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BT)) 0)#*UN|- %-M-(-N- 1u- 72s.^ .w.4.. m../~0\  `&Times New Roman' In the Superior Court of ______________ County, Georgia 6Lorraine Hoffmann-Polk0 User .   2V+S 0_level1  , >44 <DL!T$>23  ..  ;14 <DL!T$;  2S+S 0_level2  X ;14 <DL!T$;23  ..  ;14 <DL!T$;  2S+S 0_level3   ;14 <DL!T$;23  ..  ;14 <DL!T$;  2P+S 0_level4   8.444 <DL!T$823  ..  ;14 <DL!T$;  2P+S 0_level5   8.` ` ` <DL!T$823  ..  ;14 <DL!T$;  2M+S 0_level6   5+ <DL!T$523  ..  ;14 <DL!T$;  2M+S 0_level7  4 5+ <DL!T$523  ..  ;14 <DL!T$;  2J+S 0_level8  ` 2( <DL!T$223  ..  ;14 <DL!T$;  2J+S 0_level9   2( <DL!T$223  ..  ;14 <DL!T$;  2VS 0_levsl1  , >44 <DL!T$>23  Ԁ  ;14 <DL!T$;  2SS 0_levsl2  X ;14 <DL!T$;23  Ԁ  ;14 <DL!T$;  2SS 0_levsl3   ;14 <DL!T$;23  Ԁ  ;14 <DL!T$;  2PS 0_levsl4   8.444 <DL!T$823  Ԁ  ;14 <DL!T$;  2PS 0_levsl5   8.` ` ` <DL!T$823  Ԁ  ;14 <DL!T$;  2MS 0_levsl6   5+ <DL!T$523  Ԁ  ;14 <DL!T$;  2MS 0_levsl7  4 5+ <DL!T$523  Ԁ  ;14 <DL!T$;  2JS 0_levsl8  ` 2( <DL!T$223  Ԁ  ;14 <DL!T$;  2JS 0_levsl9   2( <DL!T$223  Ԁ  ;14 <DL!T$;  2VS 0_levnl1  , >44 <DL!T$>23   ;14 <DL!T$;  2SS 0_levnl2  X ;14 <DL!T$;23   ;14 <DL!T$;  2SS 0_levnl3   ;14 <DL!T$;23   ;14 <DL!T$;  2PS 0_levnl4   8.444 <DL!T$823   ;14 <DL!T$;  2PS 0_levnl5   8.` ` ` <DL!T$823   ;14 <DL!T$;  2MS 0_levnl6   5+ <DL!T$523   ;14 <DL!T$;  2MS 0_levnl7  4 5+ <DL!T$523   ;14 <DL!T$;  2JS 0_levnl8  ` 2( <DL!T$223   ;14 <DL!T$;  2JS 0_levnl9   2( <DL!T$223   ;14 <DL!T$;  h:Default ParaDefault Paragraph FontXXX<A .FooterFooter!T$A74 <DL!T$AP8Page NumberPage Number<A .HeaderHeader!T$A74 <DL!T$A@`c 0style13style13 S =jSC# $VerdanaCS\  `&Times New RomanS =jS $Verdana<.StrongStrong  ( &)..      >XcXX>XXcXX>Xc  _'!T$X'  ,  (2$ <X!..      >XcXX>XXcXX>Xc  %2A`ArialTable_A'dxdTable_B 35;AGMSY_1A.a.i.1.a.i.1.a.- i.Table_CTable_DTable_ETable_FTable_G d  d#|x(X$..      >XcXX>XXcXX>XcDell Laser Printer S2500 PS30(9 Z6Times New Roman Regular>X3#37=CIQYag1.a.i.(1)(a)(i)1)a)Ci)o6  h6:i+00U ' DDRule 24.2 Financial Affidavit 0SGJC - 2nd district 0 .    ' L DRule 24.2 Financial Affidavit 0SGJC - 2nd district 0 .    ' RDRule 24.2 Financial Affidavit 0SGJC - 2nd district 0 .    <X!..      >XcXX>XXcXX>Xc  _       %xX8cXXdd8  6" DL!T$X6&n%XXc'&%%&nIntheSuperiorCourtof______________County,Georgia      ) v ______________________,Plaintiff  ) Iy   ) L 9 DL!T$XT$9vs.  )CivilActionNo.___________    )  ______________________,Defendant  )    ) h    DOMESTICRELATIONSFINANCIALAFFIDAVIT  >    6L!T$DXT$6 1._AFFIANT_SNAME:______________________________  Age_________   < L!T$XT$<<L!T$XT$<  SpousesName:_______________________________  Age_________ Z  B" L!T$XT$B  DateofMarriage:_____________________DateofSeparation__________________ 0    Namesandbirthdatesofchildrenforwhomsupportistobedeterminedinthisaction:  *() ddd Xdd Xdd XT$T$, ZZ,, ZZ,ZZ+  1'L|L| 1Name  L|   DateofBirth 'L|  '  Resideswith-#!L|   -K*(XOKE" L!T$XT$EB ^L!T$XT$B  ________________________________________________________________________ "   ________________________________________________________________________    ________________________________________________________________________ >n   Namesandbirthdatesof_affiant_sotherchildren:  *+, dd ZZ , ZZ, ZZ()T$T$, ZZ,, ZZ,ZZ+  1'  1E" L!T$^XT$EName  !   