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["IN THE SUPERIOR COURT OF ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," COUNTY"]
["STATE OF GEORGIA"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,",",")"]
[null,null,null,null,null,null,null,null,null,null,null,"Plaintiff,",null,null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")",null,null,null,null,"CIVIL ACTION"]
["vs.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")",null,null,null,null,"File No."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,",",")"]
[null,null,null,null,null,null,null,null,null,null,null,"Defendant.",null,null,null,null,")"]
["DOMESTIC RELATIONS FINANCIAL AFFIDAVIT"]
[" SUBMITTED BY AFFIANT SUBJECT TO REVISION"]
["           BEFORE ME this day,personally appeared _________, Plaintiff/Defendant, who being first duly sworn, deposes and says that the following information is true and correct to the best of his/her knowledge and belief: "]
["1.","IDENTIFICATION"]
[null,"Affiant's Name:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Age:"]
[null,"Opposing Party's Name: ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Age:"]
[null,"Date of Marriage: ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"   Date of Separation:"]
[null,"Names and birth dates of children for whom support is to be determined in this action:"]
[null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Birth Year ",null,null,null,null,null,"  Resides with"]
[]
[]
[]
[null,"Names and birth dates of affiant's other children:"]
[null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Birth Year",null,null,null,null,null,"  Resides with"]
[]
[]
[]
[]
["2.","SUMMARY OF AFFIANT'S INCOME AND NEEDS"]
["(a)",null,"Gross monthly income  (from 3A)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$",{"$f":"Page2!F27","v":0}]
["(b)",null,"Net monthly income  (from 3B)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$",{"$f":"Page2!F30","v":0}]
["(c)",null,"Average monthly expenses  (from 5A)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$",{"$f":"Page5!O13","v":0}]
[null,null,"Monthly payments to creditors  (from 5B)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"+",{"$f":"Page5!U27","v":0}]
[null,null,"Total monthly expenses and payments to creditors  (from 5C) ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$",{"$f":"Page5!AA29","v":0}]

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["3.","A.","AFFIANT'S GROSS MONTHLY INCOME"]
[null,null,"(Complete this section or attach Child Support Schedule A.  Enter all income based on monthly average regardless of when received.)"]
[null,null,"Salary or Wages",null,"$"]
[null,null,"ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS"]
[null,null,"Commissions, Fees, Tips",null,"$"]
[null,null,"Income from self-employment, partnerships, close corporations,\nand independent contracts (gross receipts minus ordinary\nand necessary expenses required to produce income)\nATTACH SHEET ITEMIZING YOUR CALCULATIONS.",null,"$"," "]
[null,null,"Rental Income (gross receipts minus ordinary and\nnecessary expenses required to produce income)\nATTACH SHEET ITEMIZING YOUR CALCULATIONS.",null,"$"]
[null,null,"Bonuses",null,"$"]
[null,null,"Overtime Payments",null,"$"]
[null,null,"Severance Pay",null,"$"]
[null,null,"Recurring income from Pensions or Retirement Plans",null,"$"]
[null,null,"Interest Income",null,"$"]
[null,null,"Income from Dividends",null,"$"]
[null,null,"Trust Income",null,"$"]
[null,null,"Income from Annuities",null,"$"]
[null,null,"Capital Gains",null,"$"]
[null,null,"Social Security Disability or Retirement Benefits",null,"$"]
[null,null,"Workers' Compensation Benefits",null,"$"]
[null,null,"Unemployment Benefits",null,"$"]
[null,null,"Judgments from personal injury or other civil cases",null,"$"]
[null,null,"Gifts (cash or other gifts that can be converted to cash)",null,"$"]
[null,null,"Prizes / Lottery winnings",null,"$"]
[null,null,"Alimony and maintenance from persons not in this case",null,"$"]
[null,null,"Assets which are used for support of family",null,"$"]
[null,null,"Fringe benefits (if significantly reduce living expenses)",null,"$"]
[null,null,"Any other income (do NOT include means-tested\npublic assistance, such as TANF or food stamps)",null,"$"]
[null,null,"GROSS MONTHLY INCOME",null,"$",{"$f":"SUM(F3:F26)","v":0}]
[]
["B.",null,"AFFIANT'S NET MONTHLY INCOME FROM EMPLOYMENT"]
[null,null,"(deducting only state and federal taxes and FICA)",null,"$"]
[null,null,"Affiant's pay period (weekly, bi-weekly, semi-monthly, monthly, etc.)","SEMI-MONTHLY"]
[null,null,"Number of income tax withholding exemptions claimed (IRS Form W-4)",null,null,1]

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["4.","ASSETS"]
[null,"(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.)"]
