The Indiana Financial Form is a verified financial disclosure statement required by the Circuit and Superior Courts of Porter County in marriage-related cases. This form collects essential information regarding the financial circumstances of both parties, including income, expenses, and health insurance details. Completing this form accurately is crucial for ensuring fair outcomes in legal proceedings, so be sure to fill it out by clicking the button below.
When navigating financial matters during a divorce or separation in Indiana, several key forms and documents accompany the Indiana Financial form. Each of these documents serves a specific purpose, helping to ensure that all financial aspects are accurately represented and considered by the court.
By utilizing these forms and documents, individuals can better navigate the complexities of financial disclosure in divorce proceedings. Each piece plays a critical role in ensuring that the court has a comprehensive understanding of the financial circumstances involved.
Incomplete Information: Failing to fill in all required fields can lead to delays. Ensure that every section, especially personal details, is completed.
Incorrect Dates: Providing wrong dates for marriage, separation, or filing can create confusion. Double-check all dates for accuracy.
Missing Income Sources: Not listing all sources of income can result in an incomplete financial picture. Include every source, from salaries to side jobs.
Neglecting Deductions: Forgetting to itemize deductions from gross income can inflate your disposable income. Carefully list all deductions to reflect accurate financial status.
Omitting Health Care Information: Failing to provide details about health insurance coverage can lead to misunderstandings. Include all relevant health care expenses and providers.
Not Listing Children: Forgetting to include children and their details may impact child support calculations. Make sure to provide names, ages, and Social Security numbers.
Ignoring the Indiana Child Support Guideline Worksheet: Not preparing or attaching this worksheet can complicate child support assessments. Ensure it is completed and submitted on time.
Failure to Review: Skipping a final review of the form can lead to simple mistakes. Always take a moment to check for errors or omissions before submission.
Ensure that all personal information is filled out accurately. This includes names, addresses, and Social Security numbers for both parties and any children involved.
Health insurance details are crucial. List the name of the insurance company, the weekly cost of premiums, and any extraordinary health care concerns for family members.
Provide a complete income summary. Include all sources of income such as salary, pensions, and any public assistance. Be thorough in detailing your financial situation.
Itemize your weekly deductions carefully. This includes taxes, insurance, and any other mandatory or optional contributions. Accurate deductions will help in calculating your disposable income.
Attach the Indiana Child Support Guideline Worksheet if applicable. This should be done within ten days of submitting the financial form to ensure compliance with court requirements.
Sr16 Bmv - Ensure that your insurance coverage details are included for validation.
Myberbenefits - Mail the completed form directly to the specified payroll department address.
A Power of Attorney form in Arizona is a legal document that allows one person to act on behalf of another in financial or legal matters. This form is essential for ensuring that your wishes are honored when you cannot make decisions for yourself. Understanding its use and implications can provide peace of mind and security for you and your loved ones. For more information, visit https://arizonapdfforms.com/power-of-attorney/.
Uc 1 - The UC-1 should include accurate quarter data, omitting references to credit.
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:
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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:
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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
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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
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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)
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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.
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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.)
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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
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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
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