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v.11.16.21
UNCONTESTED DIVORCE WITH MINOR CHILDREN
This forms packet is designed to guide you in the preparation of your divorce papers. You must
fill in the required information as it applies to your situation. Your papers should remain in the same
order as they appear in this packet. If you do not have access to a typewriter, you may fill in the blanks
by hand, in neat print, using BLACK ink.
You should fill in every blank line EXCEPT for the civil action file number blanks and the lines
provided for signatures by the Notary Public and the Judge.
In the Complaint and the Settlement Agreement, there are some sections that have two possible
answers, separated by an [OR]. In these sections, you must choose which of the two choices fits best in
your situation, and then include only that choice in your documents. The other choice should be ignored
and should not be included in your documents.
Make sure that everything is signed. All signatures that require notarization must be notarized
before your documents will be approved for filing.
Court Personnel are NOT allowed to answer any questions concerning the preparation
of these forms. State Law O.C.G.A. §15-19-51 forbids court personnel to give legal advice.
Different situations may require special procedures and courthouse personnel cannot advise you
on how to proceed or what forms may be necessary in specific situations. Divorce can be very
complicated. The only person allowed to help you in the preparation of these forms is a licensed attorney.
Please consult an attorney if you have questions about the procedure or what action is best for you to take.
YOU MAY NEED AN ATTORNEY IF:
The case is contested and your spouse has a lawyer.
You cannot locate your spouse to serve him or her with your papers.
You or your spouse has a house, pension, or large amount of property or income.
You might lose custody of your children.
You think you will have difficulty getting documents from your spouse about retirement funds,
income, etc.
Even if it is a friendly divorce, you should talk to a lawyer before you sign any settlement papers
or file anything in court.
In the packets for marriages with children, there is a form called the Domestic Relations Financial
Affidavit. Each party will have to have one of these forms filled out prior to the final hearing on the
divorce.
If the Defendant has filed an acknowledgment of service, then each party must submit their
Domestic Relations Financial Affidavit at the time the case is filed.
If the Defendant does not file an acknowledgement of service, and the Sheriff has to serve a copy
of the complaint and summons on the Defendant, the Plaintiff must still file a copy of the Domestic
Relations Financial Affidavit with his or her complaint. The Defendant should be served with a copy
of the Domestic Relations Financial Affidavit along with the complaint and summons.
Remember, you must fully complete the forms before the Judge will be able to grant you a decree
of divorce. Incomplete forms, as well as forms that are improperly filled out, may delay the grant of your
divorce. Make sure that you take time to read over all the forms and understand what is being asked of
you in each situation.
2
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IN THE SUPERIOR COURT OF COUNTY
STATE OF GEORGIA
, )
)
Plaintiff, )
)
v. ) Civil Action No.
)
, )
)
Defendant. )
COMPLAINT FOR DIVORCE
Plaintiff, _ [Name], comes
before this Court and shows this Court as follows:
1.
Residence requirement (Check only one: a or b)
□ a) Plaintiff is a resident of County, Georgia, and has been a
resident of Georgia for at least six months prior to the filing of this action.
□ b) Plaintiff is a resident of County, Georgia, and has resided at
the military post for at least one year
before filing this petition.
□ c) Plaintiff is not a resident of the State of Georgia, but Plaintiff’s spouse has been a
resident of the state of Georgia and the county of for at least six (6)
months prior to my filing this action.
2.
Venue and Service (Check only one: a or b)
□ a) Defendant is a resident of County, Georgia, and has
acknowledged service of the Complaint and Summons and has waived further service of process.
□ b) Defendant is a resident of County, (state) and
has signed an ACKNOWLEDGEMENT OF SERVICE AFFIDAVIT OF WAIVER OF VENUE
AND PERSONAL JURISDICTION.
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v.11.16.21
3.
Date of marriage (Check only one: a or b)
□ a) Plaintiff and Defendant were lawfully married on .
□ b) Plaintiff and Defendant are common law married, having entered into a common
law marriage before January 1 1997 as of .
4.
□ The Defendant and I separated on and have remained
in a bona fide state of separation since that date.
