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IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION ___, : : Petitioner, : : CIVIL ACTION FILE v. : : NO. ___ ___, : : Respondent. : : DOMESTIC RELATIONS FINANCIAL AFFIDAVIT You

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How long have you owned your home?:___ 3. Do you live in this home: ___ 3. What is your occupation?: 4. Where do you work?: 5. What are your hours of work?:___ 6. Do you receive income or other money: ___ 7. Do you have a student debt load: ___ 8. Have you borrowed money from any source to pay that debt?: ___ 9. If so, what is the amount of the loan:___ 10. Do you have any outstanding debts or liens on this home?:___________________ 11. Did you pay this debt before? 12. Did you pay the debt within the last 60 days? 13. What is the name of the bank that is currently holding ___________________ _____________________________ 14. What is the name of your lender:___?__ ___________________ ___ _ _______________ ___________________________ 15. Have you ever paid interest on your mortgage:___ 16. Have you received a letter or written notice from the bank: 17. What has the bank told you about your mortgage:___ 18. Are you currently paying payments on your mortgage? 19. Name, address, and telephone of the person who will handle _________________ _________ _________ __________ 20. How much would it cost you to maintain and repair this home, or what steps have you Made? 21. Do you have any problems with this home?:_______________ _ _ _ ________________ _ __ :__ : (Please explain in detail) 21. Do you think it is fair to ask you to maintain, repair and pay for your current home by _________________ __________ __________ 22. Have you received any financial counseling?: 23. Can you pay for this counseling yourself? 24.

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