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.
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:
Soc. Sec. No.:
Soc. Sec No.:
Badge/Payroll No.:
Occupation:
Employer:
Birth Date:
Date of Marriage:
Date of Physical Separation:
Date of Filing:
Children:
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:
Telephone No.:
Length of Employment:
Job Description:
Gross Income:
Per week
Bi-weekly
Per month
Yearly
Net Income:
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)
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.)
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.)
(Money Mkt, Stocks,
Bonds, Mutual Funds)
Value on date of filing
9
IX. LIFE INSURANCE POLICIES (whole life, variable life, annuities, term)
Company
Policy #.
Beneficiary
Face Value
Loan
Amount
Cash Value
X.RETIREMENT ACCOUNTS (Pension, Profit Sharing, 401(K), SEP, IRA, KEOGH, ESOP, etc.)
Type of Plan
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
Acct. #
Monthly
Balance as of
Date of Filing
Current
Balance
10
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.
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.
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.
The financial declaration includes several sections that cover:
This comprehensive information helps the court assess the financial circumstances of both parties.
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.
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.
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.
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.
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.
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.
Failing to provide accurate personal information, such as names, addresses, and Social Security numbers, can lead to delays or complications in processing the form.
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.
Neglecting to itemize weekly deductions accurately can cause discrepancies. Include all relevant deductions, such as taxes, insurance, and retirement contributions.
Omitting information about health insurance coverage can impact child support calculations. Make sure to detail all health care providers and premiums.
Forgetting to attach the Indiana Child Support Guideline Worksheet can lead to processing delays. Ensure this is completed and submitted alongside the financial form.
Providing outdated or incorrect employment history can misrepresent financial stability. Include accurate details for the last five years.
Not listing extraordinary health care concerns can overlook significant expenses. Be thorough in this section to ensure all needs are addressed.
Failing to include all monthly living expenses can result in an unrealistic budget. List all necessary expenses, including utilities and groceries.
Using vague descriptions for other sources of income can lead to confusion. Specify each source clearly to avoid misunderstandings.
Not reviewing the form for errors or omissions before submission can lead to significant issues. Always double-check for accuracy and completeness.
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.
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.
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.
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:
Here are ten common misconceptions about the Indiana Financial Form, along with clarifications for each:
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:
By keeping these points in mind, you can navigate the financial disclosure process more effectively, making it smoother for everyone involved.