5.
□ There are minor children born of the marriage.
Name:
Name:
Name:
DOB: Sex:____
DOB: Sex:____
DOB: Sex:
Name: DOB: Sex:
6.
Child Custody (Check only one: a, b or c)
□ a) It is in the best interest of the minor children for
to have sole legal and physical custody.
□ b) Plaintiff and Defendant are both fit to share both temporary and permanent joint
legal custody of the minor child(ren). It is in the best interest of the minor child(ren) for
to have primary physical custody.
□ c) Plaintiff and Defendant have agreed that it is in the best interest of the minor
children for the parties to have joint legal and physical custody. The physical custody
arrangement will be as follows:
7.
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For the past five years, the children lived at the following addresses with the following persons:
Address
Dates
Lived With
8.
Other court actions concerning the children (Choose only one: a or b)
□ a) Plaintiff asserts that □ he/ □ she has not participated as a party or a witness or in
any other capacity in any other litigation concerning the children named above and knows of no
other proceeding concerning the minor children in this or any other state. No person other than
the parties to this action has physical custody of the minor children or any claim to custody or
visitation with the minor children.
□ b) The minor children have been involved in the following actions:
(Please tell the court about the following types of actions: custody, visitation, family violence,
protective orders, termination of parental rights, and adoption.)
County/State/Court Type of Custody Action Date Filed Status
9.
Others with a custody claim (Choose only one: a or b)
□ a) I know of no other person, not a party to this proceeding, who has physical
custody of the children or claims to have custody or visitation rights with respect to the minor
children.
□ b) The following persons who are not a party to this proceeding have custody or
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visitation rights with the minor children:
Name Claim
10.
□ Plaintiff is entitled to a divorce from the Defendant upon the statutory grounds that the
marriage is irretrievably broken and there is no hope of reconciliation, under O.C.G.A. § 19-5-
3(13).
11.
□ The parties have entered into a settlement agreement that resolves all issues as to an
equitable division of property and debts, as well as alimony and child support.
WHEREFORE, Plaintiff respectfully requests:
a) That the parties herein be totally divorced;
b) That the Court adopt and incorporate the parties’ settlement agreement into a final
judgment and decree in this matter;
c) That the Wife’s name be changed back to her maiden name, __________________;
d) That the Court enter an Order for Child Support;
e) That the Court award such other and further relief as the it deems equitable and just.
Respectfully submitted this the day of , 20 .
,
Plaintiff pro se [Sign here]
Plaintiff’s Address:
Plaintiff’s Telephone(s):
Defendant’s Address:
Defendant’s Telephone(s):
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IN THE SUPERIOR COURT OF COUNTY
STATE OF GEORGIA
, )
)
Plaintiff, )
)
v. ) Civil Action No.
)
)
, )
Defendant. )
VERIFICATION
Personally, appeared before me the undersigned who on oath states that the facts set
forth in this Complaint are true and correct to the best of his/her knowledge and belief.
Plaintiff pro se
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public, State of Georgia
My Commission Expires:
7
v.11.16.21
IN THE SUPERIOR COURT OF COUNTY
STATE OF GEORGIA
, )
)
Plaintiff, )
)
v. ) Civil Action No.
)
, )
)
Defendant. )
CONSENT TO TRIAL 31 DAYS AFTER SERVICE AND
WAIVER OF RIGHT TO TRIAL BY JURY
Both of the above parties, as indicated by their signatures below, waive their right to trial
by jury and consent to the hearing and granting of a divorce in this action any time thirty-one
(31) days after the filing of the acknowledgement of service or after service has been perfected.
Sworn to and subscribed before me
Plaintiff pro se
[Sign in the presence of a Notary Public]
this day of , 20 .
Notary Public, State of Georgia
My Commission Expires:
Defendant pro se
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public, State of Georgia
My Commission Expires:
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v.11.16.21
IN THE SUPERIOR COURT OF COUNTY
STATE OF GEORGIA
, )
)
Plaintiff, )
)
v. ) Civil Action No.
