Blank Indiana Financial PDF Form

Blank Indiana Financial PDF Form

The Indiana Financial Declaration Form is a critical document used in divorce proceedings within the state, specifically in Porter County's Circuit and Superior Courts. This form requires both parties to provide a comprehensive overview of their financial situation, including income, expenses, and health insurance details. Completing this form accurately is essential for ensuring fair support arrangements; click the button below to start filling out the form.

The Indiana Financial Declaration Form is a crucial document used in family law cases, particularly those related to marriage dissolution and child support matters. This form serves as a verified financial disclosure statement, requiring both the petitioner and respondent to provide detailed information about their financial situations. Key sections of the form include preliminary information about each party, such as their names, addresses, and Social Security numbers, as well as specifics about their children, including names and ages. Health insurance details are also essential, covering providers, costs, and any extraordinary health care concerns. Income information is meticulously outlined, detailing employment history, gross and net income, and a comprehensive income summary that includes various sources of revenue. Additionally, the form requires a breakdown of weekly deductions and living expenses, ensuring that all financial obligations and resources are transparently reported. For cases involving child support, it is imperative to attach an Indiana Child Support Guideline Worksheet to provide a complete financial picture. This form is not just a bureaucratic requirement; it plays a vital role in ensuring fair and informed decisions are made regarding financial responsibilities in family law cases.

Document Sample

FINANCIAL DECLARATION FORM

STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS

OF PORTER COUNTY

IN RE THE MARRIAGE OF:

Cause Number:

Petitioner,

And

Respondent

In accordance with Local Rule 18 of the Porter Superior Court and Indiana Trial Rules 26, 33, 34, 35 and 37, the undersigned, Petitioner or Respondent, hereby submits the following

VERIFIED FINANCIAL DISCLOSURE STATEMENT:

FINANCIAL DECLARATION OF

 

 

 

 

 

 

 

 

Dated:

 

I. PRELIMINARY INFORMATION:

 

 

 

 

 

 

 

 

 

Husband:

 

 

Wife:

 

Address:

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Soc. Sec. No.:

 

 

Soc. Sec No.:

 

Badge/Payroll No.:

 

 

Badge/Payroll No.:

 

Occupation:

 

 

Occupation:

 

Employer:

 

 

Employer:

 

Birth Date:

 

 

Birth Date:

 

 

 

 

 

 

Date of Marriage:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Physical Separation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Filing:

 

 

 

 

 

 

 

 

 

 

Children:

 

 

 

 

 

Name:

 

Age:

 

DOB:

 

SSN:

Name:

 

Age:

 

DOB:

 

SSN:

Name:

 

Age:

 

DOB:

 

SSN:

1

II. HEALTH INSURANCE INFORMATION:

Name and Address of health care insurance company:

Name all persons covered under plan(s):

Weekly cost of total health insurance premium:

Weekly cost of health insurance premium for children only:

Name of the children’s health care providers:

The names of the schools and grade level for each child are:

List any extraordinary health care concerns of any family member:

List any educational concerns of any family member:

III.INCOME INFORMATION:

A.EMPLOYMENT HISTORY:

Current Employer:

Address:

Telephone No.:

 

 

 

 

Length of Employment:

 

 

 

Job Description:

 

 

 

 

 

 

 

 

 

 

Gross Income:

 

 

 

 

 

 

 

 

 

 

 

Per week

 

Bi-weekly

 

 

Per month

 

 

Yearly

Net Income:

 

 

 

 

 

 

 

 

 

 

 

Per week

 

Bi-weekly

 

 

Per month

 

 

Yearly

2

B.EMPLOYMENT HISTORY FOR LAST 5 YEARS:

Employer

 

Dates of Employment

 

Compensation (per wk/mo/yr)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C.INCOME SUMMARY:

1.GROSS WEEKLY INCOME from: Salary and wages, including commissions, bonuses, allowances, and over-time

Note: If paid monthly, determine weekly income by dividing monthly income by 4.3

Pensions & Retirement

Social Security

Disability and unemployment insurance

Public Assistance (welfare, AFDC payments, etc.)