DateofBirth '"  '  Resideswith-#!#   -K*(X]KB ^L!T$XT$B  ________________________________________________________________________ 0`$   ________________________________________________________________________ &   ________________________________________________________________________ | ( 2.  SUMMARYOF_AFFIANT_SINCOMEANDNEEDS ""R*   B L!T$^XT$B  (a)Grossmonthlyincome(fromitem3A)    $______________ # ,   (b)Netmonthlyincome(fromitem3C)      ______________ n%".   (c)Averagemonthlyexpenses(item5A)    $______________ 'D$0 B" 4L!T$XT$B   4 Monthlypaymentstocreditors    +______________ (%2    4    4 Totalmonthlyexpensesandpayments `*'4    4 tocreditors(item5C)      _______________ 3+c(5  B 4L!T$4XT$B  ,6)6 _3.A.AFFIANTSGROSSMONTHLYINCOME(completethissectionorattachChildSupportScheduleA)   jB" 42L!T$4XB(Allincomemustbeenteredbasedonmonthlyaverageregardlessofdateofreceipt.)  B 4L!T$42XBSalaryorWages    $______________ Iy B" 42L!T$4XBATTACHCOPIESOF2MOSTRECENTWAGESTATEMENTS L B 4L!T$42XBCommissions,Fees,Tips    $______________  B" 42L!T$4XBB 4L!T$42XBIncomefromselfemployment,partnership,closecorporations, h  andindependentcontracts(grossreceiptsminusordinary ; k  andnecessaryexpensesrequiredtoproduceincome)  >  ATTACHSHEETITEMIZINGYOURCALCULATIONS  $______________    RentalIncome(grossreceiptsminusordinaryand   necessaryexpensesrequiredtoproduceincome) Z  ATTACHSHEETITEMIZINGYOURCALCULATIONS  $______________ -]  Bonuses 4     $______________  OvertimePayments    $______________ y SeverancePay    $______________ O RecurringIncomefromPensionsorRetirementPlans  $______________  InterestandDividends    $______________ k TrustIncome 4     $______________ A IncomefromAnnuities    $______________  CapitalGains 4     $______________ ] SocialSecurityDisabilityorRetirementBenefits  $______________ 3! WorkersCompensationBenefits    $______________ # UnemploymentBenefits    $______________ O!% JudgmentsfromPersonalInjuryorOtherCivilCases  $______________ "% ' Gifts(cashorothergiftsthatcanbeconvertedtocash)  $______________ $!) Prizes/LotteryWinnings    $______________ A&q#+ Alimonyandmaintenancefrompersonsnotinthiscase  $______________ '%- Assetswhichareusedforsupportoffamily  $______________ )&/ FringeBenefits(ifsignificantlyreducelivingexpenses)  $______________ 3+c(1 Anyotherincome(doNOTincludemeanstested , *3 Publicassistance,suchasTANForfoodstamps)  $______________ -*4  GROSSMONTHLYINCOME    $______________ R/,6  - (03C/ / ""  ,T44 <DL!T$4XT  < 4L!T$XT$<c 2  B  .3      AffiantsNetMonthlyIncomefromemploymentc J!݌  Ќ ,64X4X6     (deductingonlystateandfederaltaxesandFICA)  $_______________    Affiantspayperiod(i.e.,weekly,monthly,etc.)