)
, )
)
Defendant. )
ACKNOWLEDGMENT OF SERVICE AND SUMMONS
The undersigned Defendant hereby acknowledges service of the above Summons and
Complaint for Divorce and states that he/she has received a copy of said Complaint, and
Defendant hereby waives any further service of process.
This the day of , 20 .
Defendant pro se
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public, State of Georgia
My Commission Expires: _
8
IN THE SUPERIOR COURT OF COUNTY
STATE OF GEORGIA
, )
)
Plaintiff, )
)
v. ) Civil Action No.
)
, )
)
Defendant. )
ACKNOWLEDGMENT OF SERVICE AND WAIVER OF SUMMONS
The undersigned Defendant hereby acknowledges service of the above Petition for Divorce,
and states that he/she has received a copy of said Petition, and Defendant hereby waives any and all
future notice, service, and issuance of process.
This the day of , 20 .
Defendant pro se
[Sign in the presence of a Notary Public]
Sworn to and described before me
this day of , 20 .
Notary Public, State of Georgia
My Commission Expires:
10
IN THE SUPERIOR COURT OF COUNTY
STATE OF GEORGIA
, )
)
Plaintiff, )
)
v. ) Civil Action No.
)
, )
)
Defendant. )
SETTLEMENT AGREEMENT
This is an agreement by and between [Name],
(hereinafter referred to as “Husband”) and [Name],
(hereinafter referred to as “Wife”).
WHEREAS, the parties are married but are currently living in a bona fide state of
separation;
WHEREAS, the child(ren) born as issue of the marriage is/are:
Name: DOB:
Name: DOB:
Name: DOB:
Name: DOB: _________________
WHEREAS, the parties desire to settle between themselves all questions of division of
property, child custody, visitation, child support, alimony, and all other rights and obligations
arising out of their marital relationship:
NOW, THEREFORE, in consideration of the mutual covenants hereinafter contained, the
parties agree as follows:
11
SEPARATION
1.
□ The parties shall continue to live separate and apart and each shall be free from
interference, molestation, authority and control, direct or indirect, by the other, as fully as if sole
and unmarried, and each may reside at such place or places as he or she may select.
CUSTODY AND VISITATION
2.
□ The parties agree that the welfare of the child(ren) is of paramount importance and each
agrees to foster and encourage a feeling of affection between themselves and the child(ren).
Neither party shall do anything to hamper the natural development of the children’s love and
respect for the other party.
3.
Legal and physical custody (Check only one: a, b, or c)
□ a) The □ Husband/ □Wife shall have the temporary and permanent legal and
physical custody of the minor child(ren) born as issue of the marriage.
□ b) The Husband and Wife shall share joint legal custody of the minor child(ren). The
parties shall share decision-making concerning the children; however, the □ Husband/ □
Wife shall have the right to make the final decision in the event the parties cannot agree.
Primary physical custody of the minor child (ren) shall be with the □ Husband/ □ Wife as
follows:
Secondary physical custody shall be with the □ Husband/ □ Wife as follows:
□ c) The Husband and Wife shall share joint legal custody and joint physical custody
of the minor child(ren).
Physical custody shall be shared by the parties as follows:
12
The parties shall share decision making concerning the child (ren); however, in the event the
parties cannot decide, the □ Husband/ □ Wife shall be the tiebreaker and make the final decision.
4.
Visitation (Choose only one: a or b)
□ a) The □ Husband/ □ Wife shall have the right of visitation with the minor children
as follows:
□ b) The visitation schedule is attached hereto and incorporated herein.
CHILD SUPPORT
Please go to https://csconlinecalc.georgiacourts.gov/frontend/web/index.php and complete the Child Support
Worksheet. Then print it out and include it in your divorce papers. Your papers will NOT be accepted for
filing without these documents.
5.
Child support amount
□ The Husband/Wife shall pay to the Husband/Wife, as support of the minor child(ren), the
sum of $ * per □week/ □bi-weekly/ □ month, starting on , and
continuing per □week/ □bi-weekly/ □ month thereafter until each respective child reaches the age
of eighteen (18), or so long as the child is enrolled in and attending secondary school (not to
exceed age twenty (20)), marries, dies, or becomes otherwise emancipated. The child support
obligation shall be reduced as follows as each child becomes emancipated:
*This amount was derived from line 13 of the Child Support Worksheet, which is attached hereto as Exhibit 1.