Food Stamps

Child supports received for any child(ren) not both of the parties to this marriage

Dividends and Interest

Rents received

All other sources (specify)

TOTAL GROSS WEEKLY INCOME

2.ITEMIZED WEEKLY DEDUCTIONS: from gross income

State and Federal Income Taxes:

Social Security & Medicare Taxes:

Medical Insurance

 

 

 

Coverage:

Health

(

 

)

 

Dental

(

 

)

 

Eye Care

(

 

)

 

Psychiatric

(

 

)

3

Union or other dues:

Retirement:

Pension fund: Mandatory ( )Optional ( )

Profit sharing: Mandatory ( )Optional( )

401(K): Mandatory ( ) Optional ( )

SEP: Mandatory ( ) Optional ( )

ESOP: Mandatory ( ) Optional ( )

IRA: Mandatory ( ) Optional ( )

403 B: Mandatory ( ) Optional ( )

Child Support withheld from pay (not including this case)

Garnishments (itemize on separate sheet)

Credit Union debts

Direct Withdrawals Out of Paychecks:

Car Payments

Life Insurance

Disability Insurance

Thrift plans

Credit Union Savings

Bonds

Donations

Other (specify)

Other (specify)

TOTAL WEEKLY DEDUCTIONS:

3. WEEKLY DISPOSABLE INCOME:

(A minus B: Subtract Total Weekly Deduction from Total Weekly Gross Income)

IN ALL CASES INVOLVING CHILD SUPPORT: Prepare and attach an Indiana Child Support Guideline Worksheet (with documentation verifying your income); or, supplement with such a Worksheet within ten (10) days of the exchange of this Form.

IV. MONTHLY LIVING EXPENSES:

House

1.Rent (Mortgage)

2.2nd Mortgage

4

3.Line of Credit

4.Gas/Electric

5.Telephone

6.Water

7.Sewer

8.Sanitation (garbage)

9.Cable

10.Satellite

11.Internet

12.Taxes (real estate if not included in mortgage payment

13.Insurance (house if not included in mortgage payment)

14.Lawn Care/Snow Removal

Groceries

1.Food

2.Toiletries

3.Cleaning Products

4.Paper Products

Clothing

1.Clothes

2.Shoes

3.Uniforms

Health Care

1.Health Insurance not deducted from pay

2.Dental Insurance not deducted from pay

3.Doctor visits (non-insurance covered)

4.Dental visits (non-insurance covered)

5.Prescription Pharmaceutical (non-insurance covered)

5

6.Over-the-counter medicine

7.Glass/contact lenses

8.Other non-insurance covered health care (itemize)

Car & Travel

1.Car Payment

2.Gasoline

3.Oil/Maintenance

4.Insurance (car)

5.Car Wash

6.Tolls

7.Train/Bus

8.Parking Lot Fees

9.License Plates

Beauty Care

1.Hair Dress/Barber

2.Cosmetics

School Needs

1.Lunches

2.Books

3.Tuition/Registration

4.Uniforms

5.School Supplies

6.Extra-Curricular Activities

Infant Care

1.Diapers

2.Baby Food

6

Miscellaneous

1.Church Donations

2.Charitable Donations

3.Life Insurance

4.Babysitter

5.Newspapers & Magazines

6.Cigarettes

7.Dry Cleaning

8.Entertainment

9.Cell Phone

10.Dues/Subscriptions

11.Charge Cards

12.Other (specify)

SUB-TOTAL OF EXPENSES:

Average Weekly Expenses (multiply monthly expenses by 12 and divide by 52)

V. PROVISIONAL ARREARAGE COMPUTATIONS:

If you allege the existence of a child support, maintenance, or other arrearage, attach all records or other exhibits regarding the payment history and complete the child support arrearage.

