"@9 6  999 6[ 799([,99 @7 799([-@99 @7 ;999([."@99 @; E996#[/"@ 6 999 6E 799(k099 @7 799(k1@99 @7 ;999(k2"@99 @; E996#k3"@ 6 999 6E#X=X%%ﾒ#XX=ԀNotes(moneyowedtoyouinwriting) 799({499 @7 799({5@99 @7 ;999({6"@99 @; E996#{7"@ 6 999 6E#X=X#%%XX=#X=X%%o#XX= 799(899 @7 799(9@99 @7 ;999(:"@99 @; E996#;"@ 6 999 6E#X=X#%%XX=#X=X%%#XX= 799(<99 @7 799(=@99 @7 ;999(>"@99 @; J99;#?"@ 6 999 6J#X=X+#%%XX=#X=X%%`#XX=ԀMoneyowedtoyou(notevidencedbyanote) 799(@99 @7 799(A@99 @7 ;999(B"@99 @; J99;(C"@ 6 999 6J#X=X#%%XX=#X=X%%#XX= 799( D99 @7 799( E@99 @7 ;999( F"@99 @; E996# G"@ 6 999 6E#X=XM#%%XX=#X=X%%}#XX= 799(!H99 @7 799(!I@99 @7 ;999(!J"@99 @; J99;#!K"@ 6 999 6J#X=XÝ#%%XX=#X=X%%#XX=ԀRealestate:(Home)#X=X>#XX= 799("+L99 @7 799("+M@99 @7 ;999("+N"@99 @; J99;("+O"@ 6  999 6J#X=X#%%XX=#X=X%%ɠ#XX=  (Other#X=X#XX=) 799(#;P99 @7 799(#;Q@99 @7 ;999(#;R"@99 @; E996##;S"@ 6 999 6E#X=Xn#%%XX=#X=X%%#XX= 799($K T99 @7 799($K U@99 @7 ;999($K V"@99 @; E996#$K W"@ 6 999 6E#X=X#%%XX=#X=X%%#XX= 799( &[!X99 @7 799( &[!Y@99 @7 ;999( &[!Z"@99 @; E996# &[!["@ 6 999 6E#X=X[#%%XX=#X=X%%#XX= 799('k"\99 @7 799('k"]@99 @7 ;999('k"^"@99 @; E996#'k"_"@ 6 999 6E#X=Xѥ#%%XX=#X=X%%#XX= 799(+({#`99 @7 799(+({#a@99 @7 ;999(+({#b"@99 @; E996#+({#c"@ 6 999 6E#X=XG#%%XX=#X=X%%w#XX= 799(;)$d99 @7 799(;)$e@99 @7 ;999(;)$f"@99 @;#X=X#XX= J99;#;)$g"@ 6 999 6J#X=X#%%XX=#X=X%%4#XX=ԀBusinessinterests 799(K*%h99 7 799(K*%i99 @7 ;999(K*%j"@99 @; O99@(K*%k"@ 6  999 6O#X=Xz#%%XX=#X=X%%ǫ#XX= 799([+&l99 @7 799([+&m@99 @7 ;999([+&n"@99 @; J99;([+&o"@ 6  999 6J#X=X #%%XX=#X=X%%B#XX= 799(k,'p99 @7 799(k,'q@99 @7 ;999(k,'r"@99 @; E996#k,'s"@ 6 999 6E#X=X#%%XX=#X=X%%︮#XX= 799(.699 @7 799(.6@99 @7 ;999(.6"@99 @; E996#.6"@ 6 999 6E#X=X#%%XX=#X=X%%.#XX= 799(> F99 @7 799(> F@99 @7 ;999(> F"@99 @; J99;#> F"@ 6 999 6J#X=Xt#%%XX=#X=X%%况#XX=ԀAutomobiles 799(N V 99 @7 799(N V @99 @7 ;999(N V "@99 @; J99;(N V "@ 6 999 6J#X=X#%%XX=#X=X%%0#XX= 799(^ f 99 @7 799(^ f@99 @7 ;999(^ f"@99 @; E996#^ f"@ 6 999 6E#X=Xv#%%XX=#X=X%%領#XX= 799(n v99 @7 799(n v@99 @7 ;999(n v"@99 @; E996#n v"@ 6 999 6E#X=X#%%XX=#X=X%%#XX= 799(~ 99 @7 799(~ @99 @7 ;999(~ "@99 @; J99;#~ "@ 6 999 6J#X=Xb#%%XX=#X=X%%#XX=ԀBoats 799(99 @7 799(@99 @7 ;999("@99 @; J99;("@ 6  999 6J#X=Xݷ#%%XX=#X=X%%#XX= 799(99 @7 799(@99 @7 ;999("@99 @; E996# "@ 6 999 6E#X=X^#%%XX=#X=X%%#XX= 799(!99 @7 799("@99 @7 ;999(#"@99 @; E996#$"@ 6 999 6E#X=XԺ#%%XX=#X=X%%#XX=ԀOthervehicles 799( %99 @7 799( &@99 @7 ;999( '"@99 @; E996# ("@ 6 999 6E#X=XJ#%%XX=#X=X%%#XX= 799( )99 @7 799( *@99 @7 ;999( +"@99 @; E996# ,"@ 6 999 6E#X=XϽ#%%XX=#X=X%%#XX= 799( -99 @7 799( .