6.
Child support method of payment (Check only one: a or b)
□ a) All payments of child support shall be paid directly to the Husband/Wife at the
following address:
. No
Income Deduction Order will be entered into at this time. However, whenever, in violation of
13
the terms of this Agreement, there shall have been a failure to make the support payments due
hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1)
month, the payments required to be made may be collected by the process of continuing
garnishment for support. In the event □ Husband/ □ Wife fails to pay any child support
obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12)
month period, the parties agree that an income deduction order shall then be entered.
□ b) All payments of child support shall be paid by the employer of the non-custodial
parent pursuant to an income deduction order.
□ c) All payments of child support shall be paid to Georgia Child Support
Enforcement pursuant to an Income Deduction Order.
7.
Health insurance
□ The □ Husband/ □ Wife shall maintain a policy of medical, dental, and hospitalization
insurance for the benefit of the minor child(ren) for so long as the child support obligation set
forth herein exists. Costs not covered under the insurance policy shall be divided between
Husband and Wife as follows:
The □ Husband/ □ Wife shall provide the □ Husband/ □ Wife with an insurance identification
card or such other acceptable proof of insurance coverage and shall cooperate with the □
Husband/ □ Wife in submitting claims under the policy.
8.
Alimony (Check only one: a or b)
□ a) The □ Husband/ □ Wife shall pay to the □ Husband/ □ Wife as alimony the sum
of $ per week/month, to be paid beginning on and to continue
thereafter until the □ Husband/ □ Wife remarries or dies.
□ b) The parties hereby expressly waive alimony for the past, present, and future.
9.
Division of property (Check only one: a, b or c)
□ a) The parties acknowledge that they have no marital property to divide.
□ b) The parties acknowledge that they have previously made a division of their
household furniture, furnishings, household goods, equipment, and other such property.
Neither party shall claim any of the property in the possession of the other as of the date of the
signing of this agreement.
□ c) The parties acknowledge that they possess various items of jointly
owned property, which shall be divided as follows:
14
1) To the Wife:
2) To the Husband:
10.
Division of Debts (Check only one: a or b)
□ a) The parties acknowledge that they have no outstanding joint debts.
□ b) The parties agree to the division of debts as indicated below:
Creditor
Amount
Responsible Party
The responsible party indemnifies and holds harmless the non-responsible party for any
collection on these obligations.
11.
Name restoration
□ The parties request that Wife’s name be restored to .
12.
Binding Agreement
□ The parties acknowledge that they have entered into this Agreement freely and
voluntarily and that it is not the result of any duress or any undue influence.
15
13.
No Agreements other than this one
□ This Agreement constitutes the entire understanding of the parties. There are no
representations, warranties, covenants, or undertaking other than those expressly set forth herein.
14.
Enforceability
□ It is expressly understood that this Agreement does not obligate the parties to continue to
live in a state of separation or to proceed with an action for divorce. However, in the event that
either party shall bring or maintain an action for dissolution of the marital relationship, this
Agreement shall be presented to the court and incorporated by reference into any judgment or
decree concerning the matters provided herein. Notwithstanding such incorporation, this
Agreement shall survive and be enforceable independently of the judgment or decree.
IN WITNESS WHEREOF, the parties have signed their names, this day of
, 20 .
Plaintiff pro se
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public
My Commission Expires:
Defendant pro se
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public
My Commission Expires:
16
E
x
h
i
b
CP
= Custodial Parent
NC
= Non-custodial Parent
(Mother
or
Father should be inserted)
Exhibit _____
VISITATION
The NC
shall have liberal periods
of custody. If the
parties cannot
agree, then the
following
schedule shall control:
Visitation: The NC shall have visitation with the child every other weekend beginning Friday at 6:00
p.m. until Sunday at 6:00 p.m.