[null,"Description ",null,null,"Value",null,"Separate Asset of Husband",null,"Separate Asset of Wife",null,"Basis of Claim"]
[null,"Cash",null,"$"]
[null,"Stocks, bonds & other securities",null,"$"]
[null,"CD's, money market accounts",null,"$"]
[null,"Bank accounts: (list)"]
[null,null,null,"$"]
[null,null,null,"$"]
[null,null,null,"$"]
[null,"Retirement accounts, pensions, 401(k)s, IRAs, profit sharing"]
[null,null,null,"$"]
[null,"Money owed you",null,"$"]
[null,"Tax refund owed you",null,"$"]
[null,"Real estate: (list)"]
[null,null,null,"$"]
[null,null,"Less debt owed (negative nbr.)","$"]
[null,null,null,"$"]
[null,null,"Less debt owed (negative nbr.)","$"]
[null,null,null,"$"]
[null,null,"Less debt owed (negative nbr.)","$"]
[null,"Motor vehicles: (list)"]
[null,null,null,"$"]
[null,null,"Less debt owed","$"]
[null,null,null,"$"]
[null,null,"Less debt owed","$"]
[null,"Life insurance (net cash value)",null,"$"]
[null,"Furniture & furnishings",null,"$"]
[null,"Jewelry",null,"$"]
[null,"Collectibles",null,"$"]
[null,"Other assets: "]
[null,null,null,"$"]
[null,null,null,"$"]
[null,null,null,"$"]
[null,null,null,"$"]
["Total Assets ",null,null,null,{"$f":"SUM(E4:E35)","v":0}]

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["5.","A.","AVERAGE MONTHLY EXPENSES"]
[]
[null,null,"HOUSEHOLD",null,null,null,"OTHER EXPENSES"]
[null,null,"Mortgage pmts ","$",null,null,"Laundry & dry cleaning",null,"$"]
[null,null,"Rent","$",null,null,"Clothing",null,"$"]
[null,null,"Property taxes","$",null,null,"Medical, dental, vision & prescription"]
[null,null,"Insurance",null,null,null,"(out-of-pocket/uncovered)",null,"$"]
[null,null,"(homeowner's/renter's)","$",null,null,"Grooming & hygiene",null,"$"]
[null,null,"Electricity","$",null,null,"Gifts (for special occasions)",null,"$"]
[null,null,"Water & sewer","$",null,null,"Entertainment",null,"$"]
[null,null,"Garbage pickup","$",null,null,"Recreation & fitness",null,"$"]
[null,null,"Telephone, residential line","$",null,null,"Vacations",null,"$"]
[null,null,"Telephone, cellular","$",null,null,"Travel expenses for visitation",null,"$"]
[null,null,"Gas","$",null,null,"Publications",null,"$"]
[null,null,"Repairs & maintenance","$",null,null,"Dues & club fees",null,"$"]
[null,null,"Lawn care","$",null,null,"Religious & charities",null,"$"]
[null,null,"Pest control","$",null,null,"Cleaning Service",null,"$"]
[null,null,"Cable TV/Internet","$",null,null,"Contributions to Retirement/401K",null,"$"]
[null,null,"Security service","$",null,null,"Alimony paid to former spouse",null,"$"]
[null,null,"Groceries ","$",null,null,"Child support paid for other children",null,"$"]
[null,null,"Household supplies","$",null,null,"Date of order:"]
[null,null,"Meals outside the home","$",null,null,null,null,"$"]
[null,null,null,"$",null,null,"Subtotal:",null,"$",{"$f":"SUM(J4:J22)","v":0}]
[null,null,"Subtotal:","$",{"$f":"SUM(E4:E23)","v":0}]
[null,null,null,null,null,null,"CHILDREN'S EXPENSES"]
[null,null,"AUTOMOBILE",null,null,null,"Child care (total monthly cost)",null,"$"]
[null,null,"Gasoline & oil","$",null,null,"School tuition",null,"$"]
[null,null,"Repairs","$",null,null,"Tutoring",null,"$"]