@99 @7 ;999( /"@99 @; J99;# 0"@ 6 999 6J#X=XE#%%XX=#X=X%%z#XX=ԀRetirementplans(ProfitSharing,Pension,IRA,401(k)'s,etc.) 799( 199 @7 799( 2@99 @7 ;999( 3"@99 @; J99;( 4"@ 6  999 6J#X=X#%%XX=#X=X%%5#XX= 799(599 @7 799(6@99 @7 ;999(7"@99 @; E996#8"@ 6 999 6E#X=X{#%%XX=#X=X%%#XX= 799(999 @7 799(:@99 @7 ;999(;"@99 @; E996#<"@ 6 999 6E#X=X#%%XX=#X=X%%!#XX= 799(&=99 @7 799(&>@99 @7 ;999(&?"@99 @; J99;#&@"@ 6 999 6J#X=Xg#%%XX=#X=X%%#XX=ԀFurniture&furnishingsinhome 799(.6A99 @7 799(.6B@99 @7 ;999(.6C"@99 @; J99;(.6D"@ 6  999 6J#X=X#%%XX=#X=X%%7#XX= 799(>FE99 @7 799(>FF@99 @7 ;999(>FG"@99 @; E996#>FH"@ 6 999 6E#X=X}#%%XX=#X=X%%#XX=ԀFurniture&furnishingselsewhere 799(NVI99 @7 799(NVJ@99 @7 ;999(NVK"@99 @; E996#NVL"@ 6 999 6E#X=X#%%XX=#X=X%%E#XX= 799(^fM99 @7 799(^fN@99 @7 ;999(^fO"@99 @; J99;#^fP"@ 6 999 6J#X=X#%%XX=#X=X%%#XX=ԀCollectibles 799(nvQ99 @7 799(nvR@99 @7 ;999(nvS"@99 @; J99;(nvT"@ 6 999 6J#X=X#%%XX=#X=X%%H#XX= 799(~U99 @7 799(~V@99 @7 ;999(~W"@99 @; J99;#~X"@ 6 999 6J#X=X#%%XX=#X=X%%#XX=ԀJewelry 799(Y99 @7 799(Z@99 @7 ;999(["@99 @; J99;(\"@ 6 999 6J#X=X #%%XX=#X=X%%F#XX= 799( ]99 @7 799( ^@99 @7 ;999( _"@99 @; J99;# `"@ 6 999 6J#X=X#%%XX=#X=X%%#XX=ԀLifeinsurance(cashsurrendervalue) 799(!a99 @7 799(!b@99 @7 ;999(!c"@99 @; J99;(!d"@ 6  999 6J#X=X#%%XX=#X=X%%b#XX= 799("e99 @7 799("f@99 @7 ;999("g"@99 @; E996#"h"@ 6 999 6E#X=X#%%XX=#X=X%%#XX= 799(#i99 @7 799(#j@99 @7 ;999(#k"@99 @; J99;##l"@ 6 999 6J#X=X#%%XX=#X=X%%S#XX=ԀSportingandentertainment(T.V.,stereo,etc.)equipment 799($m99 @7 799($n@99 @7 ;999($o"@99 @; J99;($p"@ 6 999 6J#X=X#%%XX=#X=X%%#XX= 799(%q99 @7 799(%r@99 @7 ;999(%s"@99 @; E996#%t"@ 6 999 6E#X=XN#%%XX=#X=X%%~#XX= 799(&u99 @7 799(&v@99 @7 ;999(&w"@99 @; E996#&x"@ 6 999 6E#X=X#%%XX=#X=X%%#XX= 799(( y99 @7 799(( z@99 @7 ;999(( {"@99 @; E996#( |"@ 6 999 6E#X=X:#%%XX=#X=X%%j#XX= 799()&!}99 @7 799()&!~@99 @7 ;999()&!"@99 @; E996#)&!"@ 6 999 6E#X=X#%%XX=#X=X%%#XX=ԀOtherassets#X=X&#XX= 799(.