You must attach a Child Support Guideline Worksheet to your Financial Declaration Form or one must be exchanged with the opposing party/counsel within 10 days of receipt of the other parties= Financial Declaration Form.

7

ASSETS

All property is to be listed regardless of whether it is titled in your name only or jointly of if the property you own is being held for you in the name of a third party.

VI. PROPERTY:

A. MARITAL RESIDENCE:

Description:

Location:

Date Acquired:

 

Titled:

 

Purchase Price:

 

Down Payment:

 

Source of down payment:

 

 

 

 

Current Indebtedness:

 

 

 

 

Monthly Payment:

 

 

 

 

Current Market Value:

 

 

 

 

B.OTHER REAL PROPERTY: (Complete B on a separate sheet of paper for each additional parcel of real estate owned etc.)

Description:

Location:

Date Acquired:

 

Titled:

 

Purchase Price:

 

Down Payment:

 

Source of down payment:

 

 

 

 

Current Indebtedness:

 

 

 

 

Monthly Payment:

 

 

 

 

Current Market Value:

 

 

 

 

8

C.PERSONAL PROPERTY: (motor vehicles, boats, motorcycles, furnishings, household goods, jewelry, firearms, etc. Household furnishings and household goods such as pots and pans need not

be itemized).

Description

Titled

Current Value

Indebtedness

Payment

Present User

VII. BANK ACCOUNTS:

Name

Type of Account

(Checking, Savings,

CD’s, etc.)

Owner

Account No.

Balance on Date of Filing

VIII. NON-RETIREMENT SECURITIES: (stocks, bonds, mutual funds, etc.)

Name

Type of Account

(Money Mkt, Stocks,

Bonds, Mutual Funds)

Owner

Account No.

Value on date of filing

9

IX. LIFE INSURANCE POLICIES (whole life, variable life, annuities, term)

Company

Owner

Policy #.

Beneficiary

Face Value

Loan

Amount

Cash Value

X.RETIREMENT ACCOUNTS (Pension, Profit Sharing, 401(K), SEP, IRA, KEOGH, ESOP, etc.)

Company

Type of Plan

Owner

Account #

Vested (yes/no)

Value as of date of filing

XI. OTHER PROFESSIONAL OR BUSINESS INTERESTS:

Name of Business

Type (Corp., Part., Sole Owner

% Owned

Estimated Value

XII. MARITAL BILLS, DEBTS, AND OBLIGATIONS: (list every single bill, debt and obligation regardless of whether the bill is title in your name, your spouse=s name, or jointly. Please include all mortgages, 2nd mortgages, home equity loans, charge cards, other loans, credit union loans, car payments, and unpaid medical bills, etc. Do not include monthly expenses such as utilities that are paid in full every month).

Creditor

Description

Acct. #

Monthly

Payment

Balance as of

Date of Filing

Current

Balance

10

File Specifics

Fact Name Details
Governing Laws This form is governed by Local Rule 18 of the Porter Superior Court and Indiana Trial Rules 26, 33, 34, 35, and 37.
Purpose The Indiana Financial Declaration Form is used to provide a verified financial disclosure statement in divorce proceedings.
Required Information It requires detailed information about income, expenses, health insurance, and employment history from both parties.
Child Support Consideration In cases involving child support, an Indiana Child Support Guideline Worksheet must be attached or provided within ten days.
Submission The form must be submitted by the Petitioner or Respondent in accordance with local court rules.

How to Use Indiana Financial

Filling out the Indiana Financial Declaration Form is an important step in the legal process regarding marriage dissolution. This form requires detailed information about your financial situation, including income, expenses, and health insurance details. Completing it accurately ensures that all parties involved have a clear understanding of financial obligations and resources.