Summer:
The NC shall have the child(ren) for two non-consecutive weeks during June or July,
uninterrupted by the mother’s visitation, provided that by May 1
st
of each year, the NC gives the CP
written notice of when he/she intends to exercise the visitation.
Christmas: The CP
shall
have
the
minor
child beginning the day after
school
recesses for
Christmas
holidays until
December 26
th
at 9:00 a.m.
during
even
numbered
years. The NC s
hall have the same
time for his/her visitation during odd number
years. The CP shall have the minor child with
him/her
from December 26
th
beginning
at
9:00 a.m. until January 2
nd
at
9:00 a.m. during odd numbered years.
The NC shall have the
same time
during even
numbered years.
Thanksgiving:
In even-numbered years, the NC shall have the child(ren) from 6:00 p.m. on the day the
child(ren) is/are released from school preceding Thanksgiving holiday until the Sunday following
Thanksgiving Day at 6:00 p.m.
The CP shall have
the child
during
this time period during odd
numbered years.
July 4
th
: The NC shall have the minor child during odd numbered years from
July
4
at 9:00 a.m.
until
July
5 at
10:00 a.m. The CP
shall have
the minor child for this schedule during even numbered years.
Spring Break: The CP shall have the child during Spring Break from
6:00
p.m.
on the day school
recesses for Spring Break
until 6:00 p.m. on the
day before school resumes in odd numbered years.
The NC shall
have
this time period
in even numbered years.
Fall Break:
The CP shall have the child during Fall Break from 6:00
p.m.
on the day school recesses
for Fall Break
until 6:00 p.m. on the
day before school resumes in even numbered years.
The NC
shall
have
this time period
in odd numbered years.
Mother’s Day: The mother shall have
the
child on the
Friday
preceding Mother’s Day from 6:00
p.m.
until Sunday at 6:00 p.m., regardless
of the weekend
visitation schedule.
Father’s Day: The father shall have
the child on the Friday preceding Father’s
Day from 6:00 p.m.
until
Sunday at
6:00 p.m.,
regardless of the weekend visitation
schedule.
Federal Holidays: If the NC parent
has the child for a weekend visitation
where a federal holiday falls
on a Monday, then
the visitation shall
include
that Monday
until 6:00 p.m.
17
General Considerations: The NC shall
have the responsibility
of
transporting
the child for each period
of custody. The NC,
or other responsible adult with
a
valid driver’s
license, shall pick the child
up
at
the CP’s
residence at the
beginning of the visitation
and
return the child to the CP’s residence at the
end
of the
visitation. During the summer visitation, the parent who is beginning his or her custodial
period shall be responsible for picking up the child from the other parent’s residence.
Revised 01/31/21
18
STANDARD ORDERS FOR PARENTING
1.
Each parent shall always keep the
other informed of his/her
actual address of
residence, mailing
address if different,
home and work telephone
numbers and any
changes
within twenty-four hours of such change
occurring.
2.
Should
either
parent require child care for twenty-four hours or longer when
the child
is in his/her care, the other parent shall
have
first option to
provide such care.
3.
Neither parent shall say or do anything in the presence or hearing of
the child
that would in any way
diminish the
child’s
love or affection for
the
other parent,
and shall not
allow others to do so.
4.
All former marital, child sharing, court related and financial communications between the parents
shall occur at a time when the child is not present or within hearing
range. Communication regarding these issues shall
not
occur at times
of
exchanges of the
child or during telephone
visits with the child.
5.
Each
parent shall
inform the other
as soon as
possible
of all
school, sporting,
and other special activity notices and cooperate in the child’s consistent attendance at such
events. Neither
parent
shall schedule activities during the other parent’s scheduled parenting time without the other parent’s prior agreement.
6.
At least 24-hour notice of schedule
change shall
be given
to the
other parent.
The parent
requesting
the change shall be responsible
for any additional child
care that
results from the change.
7.
The
parties shall
have the right to
call the minor child on the telephone
at any
reasonable time, so
long as the telephone calls to the child do not become excessive or disrupt
the child’s
normal homework or
sleep
schedule.