*6"99 @7 799(.*6"@99 @7 ;999(.*6""@99 @;#X=Xu#XX= E996#.*6""@ 6 999 6E#X=X`#%%XX=#X=X%%#XX= 799(>+F#99 @7 799(>+F#@99 @7 ;999(>+F#"@99 @; E996#>+F#"@ 6 999 6E#X=X-# XX=#X=X ]#%%XX= 799(N,V$99 @7 799(N,V$@99 @7 ;999(N,V$"@99 @; E996#N,V$"@ 6 999 6E#X=X%%# XX=#X=X #%%XX= 799(.699 @7 799(.6@99 @7 ;999(.6"@99 @; E996#.6"@ 6 999 6E#X=X%%# XX=#X=X I#%%XX= 799(> F99 @7 799(> F@99 @7 ;999(> F"@99 @; E996#> F"@ 6 999 6E#X=X%%# XX=#X=X #%%XX= 799(N V 99 @7 799(N V @99 @7 ;999(N V "@99 @; E996#N V "@ 6 999 6E#X=X%%#XX=ԛ 799(^ f 99 @7 799(^ f@99 @7 ;999(^ f"@99 @;#X=X9#XX= E996#^ f"@ 6 999 6E#X=X%#%%XX=#X=X%%#XX= 799(n v99 @7 799(n v@99 @7 ;999(n v"@99 @; P9992;#n v"@ 6 999 6P#X=X#%%XX= TotalAssets (addcolumnB) =9992(~ 9992 =$~~>#X=X%%-#XX=Ԉ 9999(~ 9992 @9 ;9999(~ "@999 @;8.,~ "@ 6 @ 9999 8 #X=X#%%XX= @& : B.0  LIABILITIES/DEBTS(ThisiswhereyoulistwhatyouOWE.) hp(#(# #X=X%%#;XX= INSTRUCTIONS:  x  STEP1:IncolumnA ,listadescriptionofeachseparatedebtowedbyyou(and/oryourspouse,ifthisisapetitionfordissolution Ya  ofmarriage).Blankspacesareprovidedifyouneedtolistmorethanoneofanitem. STEP2: Ifthisisapetitionfordissolutionofmarriage,checkthebox inColumnA nexttoanydebt(':h s)forwhichyoubelieveyou   shouldberesponsible. STEP3:IncolumnB ,writewhatyoubelievetobethecurrentamountowedforallitemslisted.    STEP4:UsecolumnConlyifthisisapetitionfordissolutionofmarriageandyoubelieveanitemis nonmarital,meaning dl  thedebtbelongstoonlyoneofyouandshouldnotbedivided. Youshouldindicatetowhomyoubelievethedebtbelongs.  ! (Typically,youwillonlyuseColumnCifthedebtwasowedbyonespousebeforethemarriage.Seetheinstructionswiththisformandsection61.075(1),FloridaStatutes,fordefinitionsof maritaland nonmaritalassetsandliabilities.)#X=X;#%%XX= #  @*9 dAd66 F6 ""FF"9(#(#,66 ,F6 ,"",FF"+  #X=X%%#cXX= ;9992& ;C% x;#X=Xc#cXX=A & LIABILITIES:DESCRIPTIONOFITEM(S)#X=Xcv#%%XX=  Ӏ#X=X%%#cXX=Ԁtheboxnexttoanydebt(s)forwhichyoubelieveyoushouldberesponsible.#X=XcG#%%XX= R9992=.) 9992 R#X=X%%#cXX=B * CurrentAmountOwed R9992=.," ))9992 RC - Nonmarital(correctcolumn)#X=Xcj#%%XX= \9992G+/" x  9992 <\ 799(/9992 7#X=X%%]#cXX= 99992$/99 9husband =99992(0"9992 =wife#X=Xc2#%%XX= O99@(1" <  99992 fFO#X=X%%# XX=ԀMortgagesonrealestate:(Home)#X=X #%%XX= 799(299 7$ 799(399 7 ;999(4"99 ; J99;(5" F f 999 6J#X=X%%# XX=   2  (Other)#X=X (#%%XX= 799(699 @7 799(7@99 @7 ;999(8"@99 @; E996#9"@ 6 999 6E 799(:99 @7 799(;@99 @7 ;999(<"@99 @; E996#="@ 6 999 6E ;99,>99 @; L99=.?