  1. Begin by entering the Cause Number at the top of the form.
  2. Identify yourself as either the Petitioner or Respondent and fill in the respective names.
  3. Provide the date of filling out the form.
  4. In the Preliminary Information section, fill in the names, addresses, Social Security numbers, and occupations for both the husband and wife.
  5. Record the birth dates, date of marriage, date of physical separation, and date of filing.
  6. List the names, ages, dates of birth, and Social Security numbers of all children.
  7. In the Health Insurance Information section, provide the name and address of your health care insurance company.
  8. List all persons covered under the health insurance plan and the weekly costs for total health insurance premiums.
  9. Identify the children’s health care providers and their respective schools and grade levels.
  10. Note any extraordinary health care or educational concerns for family members.
  11. Move to the Income Information section. Start with your current employer and fill in the address, telephone number, length of employment, job description, and gross and net income.
  12. Provide employment history for the last five years, including employers, dates of employment, and compensation.
  13. Summarize your gross weekly income from various sources, such as salary, pensions, and public assistance.
  14. List all itemized weekly deductions from your gross income, including taxes, medical insurance, and retirement contributions.
  15. Calculate your weekly disposable income by subtracting total weekly deductions from total gross weekly income.
  16. For cases involving child support, prepare and attach an Indiana Child Support Guideline Worksheet.
  17. In the Monthly Living Expenses section, list all housing-related costs, including rent, utilities, and taxes.
  18. Detail your grocery expenses, including food and toiletries.
  19. List clothing expenses, including clothes and shoes.
  20. Finally, document health care expenses not covered by insurance, such as doctor visits and prescriptions.

Your Questions, Answered

What is the purpose of the Indiana Financial Form?

The Indiana Financial Form is designed to provide a comprehensive disclosure of financial information for individuals involved in divorce proceedings or child support cases. It ensures that both parties have a clear understanding of each other's financial situations, which is essential for equitable decisions regarding support and asset division.

Who is required to complete the form?

Both parties in a divorce or child support case must complete the Indiana Financial Form. This includes the Petitioner and the Respondent. Each party is responsible for accurately reporting their financial information to facilitate fair negotiations and court decisions.

What information is included in the financial declaration?

The financial declaration includes several sections that cover:

  • Preliminary information about both parties
  • Health insurance details
  • Employment history and income information
  • Itemized weekly deductions from gross income
  • Monthly living expenses

This comprehensive information helps the court assess the financial circumstances of both parties.

How is gross income calculated on the form?

Gross income is calculated by summing all sources of income, including salary, wages, commissions, bonuses, and any other earnings. If income is received monthly, it should be converted to a weekly amount by dividing the monthly total by 4.3. Other sources such as pensions, social security, and child support received must also be included in this calculation.

What are itemized weekly deductions?

Itemized weekly deductions refer to the specific amounts deducted from an individual's gross income. These may include state and federal taxes, social security contributions, medical insurance premiums, retirement contributions, and any other relevant deductions. This section helps to determine the disposable income available after necessary expenses are accounted for.

What should I do if I have extraordinary health care concerns?

If there are extraordinary health care concerns for any family member, these should be clearly listed in the designated section of the form. Providing detailed information about these concerns is crucial, as they can impact the financial obligations of both parties, especially in relation to child support and medical expenses.

Is there a requirement for child support documentation?

Yes, in all cases involving child support, it is mandatory to prepare and attach an Indiana Child Support Guideline Worksheet. This worksheet must include documentation verifying the reported income. Additionally, it should be supplemented within ten days of exchanging the Financial Form to ensure compliance with court requirements.

How are monthly living expenses reported?

Monthly living expenses are reported by itemizing various categories such as housing costs, groceries, clothing, and health care. Each expense should be detailed to provide a complete picture of the financial obligations faced by each party. This information is vital for the court to assess the overall financial needs of the family.

What happens if the form is not completed accurately?

Failure to complete the Indiana Financial Form accurately can lead to serious consequences. Inaccurate information may result in unfavorable court decisions regarding support and asset division. It is essential to provide truthful and complete information to avoid potential legal repercussions and ensure a fair process.