Likewise, the child shall
have the
right
to
call
either parent
at all
reasonable times. In
the
event a long
distance telephone call
is required, the noncustodial parent shall provide a calling card for use by the child to place
telephone calls to said parent. All parties will allow the child to have uninterrupted, private conversations with the
parent and neither parent shall tape record
the child’s
conversation with
the
other parent or other
person.
In
the
event
that there is a
dispute
between the
parties as to
when a
telephone
call can be made, then calls from the
parent
shall be
twice
per
week
on
Tuesday and Thursday evenings between the hours
of 7:00
p.m. and 9:00
p.m.
8.
Each party shall notify the other party
as soon
as
reasonable of any
serious
illness
or
emergency
affecting the child while in that party’s physical custody.
9.
Each party shall have the right to
communicate
with
the child’s
teachers,
coaches, tutors,
and
other
educational providers;
doctors,
nurses, counselors,
psychiatrists, and other health care providers;
and
to obtain copies of the
child’s school and
medical records. Each
party shall
have the right
to
attend
all school and
extra-curriculum
events, religious
events
of significance,
graduation,
recitals, award
ceremonies,
and other
such events relating to the child.
Revised
01/31/21
19
In the Superior Court of County, Georgia
)
, Plaintiff )
)
vs. ) Civil Action No.
)
, Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF HUSBAND
1. AFFIANT’S NAME: Age
Spouse’s Name: Age
Date of Marriage: Date of Separation
Names and birth dates of children for whom support is to be determined in this action:
Name Date of Birth Resides with
Names and birth dates of affiant’s other children:
Name Date of Birth Resides with
__
2. SUMMARY OF AFFIANT’S INCOME AND NEEDS
(a) Gross monthly income (from item 3A) $
(b) Net monthly income (from item 3C) $
(c) Average monthly expenses (item 5A) $
Monthly payments to creditors +
Total monthly expenses and payments
to creditors (item 5C)
20
(subsections (d) & (e) deleted)
3. A. AFFIANT’S GROSS MONTHLY INCOME (complete this section or attach Child Support
Schedule A)
(All income must be entered based on monthly average regardless of date of receipt.)
Salary or Wages $
ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS
Commissions, Fees, Tips $
Income from self-employment, partnership, close corporations,
and independent contracts (gross receipts minus ordinary
and necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $
Rental Income (gross receipts minus ordinary and
necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $
Bonuses $
Overtime Payments $
Severance Pay $
Recurring Income from Pensions or Retirement Plans $
Interest and Dividends $
Trust Income $
Income from Annuities $
Capital Gains $
Social Security Disability or Retirement Benefits $
Workers’ Compensation Benefits $
Unemployment Benefits $
Judgments from Personal Injury or Other Civil Cases $
Gifts (cash or other gifts that can be converted to cash) $
Prizes/Lottery Winnings $
Alimony and maintenance from persons not in this case $
21
Assets which are used for support of family $
Fringe Benefits (if significantly reduce living expenses) $
Any other income (do NOT include means-tested
Public assistance, such as TANF or food stamps) $
GROSS MONTHLY INCOME $
(prior section B deleted)
B. Affiant’s Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $
Affiant’s pay period (i.e., weekly, monthly, etc.)
Number of exemptions claimed
4. ASSETS
(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion
under the appropriate spouse’s column and state the amount and the basis: pre-marital, gift,
inheritance, source of funds, etc.).
Description
Value
Separate Asset Separate Asset
Basis of the
of the Husband of the Wife
Claim
Cash
$
Stocks, bonds
$
CD’s/Money Market
$
Accounts
Bank Accounts
(list each account):
$
$
$
Retirement Pensions,
401K, IRA, or
$
__
Profit Sharing
Money owed to you:
$
Tax Refund
owed to you:
$
22
Real Estate:
home:
debt owed:
$
$
other:
debt owed:
$
$
Automobiles/Vehicles:
Vehicle 1:
$
debt owed:
$
Vehicle 2:
$
debt owed:
$
Life Insurance
(net cash value):
$
Furniture/furnishings:
$
Jewelry:
$
__
Collectibles:
$
Other Assets:
$
$
_
$
$
Total Assets:
$
5. A. AVERAGE MONTHLY EXPENSES
HOUSEHOLD
Mortgage or rent payments
$ Cable TV
$
Property taxes
$ Misc. household and grocery
Items
$
Homeowner/Renter Insurance
$ Meals outside the home
$
Electricity
$ Other
$
Water
$ AUTOMOBILE
Gasoline and oil
$
Garbage and Sewer
$
23
Telephone:
residential line:
cellular telephone:
Repairs $
$ Auto tags and license $
$ Insurance $
Gas $ OTHER VEHICLES
(boats, trailers, RVs, etc.)