@9C99 @L P999=.@"@999 @P V99G4A"@9 6 999 6V#X=X%%# XX=ԀCharge/creditcardaccounts#X=X #%%XX= 799( !B99 @7 799( !C@99 @7 ;999( !D"@99 @; E996# !E"@ 6 999 6E 799("!F99 @7 799("!G@99 @7 ;999("!H"@99 @; E996#"!I"@ 6 999 6E 799()#1J99 @7 799()#1K@99 @7 ;999()#1L"@99 @; E996#)#1M"@ 6 999 6E 799(9$AN99 @7 799(9$AO@99 @7 ;999(9$AP"@99 @; E996#9$AQ"@ 6 999 6E 799(I%QR99 @7 799(I%QS@99 @7 ;999(I%QT"@99 @; E996#I%QU"@ 6 999 6E 799(Y&aV99 @7 799(Y&aW@99 @7 ;999(Y&aX"@99 @; E996#Y&aY"@ 6 999 6E#X=X%%P# XX=ԀAutoloan#X=X >#%%XX= 799(i'qZ99 @7 799(i'q[@99 @7 ;999(i'q\"@99 @; E996#i'q]"@ 6 999 6E#X=X%%# XX=ԀAutoloan#X=X #%%XX= 799(y( ^99 @7 799(y( _@99 @7 ;999(y( `"@99 @; J99;#y( a"@ 6 999 6J#X=X%% # XX=Bank/CreditUnionloans#X=X D#%%XX= 799()!b99 @7 799()!c@99 @7 ;999()!d"@99 @; J99;()!e"@ 6  999 6J 799(*"f99 @7 799(*"g@99 @7 ;999(*"h"@99 @; E996#*"i"@ 6 999 6E 799(+#j99 @7 799(+#k@99 @7 ;999(+#l"@99 @; E996#+#m"@ 6 999 6E 799(.699 @7 799(.6@99 @7 ;999(.6"@99 @; E996#.6"@ 6 999 6E#X=X%%# XX=ԀMoneyyouowe(notevidencedbyanote)#X=X  #%%XX= 799(> F99 @7 799(> F@99 @7 ;999(> F"@99 @; E996#> F"@ 6 999 6E 799(N V 99 @7 799(N V @99 @7 ;999(N V "@99 @; J99;#N V "@ 6 999 6J#X=X%%* # XX=ԀJudgments#X=X U#%%XX= 799(^ f 99 @7 799(^ f@99 @7 ;999(^ f"@99 @; J99;(^ f"@ 6 999 6J 799(n v99 @7 799(n v@99 @7 ;999(n v"@99 @; J99;#n v"@ 6 999 6J#X=X%%# XX=ԀOther#X=X #%%XX= 799(~ 99 7 799(~ 99 @7 ;999(~ "@99 @; J99;(~ "@ 6  999 6J 799(99 @7 799(@99 @7 ;999("@99 @; E996#"@ 6 999 6E 799(99 @7 799(@99 @7 ;999("@99 @; E996# "@ 6 999 6E 799(!99 @7 799("@99 @7 ;999(#"@99 @; E996#$"@ 6 999 6E 799( %99 @7 799( &@99 @7 ;999( '"@99 @; E996# ("@ 6 999 6E 799( )99 @7 799( *@99 @7 ;999( +"@99 @; E996# ,"@ 6 999 6E 799( -99 @7 799( .@99 @7 ;999( /"@99 @; P992;# 0"@ 6 999 6P TotalDebts (addcolumnB) =992( 1992 =$~~> 799( 2992 @7 ;999( 3"@99 @;8., 4"@ 6  999 8 <XX<X5%'XhXXB''X<& d C.  