Free STATE OF SOUTH DAKOTA) - All

Instructions for Financial Affidavit Form
The Financial Affidavit is a sworn statement about the financial situation of the party completing the form. It is meant to give the judge and the parties accurate information about the property and debts involved in the divorce. Each party should complete a Financial Affidavit. The Financial Affidavits should be filed with the Clerk of Courts. A copy should be served on the other party. Any blanks following dollar signs ($) should be an actual amount (if known) or an estimate of what the property is worth. The values used should be as of the day the party completes the Financial Affidavit. The Financial Affidavit must be signed in front of a Notary Public or the Clerk of Courts. Financial Affidavits that are not signed in front of a Notary Public or the Clerk of Courts are invalid and are not allowed in any court proceedings.

Form UJS-304 Rev. 11/08

STATE OF SOUTH DAKOTA) :SS COUNTY OF______________)

IN CIRCUIT COURT ___________ JUDICIAL CIRCUIT

_____________________, Plaintiff, vs. _____________________, Defendant.

DIV _____ FINANCIAL AFFIDAVIT

I, ________________________________, hereby swear on oath and under penalty of law that the following is true.
(Name of party completing affidavit)

(1) (2) (3) (4) (5) (6) (7) (8) (10)

My address is ______________________________________________________ My telephone number is ( ) _______________________________________ I am (check one) _____ EMPLOYED _____ UNEMPLOYED _____ SELF-EMPLOYED (If employed) my weekly take home pay is: $_____________________________. Retirement, disability, or insurance benefits: $________________ per ______________. My total income before deductions for year _________ was $______________________. My total income before deductions for year _________ was $______________________. Including myself, I have the following number of dependants: _____________________. The following amounts accurately represent my assets and liability: I. ASSETS (things I own or am buying)

a. CASH (on hand or in banks) .......................................................................$_____________ b. ACCOUNTS and NOTES RECEIVABLE (IOU's and other money payable to me)......$_____________ c. INVESTMENTS (stocks, bonds, savings bond, etc.)...........................................$_____________ d. REAL ESTATE (house, land, tribal lease land, rental property, etc.).........................$_____________ e. AUTOMOBILE(S) make, model, year: ________________________________________________________________________ $_____________ f. HOUSEHOLD GOODS (furniture, appliances, TV, stereo, etc.)..............................$_____________ g. OTHER PERSONAL PROPERTY (tools, sports equipment, etc.)...........................$_____________ h. ANY OTHER ASSETS (anything else I could sell or borrow money on)...................$_____________ TOTAL ASSETS.............$_____________ II. LIABILITIES (money that I owe)

a. My regular monthly expenses are: (housing, utilities, food, etc.).............................$_____________ b. DEBTS: I owe_______________________________ this amount...................$_____________ I owe_______________________________ this amount...................$_____________ I owe_______________________________ this amount...................$_____________ TOTAL LIABILITIES .....$_____________

Form UJS-304 Rev. 11/08

III.

ANTICIPATED INCOME (money or property you are expecting)

a. Total monies or income from sale of house or land, gifts, inheritance, allotments, trust funds, lease money, etc........................................................................$______________

Dated: Signature of Person Completing Affidavit (Sign only in front of notary public or clerk of courts.)

Sworn/affirmed before me this day of , .

Notary Public \ Clerk of Courts

(SEAL)

Form UJS-304 Rev. 11/08