___________________ Iy   Numberofexemptionsclaimed____________  4.ASSETS  (Ifyouclaimoragreethatallorpartofanassetisnonmarital,indicatethenonmaritalportionunderthe ; k  appropriatespousescolumnandstatetheamountandthebasis:premarital,gift,inheritance,sourceof  >  funds,etc.).    */0 *dd ZZ , ZZ, ZZ+,$$,bZZ,ZZ,ZZ,ZZ,ZZ+  1'Z Z  1  Description 'Z  '  Value 'Z   '  'Ц%'&SeparateAsset Z  oftheHusband'&%'Ц 'I   '  'Ц%'&SeparateAsset Z  oftheWife'&%'Ц 'I   '  Basisofthe Z  Claim ?5-]    ? K*(X0 K? 4L!T$4X?Cash   $____________   ______________   ______________   ____________________ 6,   6K*(XK? 4L!T$4X?Stocks,bonds  y" $____________  y$ ______________  y& ______________  y( ____________________ 6,y*  6K*(XL|K? 4L!T$4X?CDs/MoneyMarket O, Accounts  "- $____________  O/ ______________  O1 ______________  O3 ____________________ 6,O5  6K*(XK? 4L!T$4X?BankAccounts 7 (listeachaccount):  k8   9   :   ;  6,<  6K*(X>nK? 4L!T$4X?_______________  A> $____________  A@ ______________  AB ______________  AD ____________________ 6,AF  6K*(XK? 4L!T$4X?_______________  H $____________  J ______________  L ______________  N ____________________ 6,P  6K*(XK? 4L!T$4X?_______________  ]R $____________  ]T ______________  ]V ______________  ]X ____________________ 6,]Z  6K*(X0`K? 4L!T$4X?RetirementPensions, 3\ 401K,IRA,or ] ProfitSharing  ^ $____________  a ______________  d ______________  g ____________________ 6,j  6K*(X|  K? 4L!T$4X?Moneyowedyou:  O!l $____________  O!n ______________  O!p ______________  O!r ____________________ 6,O!t  6K*(X""R K? 4L!T$4X?TaxRefund "% v owedyou:  # w $____________  # z ______________  # } ______________  #  ____________________ 6,#   6K*(X$! K? 4L!T$4X?RealEstate:  n%"   $!   $!   $!  6,$!  6K*(XA&q# K? 4L!T$4X?̀home: 'D$ ̀debtowed:  (% < 4L!T$XX<$___________ 'D$ $___________  (% _____________  'D$ _____________  'D$ ____________________ 6,'D$  6K*(X)& K? 4L!T$4X?̀other: `*' ̀debtowed:  ,6) $____________ `*' $____________  ,6) ______________  `*' ______________  `*' ____________________ 6,`*'  6K*(X, *K? 4L!T$4X?Automobiles/Vehicles:  , *   , *   , *   , *  6,, *  6K*(X-*K? 4L!T$4X?ӀVehicle1: -* Ѐ .+ Ѐdebtowed:  R/, $____________ -* $___________  R/, ______________  -* ______________  -*  ____________________ 6,-*  6K*(XK? 4L!T$4X?ӀVehicle2:   ̀debtowed:  v $____________  $____________  v ______________   ______________   ____________________ 6,   6K*(XIyK? 4L!T$4X?LifeInsurance L  (netcashvalue):    $____________   ______________   ______________   ____________________ 6,  6K*(XK? 4L!T$4X?Furniture/furnishings:   $____________   ______________   ______________    ____________________ 6,"  6K*(Xh K? 4L!T$4X?Jewelry:  ; k$ $____________  ; k& ______________  ; k( ______________  ; k* ____________________ 6,; k,  6K*(X >K? 4L!T$4X?Collectibles:    . $____________    0 ______________    2 ______________    4 ____________________ 6,  6  6K*(X K? 4L!T$4X?OtherAssets:   8 $____________   : ______________   < ______________   > ____________________ 6, @  6K*(XZ K? 4L!T$4X?