[null,null,"Auto tags & license","$",null,null,"Private lessons (music, dance, etc.)",null,"$"]
[null,null,"Insurance","$",null,null,"School supplies & expenses",null,"$"]
[null,null,"Parking","$",null,null,"Lunch money",null,"$"]
[null,null,null,"$",null,null,"Other educational expenses: (list)"]
[null,null,"Subtotal:","$",{"$f":"SUM(E27:E32)","v":0},null,null,null,"$"]
[null,null,null,null,null,null,null,null,"$"]
[null,null,"OTHER VEHICLES",null,null,null,null,null,"$"]
[null,null,"(boats, trailers, RVs, etc.)",null,null,null,"Allowance",null,"$"]
[null,null,"Gasoline & oil","$",null,null,"Clothing",null,"$"]
[null,null,"Repairs","$",null,null,"Diapers",null,"$"]
[null,null,"Tags & license","$",null,null,"Medical, dental, vision & prescription",null,"$"]
[null,null,"Insurance","$",null,null,"(out-of-pocket/uncovered)",null,"$"]
[null,null,"Storage","$",null,null,"Grooming & hygiene",null,"$"]
[null,null,null,"$",null,null,"Gifts from children to others",null,"$"]
[null,null,"Subtotal:","$",{"$f":"SUM(E37:E42)","v":0},null,"Entertainment",null,"$"]
[null,null,null,null,null,null,"Activities (including extra-curricular,"]
[null,null,null,null,null,null,"school, religious, cultural, etc.) ",null,"$"]
[null,null,null,null,null,null,"Summer camps",null,"$"]
[null,null,null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,"Subtotal:",null,"$",{"$f":"SUM(J26:J48)","v":0}]

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[null,null,"OTHER INSURANCE"]
[null,null,null,null,null,null,null,null,null,"Monthly",null,null,null,null,"Children's"]
[null,null,null,null,null,null,null,null,null,"Cost",null,null,null,null,"Portion"]
[]
[null,null,"Health",null,null,null,null,null,null,"$",null,null,null,null,"$"]
[null,null,"Dental",null,null,null,null,null,null,"$",null,null,null,null,"$"]
[null,null,"Vision",null,null,null,null,null,null,"$",null,null,null,null,"$"]
[null,null,"Disability",null,null,null,null,null,null,"$",null,null,null,null,"$"]
[null,null,"Life",null,null,null,null,null,null,"$",null,null,null,null,"$",null,null,null,"Beneficiary:"]
[null,null,"Other",null,null,null,null,null,null,"$",null,null,null,null,"$"]
[null,null,"Subtotal:",null,null,null,null,null,null,"$",{"$f":"SUM(K5:M10)","v":0},null,null,null,"$",{"$f":"SUM(P5:R10)","v":0}]
[]
[null,null,"TOTAL MONTHLY EXPENSES:",null,null,null,null,null,null,null,null,null,null,"$",{"$f":"SUM(Page4!E24,Page4!J23,Page4!E33,Page4!E43,Page4!J49+Page5!K11)","v":0}]
[]
[null,"B. ","PAYMENTS TO CREDITORS"]
[null,null,"(Other than mortgage payment entered in Section 5A)"]
[]
[null,null,"Creditor",null,null,null,null,null,null,null,null,null,null,null,"Balance\nDue",null,null,null,"Monthly\nPayment",null,null,null,null,"Joint",null,null,null,"Plaintiff",null,null,null,"Defendant"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
[]
[]
[]
[null,null,"TOTAL MONTHLY PAYMENTS TO CREDITORS:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$",null,{"$f":"SUM(S19:W25)","v":0}]
[]
["C.",null,"TOTAL MONTHLY EXPENSES AND PAYMENTS TO CREDITORS:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$",{"$f":"SUM(O13,U27)","v":0}]