NETWORTH (excludingcontingentassetsandliabilities)  5   TotalAssets (entertotalofColumnBinAssetTable;SectionA)  $v v <(##X=X%%#%%XX=ԁ |6   TotalLiabilities (entertotalofColumnBinLiabilitiesTable;SectionB)#X=X%%V#%%XX=ԁ$v v <(##X=X%%#%%XX=ԁ#X=X%%x#%%XX=Ԉ V^7 K/2(X K  TOTALNETWORTH(TotalAssetsminusTotalLiabilities)  .69   (excludingcontingentassetsandliabilities)   p      x $ (#(#K(#'dF  ,4: @9-*2$$$@ @D.  CONTINGENTASSETSANDLIABILITIES   < #X=X%%#;XX=INSTRUCTIONS: = Ifyouhaveany POSSIBLE assets (incomepotential,accruedvacationorsickleave,bonus,inheritance,etc.)or POSSIBLE > liabilities (possiblelawsuits,futureunpaidtaxes,debtsassumedbyanother),youmustlistthemhere.#X=X;+#%%XX= ?  @*9 dd66 F6 ""FF"9(#(#,66 ,F6 ,"",FF"+  ;9992& d!lA F;#X=X%% #cXX=A !B ContingentAssets#X=Xc9"#%%XX=  Ӏ#X=X%%"#cXX=theboxnexttoanycontingentasset(s)whichyouarerequestingthejudgeawardtoyou#X=Xc"#%%XX=. R992=.#E}}C9992 R#X=X%%##*lXX=B !F PossibleValue R9992=."H"H992 RC !I Nonmarital(correctcolumn)#X=X*l%$#%%XX= \9992G+"K" F  9992 <\ 799(#K9992 7#X=X%%%#*lXX= 99992$#K99 9husband =99992(#L"9992 =wife#X=X*l%#%%XX= O99@(#M" <  99992 fFO 799($N99 7$ 799($O99 7 ;999($P"99 ; J99;($Q" F f 999 6J 799(%R99 @7 799(%S@99 @7 ;999(%T"@99 @; E996#%U"@ 6 999 6E 799(&V99 @7 799(&W@99 @7 ;999(&X"@99 @; J99;#&Y"@ 6 999 6J ;99,'Z99 @; L99=.'[@9{a99 @L P999=.'\"@9H99 @P [99L9']"@9H 6  999 6[ 799()!^99 @7 799()!_@99 @7 ;999()!`"@99 @; E996#)!a"@ 6 999 6ETotalContingentAssets 799(*"b99 7$>#X=X%%&#XX= 799(*"c99 @7 ;999(*"d"@99 @;3)'*"e"@ 6  999 3  *"e *9 dd66 F6 ""FF"9(#(#,66 ,eF6 ,"",FF"+  ;9992&  F;#X=X,#cXX=A F ContingentLiabilities #X=Xc.#%%XX=  #X=X%%d/#cXX=theboxnexttoanycontingentdebt(s)forwhichyoubelieveyoushouldberesponsible#X=Xc/#cXX=. R992=. \za9992 RB F PossibleAmountOwed#X=XcO0#cXX= R9992=. "__f992 RC F  Nonmarital(correctcolumn) \9992G+2 " F  9992 <\ 799(  9992 7#X=Xc1#cXX= 99992$  99 9husband =99992( \ "9992 =wife#X=Xcl2#%%XX= O99@( \ " <  99992 fFO 799( \99 7$ 799( \99 7 ;999( \"99 ; J99;( \" F f 999 6J 799( l99 @7 799( l@99 @7 ;999( l"@99 @; E996# l"@ 6 999 6E 799(, |99 @7 799(, |@99 @7 ;999(, |"@99 @; J99;#, |"@ 6 999 6J ;99,< 99 @; L99=.< @9i99 @L P999=.< "@9f99 @P [99L9< "@9f 6  999 6[ 799(L 99 @7 799(L @99 @7 ;999(L  "@99 @; E996#L !"@ 6 999 6ETotalContingentLiabilities#X=X%%/3#XX= 799(\ "99 7$> 799(\ #99 @7 ;999(\ $"@99 @;3)'\ %"@ 6  999 3#X=X8#%%XX= E.   