_______________  -] B $____________  -] D ______________  -] F ______________  -] H ____________________ 6,-] J  6K*(X0 K? 4L!T$4X?_______________  L $____________  N ______________  P ______________  R ____________________ 6,T  6K*(XK? 4L!T$4X?_______________  yV $____________  yX ______________  yZ ______________  y\ ____________________ 6,y^  6K*(XL|K? 4L!T$4X? TotalAssets:  O`  $____________  Ob ______________  Od ______________  Of ____________________$Oh   $K*(X"K? 4L!T$4X?5.A.AVERAGEMONTHLYEXPENSES i *12 *d*dbZZbZZZZZZZZ/0$$, ZZ,FZZ," ZZ, ZZ+  1'j [1 HOUSEHOLD  kl   m   n  6,o [ 6K*(X>nK? 4L!T$4X?Mortgageorrentpayments  >np $__________  >nq CableTV  >nr $__________ 6,>ns  6K*(XAK? 4L!T$4X?Propertytaxes  u $__________  w Misc.householdandgrocery y Items  z $__________ 6,}  6K*(XK? 4L!T$4X?Homeowner/RenterInsurance  ] $__________  ] Mealsoutsidethehome  ] $__________ 6,]  6K*(X0`K? 4L!T$4X?Electricity  3 $__________  3 Other  3 $__________ 6,3  6K*(XK? 4L!T$4X?Water   $__________    AUTOMOBILE    6,  6K*(X|  K? 4L!T$4X?GarbageandSewer  O! $__________  O! Gasolineandoil  |  $__________ 6,|   6K*(X""R!K? 4L!T$4X?Telephone: "%  Ѐresidentialline: #  ̀cellulartelephone:  n%" $__________ #  $__________  n%" Repairs ""R Autotagsandlicense #  Insurance  n%" $__________ ""R $__________ #  $__________ 6,n%"  6K*(XA&q#"K? 4L!T$4X?Gas  'D$ $__________  'D$  OTHERVEHICLES 'D$ (boats,trailers,RVs,etc.)  '%  6,A&q#  6K*(X(%#K? 4L!T$4X?Repairsandmaintenance:  )& $__________  )& Gasolineandoil  (% $__________ 6,(%  6K*(X`*'$K? 4L!T$4X?LawnCare  3+c( $__________  3+c( Repairs  `*' $__________ 6,`*'  6K*(X,6)%K? 4L!T$4X?PestControl  , * $__________  , * Tagsandlicense ,6) Insurance  -* $__________ ,6) $__________$-*  $K*(X.+&K? 4L!T$4X? R/, *34 *d *d ZZ FZZF" ZZ" ZZ 12$$, ZZ,FZZ," ZZ, ZZ+  1' 1 CHILDRENSEXPENSES       AFFIANTSOTHEREXPENSES    6,  6K*(X'K? 4L!T$4X?Childcare(totalmonthlycost)  v $__________  v Drycleaning/laundry  v  $__________ 6,v   6K*(XIy(K? 4L!T$4X?Schooltuition  L $__________  L Clothing  L $__________ 6,L  6K*(X)K? 4L!T$4X?Tutoring   $__________   Medical,dental,prescription  'Ц%'&(outofpocket/uncoveredexpenses)   '&%'Ц$__________ 6,  6K*(Xh *K? 4L!T$4X?Privatelessons(e.g.,music,dance)  h  $__________  h   Affiantsgifts(specialholidays)  ; k" $__________ 6,; k$  6K*(X >+K? 4L!T$4X?Schoolsupplies/expenses    & $__________    ( Entertainment    * $__________ 6,  ,  6K*(X ,K? 4L!T$4X?LunchMoney   . $__________   0 RecreationalExpenses(e.g.,  2 fitness)  Z 3 $__________ 6, 5  6K*(X-] -K? 4L!T$4X?OtherEducationalExpenses(list)  0 7   0 9 Vacations  0 ; $__________ 6,0 =  6K*(X.K? 4L!T$4X?Ӏ > Ѐ____________________  ? $__________  A TravelExpensesforVisitation  C $__________ 6,E  6K*(Xy/K? 4L!T$4X?