Common mistakes

  1. Failing to provide accurate personal information, such as names, addresses, and Social Security numbers, can lead to delays or complications in processing the form.

  2. Not including all sources of income in the income summary section can result in an incomplete financial picture. Be sure to list salaries, bonuses, and any additional income.

  3. Neglecting to itemize weekly deductions accurately can cause discrepancies. Include all relevant deductions, such as taxes, insurance, and retirement contributions.

  4. Omitting information about health insurance coverage can impact child support calculations. Make sure to detail all health care providers and premiums.

  5. Forgetting to attach the Indiana Child Support Guideline Worksheet can lead to processing delays. Ensure this is completed and submitted alongside the financial form.

  6. Providing outdated or incorrect employment history can misrepresent financial stability. Include accurate details for the last five years.

  7. Not listing extraordinary health care concerns can overlook significant expenses. Be thorough in this section to ensure all needs are addressed.

  8. Failing to include all monthly living expenses can result in an unrealistic budget. List all necessary expenses, including utilities and groceries.

  9. Using vague descriptions for other sources of income can lead to confusion. Specify each source clearly to avoid misunderstandings.

  10. Not reviewing the form for errors or omissions before submission can lead to significant issues. Always double-check for accuracy and completeness.

Documents used along the form

The Indiana Financial Declaration Form is a critical document in divorce proceedings, particularly when determining financial obligations, including child support. However, it is often accompanied by several other forms and documents that provide a more comprehensive view of the financial situation of both parties involved. Below is a list of commonly used documents that complement the Indiana Financial form.

  • Indiana Child Support Guideline Worksheet: This form calculates the appropriate amount of child support based on the income of both parents and the needs of the children. It serves as a standardized tool to ensure fairness in support obligations.
  • Income Verification Documents: These include pay stubs, tax returns, and bank statements that verify the income reported on the financial declaration. They provide evidence of earnings and financial stability.
  • Health Insurance Information Form: This document outlines the health insurance coverage for the children and any additional costs associated with medical care. It is essential for determining health-related expenses in support calculations.
  • Property Settlement Agreement: This agreement details how marital assets and debts will be divided between the parties. It is often negotiated alongside financial disclosures to ensure a fair distribution of property.
  • Affidavit of Financial Disclosure: This sworn statement provides a detailed account of an individual’s financial situation, including assets, liabilities, and income. It is a legal document that enhances the transparency of financial dealings.
  • Expense Worksheets: These worksheets itemize monthly living expenses, including housing, utilities, groceries, and other costs. They help establish the financial needs of each party and the children.
  • Tax Returns: Typically, the last two years of tax returns are submitted to provide a historical view of income and financial stability. They are crucial for verifying income claims made in the financial declaration.
  • Retirement Account Statements: These statements provide information about any retirement savings, including 401(k) or IRA accounts. They are important for assessing the overall financial picture and potential future income.
  • Credit Reports: A credit report can reveal outstanding debts and liabilities, providing insight into each party’s financial obligations. It is often considered in the context of asset division and support calculations.

Understanding these accompanying documents is essential for anyone navigating the complexities of divorce and financial disclosures in Indiana. Each form plays a vital role in ensuring that all financial aspects are thoroughly examined, leading to fair and equitable outcomes for all parties involved.

Similar forms

The Indiana Financial Declaration Form shares similarities with the Child Support Worksheet, which is also used during divorce proceedings. Both documents aim to provide a clear financial picture of each party involved. The Child Support Worksheet focuses specifically on income and expenses related to child support obligations, while the Indiana Financial Declaration Form encompasses a broader financial overview, including employment history, health insurance details, and monthly living expenses. Each document is essential for ensuring that financial responsibilities are understood and fairly allocated between the parties.

