Financial Affidavit

State: Alabama

County: ________

I, the undersigned, do swear and affirm the following facts:

1. My legal name is as follows: ________.

2. My present address is as follows:

________

3. I am currently employed in the following position: ________. I work for the following:

________

4. My gross monthly income comes from the following source:

________
Monthly Income From This Source: $________

5. The deductions made each month from my income are as follows:

________

6. My monthly household expenses are as follows:

________

7. I have no monthly debts.

8. I have no assets.

9. My financial summary is as follows:

Total Net Monthly Income: $________

Total Monthly Expenses And Debts: $________

Total Current Assets: None

10. I provided the following form of identification to the Notary Public to prove my identification:

________

11. This Financial Affidavit is being sworn for the following reason:

________

12. I am aware that any false information on this Financial Affidavit is punishable to the fullest extent of the law, up to and including monetary fine or imprisonment.

13. The below is my true and correct signature.

I swear under penalty of perjury that I am the party described above and that all statements in this Financial Affidavit are true.

________

Signature: _____________________

Date:_________________________

State of Alabama NOTARIZATION:

State: Alabama

County: ________

On the following date: ________________________ before me personally appeared the above signatory. I am a Notary Public in and for the state of Alabama and the signatory above is personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) whose name is signed herein and acknowledged that he/she/they executed the same.

WITNESS my hand and official seal:

Seal:

Name: __________________________________

Signature: _______________________________

My commission expires: ____________________