Ӏ yF Ѐ____________________  L|G $__________  L|I Publications  L|K $__________ 6,L|M  6K*(XO0K? 4L!T$4X?Allowance  "O $__________  "Q Dues,clubs  "S $__________ 6,"U  6K*(X1K? 4L!T$4X?Clothing  W $__________  Y Religiousandcharities  [ $__________ 6,]  6K*(Xk2K? 4L!T$4X?Diapers  >n_ $__________  >na Petexpenses  >nc $__________ 6,>ne  6K*(XA3K? 4L!T$4X?Medical,dental,prescription g (outofpocket/uncoveredexpenses)  h $__________  k Alimonypaidtoformerspouse  m $__________ 6,o  6K*(X4K? 4L!T$4X?Grooming,hygiene  ]q $__________  ]s Childsupportpaidforother t children  ]u $__________ 6,]w  6K*(X0`5K? 4L!T$4X?Giftsfromchildrentoothers  3y $__________  3{ ̀Dateofinitialorder:  3} __________ 6,3  6K*(X6K? 4L!T$4X?Entertainment   $__________   Other(attachsheet)   $__________ 6,  6K*(X| 7K? 4L!T$4X?Activities(includingextracurricular, O! school,religious,cultural,etc.)  ""R $__________  O!   |   6,|   6K*(X"% 8K? 4L!T$4X?SummerCamps  #  $__________  #    "%  $"%    $K*(X$!9K? 4L!T$4X?*56 *d*d ZZ FZZF" ZZ" ZZ 34$$, ZZ,FZZ,FZZ+  1'n%"n%" 1 OTHERINSURANCE  n%"   n%"  6,n%"  6K*(XA&q#:K? 4L!T$4X?Health A&q# ЀChild(ren)sportion:  'D$ $__________  A&q# $__________ 6,'D$  6K*(X'%;K? 4L!T$4X?Dental '% ЀChild(ren)sportion:  (% $__________  '% $__________ 6,(%  6K*(X)&<K? 4L!T$4X?Vision )& ЀChild(ren)sportion:  `*' $__________  )& $__________ 6,`*'  6K*(X3+c(=K? 4L!T$4X?Life 3+c( ЀRelationshipofBeneficiary:  ,6) $__________  3+c( ____________ 6,,6)  6K*(X, *>K? 4L!T$4X?Disability  , * $__________  , *  6,, *  6K*(X-*?K? 4L!T$4X?Other(specify):  .+ $__________  .+ $-*   $K*(XR/,@K? 4L!T$4X?    4   TOTALABOVEEXPENSES   $_______________________ R/,  *78 *d*d ZZ FZZFFZZF56$$, sZ,fZ,FfZ,fZ,fZ,tfs+  :99+ : B.PAYMENTSTOCREDITORS =9:9*99 =  (pleasecheckone) X:99G/v   9:9 X K*(XIyAK? 4L!T$4X?ToWhom: 4::9#Iy:99 4BalanceDue 4::9#Iy::9 4Monthly Iy Payment 4::9#L::9 4Joint 4::9#Iy ::9 4Plaintiff 6::99#Iy ::9 6 Defendant J9;#Iy   ::99 J K*(XBK? 4L!T$4X? 2:#9 2 2:#: 2 2:#: 2 2:#: 2 6:9#: 6 J:9;#  :9 JK*(Xh CK? 4L!T$4X? 2::# >:9 2 2::#h :: 2 2::#h :: 2 2::#h :: 2 6::9#h :: 6 J:9;#h   ::9 JK*(X  DK? 4L!T$4X? 2::# :9 2 2::#  :: 2 2::#  !:: 2 2::#  ":: 2 6::9#  #:: 6 J:9;#  $  ::9 JK*(XZ EK? 4L!T$4X? 2::#0 ':9 2 2::#Z (:: 2 2::#Z ):: 2 2::#Z *:: 2 6::9#Z +:: 6 J:9;#Z ,  ::9 JK*(XFK? 4L!T$4X? 2::#y/:9 2 2::#0:: 2 2::#1:: 2 2::#2:: 2 6::9#3:: 6 J:9;#4  ::9 JK*(XL|GK? 4L!T$4X? 2::#"7:9 2 2::#L|8:: 2 2::#L|9:: 2 2::#L|::: 2 6::9#L|;:: 6 L:99;#L|<  ::9 LK*(XHK? 4L!T$4X? 4::9#k?:99 4 4::9#@::9 4 4::9#A::9 4 4::9#B::9 4 6::99#C::9 63)'D   ::99 3K*(X>nIK? 4L!T$4X?? N L!T$4X?   TOTALMONTHLYPAYMENTSTOCREDITORS:  $___________________ AE  B" N L!T$N XBC.  TOTALMONTHLYEXPENSES:    $______________________ H  This______________________dayof___________,20________. L E" N L!T$N XE_____________________________________  _____________________________________ "% Q NotaryPublic N   Affiant # R  jQ14 <DL!T$XQ$   '4 %'&Rule24.4.Temporaryhearing,scheduling. (%W "S)!')& S#  '4  SS"  '4  #RESERVED.(FormerRule24.4isnowincorporatedinRule24.2)."݌ )!'X Ќ'4  '4 =jS  j9" N L!T$XT$9$$_   'XX '4XcXX'X jQ14 <DL!T$XQ