Another document akin to the Indiana Financial Declaration Form is the Affidavit of Financial Disclosure. This affidavit serves a similar purpose by requiring parties to disclose their financial situation in a structured manner. Like the Indiana form, it includes sections for income, expenses, and assets. However, the Affidavit of Financial Disclosure may be used in various legal contexts, not just divorce cases. Both documents are verified statements, meaning the information provided must be accurate and truthful, reinforcing the importance of honesty in financial disclosures.

The Financial Statement used in bankruptcy proceedings also bears resemblance to the Indiana Financial Declaration Form. Both documents require individuals to outline their financial status comprehensively. The Financial Statement in bankruptcy focuses on liabilities, assets, and income to determine eligibility for relief, while the Indiana form emphasizes financial details relevant to family law. Despite their different contexts, both documents serve to provide a complete picture of an individual’s financial standing, ensuring that all parties have access to the necessary information for informed decision-making.

Lastly, the IRS Form 1040, which is the standard individual income tax return, shares similarities with the Indiana Financial Declaration Form in terms of financial disclosure. Both forms require individuals to report income, deductions, and other financial information. While the IRS Form 1040 is primarily concerned with tax obligations, the Indiana Financial Declaration Form serves a different legal purpose but still emphasizes transparency in financial matters. Each document plays a crucial role in its respective process, ensuring that all relevant financial information is disclosed accurately.

Dos and Don'ts

When filling out the Indiana Financial Declaration Form, it is important to follow specific guidelines to ensure accuracy and completeness. Here are four key dos and don'ts:

  • Do provide accurate and complete information for all required sections.
  • Do double-check your calculations for income and deductions to avoid errors.
  • Don't leave any sections blank; if a question does not apply, indicate that clearly.
  • Don't forget to attach any necessary supporting documents, such as the Indiana Child Support Guideline Worksheet.

Misconceptions

Here are ten common misconceptions about the Indiana Financial Form, along with clarifications for each:

  1. Only one spouse needs to fill it out. Both parties must complete the form to provide a complete financial picture.
  2. It is only necessary for divorce cases. The form is also required in legal separations and child support cases.
  3. All income sources must be reported. Only income relevant to the case needs to be disclosed, but omitting any income can lead to complications.
  4. Health insurance information is optional. This section is mandatory and essential for understanding family health care costs.
  5. Living expenses can be estimated. Accurate figures must be provided to ensure fair assessments of financial needs.
  6. Filing the form is a one-time requirement. Updates may be necessary if financial circumstances change significantly.
  7. Children's expenses are not included. Expenses related to children must be detailed, as they impact child support calculations.
  8. It is only for those with high incomes. The form is applicable to all income levels to assess financial responsibilities.
  9. Documentation is not needed. Supporting documents, such as pay stubs and tax returns, should accompany the form for verification.
  10. Legal advice is not necessary. Consulting with a legal professional can help ensure the form is completed accurately and comprehensively.

Key takeaways

Filling out the Indiana Financial form is an important step in the legal process of divorce or separation. Here are some key takeaways to consider:

  • Accuracy is crucial. Ensure all information is correct to avoid delays or complications in your case.
  • Be thorough. Provide complete details about your income, expenses, and financial situation.
  • Include all sources of income. This includes wages, benefits, and any additional financial support you may receive.
  • Document your deductions. List all deductions clearly, including taxes and insurance, to give a complete picture of your financial obligations.
  • Health insurance information is essential. Provide details about your health coverage and any extraordinary medical expenses.
  • Child support guidelines must be followed. Attach the Indiana Child Support Guideline Worksheet to ensure compliance with state requirements.
  • Monthly living expenses should be itemized. Break down your expenses into categories like housing, groceries, and healthcare for clarity.
  • Review before submission. Double-check all entries for accuracy and completeness to prevent issues later.
  • Seek assistance if needed. If you have questions, consider consulting a legal professional for guidance.

By keeping these points in mind, you can navigate the financial disclosure process more effectively, making it smoother for everyone involved.