Hastherebeenanyagreementbetweenyouandtheotherpartythatoneofyouwilltake ` & responsibilityforadebtandwillholdtheotherpartyharmlessfromthatdebt?()yes()noIfyes,explain:(#(#K(#  ( (#(#K(#(#(#K(#(#(#K(#(#(#K(#(#(#K(#'; 5525ATTACHMENTS V6 @-JI1QQQQ!<@CHILDSUPPORTGUIDELINESWORKSHEET. (ChildSupportGuidelinesWorksheet,.rFlorida 17 FamilyLawForm12.901(g),MUSTbefiledinallcasesinwhichthepartieshaveoneormorechildrenincommon,INCLUDINGmodificationsofchildsupport.)[ one only] : 򀀀0  AChildSupportGuidelinesWorksheetISbeingfiledinthiscase. Thepartieshaveoneormore ; minorchildrenincommon or oneofthepartiesisrequestingamodificationofapreviouscourt s< orderregardingchildsupport. (#(# 򀀀0  AChildSupportGuidelinesWorksheetISNOTbeingfiledinthiscase. Therearenominor '!w> childrencommontothepartiesinthiscase or ,ifthiscaseinvolvesamodificationofaprevious "Q? courtorder,childsupportisnotanissue. (#(#  Icertifythatacopyofthisfinancialaffidavitwas:()mailed,()faxedandmailed,or()hand $B deliveredtotheperson(s)listedbelowon{date}""J(#.  i% C  r@ Otherpartyorhis/herattorney : &"E Name:   `   <      p  '"F Address: `   <      p  d(#G City,State,Zip:  <      p  >)$H FaxNumber: `   <      p  *h%I   *B&J  & 8    IunderstandthatIamswearingoraffirmingunderoathtothetruthfulnessoftheclaimsmade  inthisaffidavitandthatthepunishmentforknowinglymakingafalsestatementincludesfinesand/orimprisonment.  d Dated:򀀀 h    `   <   (#(#K(# B    `   <   SignatureofParty0  0` (#(#0 ` (#` (#0< (# (#0<(#<(#PrintedName:(#(#K(#(#(#      `   <   Address:(#(#K(#      `   <   City,State,Zip:(#(#K(# Z      `   <   TelephoneNumber:(#(#K(# 4      `   <   FaxNumber:(#(#K(#'8 C ^  STATEOFFLORIDACOUNTYOF򀀀   Sworntooraffirmedandsignedbeforemeon򀀀by""J(#.      `   <   (#(#K(# *z 0  0` (#(#0 ` (#` (#0< (# (#0<(#<(#NOTARYPUBLIC"STATEOFFLORIDA (#(#    `   <   (#(#K(#  򀀀  Personallyknown0 <   [Print,type,orstampcommissionednameofnotary.]<(#<(# 򀀀0  Producedidentificationl(#(#   Typeofidentificationproduced򀀀   F  IFANONLAWYERHELPEDYOUFILLOUTTHISFORM,HE/SHEMUSTFILLINTHE J BLANKSBELOW: [-fillin all blanks] $ I,{fulllegalnameandtradenameofnonlawyer}""J(#,  anonlawyer,locatedat{street} <      p   ,{city}""J(#,  {state}   `  ,{phone} <     ,helped{name}""J(#, b whoisthe[ one only]򁁁petitioner or 򁁁respondent,filloutthisform.#X=X%%:#