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RULES OF CIVIL PROCEDURE - Supreme Court

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COURT <strong>OF</strong> COMMON PLEASCOUNTY, OHIOPlaintiff/Petitionerv./andCase No.JudgeMagistrateDefendant/PetitionerInstructions: Check local court rules to determine when this form must be filed.This affidavit is used to make complete disclosure of income, expenses and money owed. It is used to determine child andspousal support amounts. Do not leave any category blank. Write “none” where appropriate. If you do not know exactfigures for any item, give your best estimate, and put “EST.” If you need more space, add additional pages.AFFIDAVIT <strong>OF</strong> INCOME AND EXPENSESAffidavit of(Print Your Name)Date of marriageDate of separationSECTION I - INCOMEHusbandWifeEmployed Yes No Yes NoEmployerPayroll addressPayroll city, state, zipScheduled paychecks per year 12 24 26 52 12 24 26 52A. YEARLY INCOME, OVERTIME, COMMISSIONS AND BONUSES FOR PAST THREE YEARSHusbandWife$ 3 years ago 20 $Base yearly income$ 2 years ago 20 $$ Last year 20 $Yearly overtime, commissionsand/or bonuses$ 3 years ago 20 $$ 2 years ago 20 $$ Last year 20 $<strong>Supreme</strong> <strong>Court</strong> of OhioUniform Domestic Relations Form – Affidavit 1Affidavit of Income and ExpensesApproved under Ohio Civil Rule 84Effective Date: July 1, 2010 Page 1 of 7

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