Gasoline and oil $
Repairs and maintenance: $
Lawn Care $
Repairs $
Pest Control $
Tags and license $
Insurance $
CHILDREN’S EXPENSES
AFFIANT’S OTHER EXPENSES
Childcare (total monthly cost)
$
Dry cleaning/laundry
$
School tuition
$
Clothing
$
Tutoring
$
Medical, dental, prescription
(out of pocket/uncovered expenses)
$
Private lessons (e.g., music, dance)
$
Affiant’s gifts (special holidays)
$
School supplies/expenses
$
Entertainment
$
Lunch Money
$
Recreational Expenses (e.g.,
$
fitness)
Other Educational Expenses (list)
Vacations
$
$
Travel Expenses for Visitation
$
$
Publications
$
Allowance
$
Dues, clubs
$
Clothing
$
Religious and charities
$
Diapers
$
Pet expenses
$
Medical, dental, prescription
(out of pocket/uncovered expenses)
$
Alimony paid to former spouse
$
Child support paid for other
Grooming, hygiene
$
children
$
Gifts from children to others
$
Date of initial order:
24
$
TOTAL ABOVE EXPENSES $ ________________
B. PAYMENTS TO CREDITORS
(please check one)
To Whom:
Balance Due
Monthly
Payment
Joint
Plaintiff
Defendant
TOTAL MONTHLY PAYMENTS TO CREDITORS: $
Entertainment
Activities (including extra-curricular,
school, religious, cultural, etc.)
Summer Camps
$
$
$
Other (attach sheet)
OTHER INSURANCE
Health
$
Child(ren)’s portion:
$
Dental
Child(ren)’s portion:
$
$
Vision
$
Child(ren)’s portion:
$
Life
Relationship of Beneficiary:
$
Disability
$
Other(specify):
$
25
C. TOTAL MONTHLY EXPENSES: $
This day of , 20 .
Affiant
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public
My Commission Expires:
26
In the Superior Court of County, Georgia
)
, Plaintiff )
)
vs. ) Civil Action No.
)
, Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF WIFE
1. AFFIANT’S NAME: Age
Spouse’s Name: Age
Date of Marriage: Date of Separation
Names and birth dates of children for whom support is to be determined in this action:
Name Date of Birth Resides with
Names and birth dates of affiant’s other children:
Name Date of Birth Resides with
__
2. SUMMARY OF AFFIANT’S INCOME AND NEEDS
(a) Gross monthly income (from item 3A) $
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A) $
Monthly payments to creditors +
27
Total monthly expenses and payments
to creditors (item 5C)
(subsections (d) & (e) deleted)
3. A. AFFIANT’S GROSS MONTHLY INCOME (complete this section or attach Child Support
Schedule A)
(All income must be entered based on monthly average regardless of date of receipt.)
Salary or Wages $
ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS
Commissions, Fees, Tips $
Income from self-employment, partnership, close corporations,
and independent contracts (gross receipts minus ordinary
and necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $
Rental Income (gross receipts minus ordinary and
necessary expenses required to produce income)
ATTACH SHEET ITEMIZING YOUR CALCULATIONS $
Bonuses $
Overtime Payments $
Severance Pay $
Recurring Income from Pensions or Retirement Plans $
Interest and Dividends $
Trust Income $
Income from Annuities $
Capital Gains $
Social Security Disability or Retirement Benefits $
Workers’ Compensation Benefits $
Unemployment Benefits $
Judgments from Personal Injury or Other Civil Cases $
Gifts (cash or other gifts that can be converted to cash) $
Prizes/Lottery Winnings $
Alimony and maintenance from persons not in this case $
28
Assets which are used for support of family $
Fringe Benefits (if significantly reduce living expenses) $
Any other income (do NOT include means-tested
Public assistance, such as TANF or food stamps) $
GROSS MONTHLY INCOME $
(prior section B deleted)
C. Affiant’s Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $
Affiant’s pay period (i.e., weekly, monthly, etc.)
Number of exemptions claimed
4. ASSETS
(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portion
under the appropriate spouse’s column and state the amount and the basis: pre-marital, gift,
inheritance, source of funds, etc.).
Description
Value
Separate Asset Separate Asset
Basis of the
of the Husband of the Wife
Claim
Cash
$
Stocks, bonds
$
_
CD’s/Money Market
$
Accounts
Bank Accounts
(list each account):
$
$
$
Retirement Pensions,
401K, IRA, or
$
Profit Sharing
Money owed to you:
$
Tax Refund
owed to
you:
$
29
Real Estate:
home:
debt owed:
$
$
other:
debt owed:
$
$
Automobiles/Vehicles:
Vehicle 1:
$
debt owed:
$
Vehicle 2:
$
debt owed:
$
Life Insurance
(net cash value):
$
Furniture/furnishings:
$
_
Jewelry:
$
Collectibles:
$
Other Assets:
$
$
$
$
Total Assets:
$
5. A. AVERAGE MONTHLY EXPENSES
HOUSEHOLD
Mortgage or rent payments
$ Cable TV
$
Property taxes
$ Misc. household and grocery
Items
$
Homeowner/Renter Insurance
$ Meals outside the home
$
Electricity
$ Other
$
Water
$ AUTOMOBILE
Gasoline and oil
$
Garbage and Sewer
$
30
Telephone:
residential line:
cellular telephone:
Repairs $
$ Auto tags and license $
$ Insurance $
Gas $ OTHER VEHICLES
(boats, trailers, RVs, etc.)
Gasoline and oil $
Repairs and maintenance: $
Lawn Care $
Repairs $
Pest Control $
Tags and license $
Insurance $
CHILDREN’S EXPENSES
AFFIANT’S OTHER EXPENSES
Childcare (total monthly cost)
$
Dry cleaning/laundry
$
School tuition
$
Clothing
$
Tutoring
$
Medical, dental, prescription
(out of pocket/uncovered expenses)
$
Private lessons (e.g., music, dance)
$
Affiant’s gifts (special holidays)
$
School supplies/expenses
$
Entertainment
$
Lunch Money
$
Recreational Expenses (e.g.,
$
fitness)
Other Educational Expenses (list)
Vacations
$
$
Travel Expenses for Visitation
$
$
Publications
$
Allowance
$
Dues, clubs
$
Clothing
$
Religious and charities
$
Diapers
$
Pet expenses
$
Medical, dental, prescription
(out of pocket/uncovered expenses)
$
Alimony paid to former spouse
$
Child support paid for other
Grooming, hygiene
$
children
$
Gifts from children to others
$
Date of initial order:
31
$
B. PAYMENTS TO CREDITORS
TOTAL ABOVE EXPENSES $ _____________________
(please check one)
To Whom:
Balance Due
Monthly
Payment
Joint
Plaintiff
Defendant
TOTAL MONTHLY PAYMENTS TO CREDITORS: $
Entertainment
Activities (including extra-curricular,
school, religious, cultural, etc.)
Summer Camps
$
$
$
Other (attach sheet)
OTHER INSURANCE
Health
$
Child(ren)’s portion:
$
Dental
Child(ren)’s portion:
$
$
Vision
$
Child(ren)’s portion:
$
Life
Relationship of Beneficiary:
$
Disability
$
Other(specify):
$
32
D. TOTAL MONTHLY EXPENSES: $
This day of , 20 .
Affiant
[Sign in the presence of a Notary Public]
Sworn to and subscribed before me
this day of , 20 .
Notary Public
My Commission Expires:
