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Sample Financial Statement

Before entering into a prenuptial or premarital agreement, each prospective spouse must make a complete and honest financial disclosure to the other. The following form, used in conjunction with the advice and counsel of your family law attorney, can be useful in putting together your own financial statement and verifying that the information you receive from your spouse is complete.

A. Gross Monthly Income

Source/Amount ________________/$________

Source/Amount ________________/$________

Source/Amount ________________/$________

TOTAL: $________________

B. Deductions from Gross Income

State Income Tax $____________________
Federal Income Tax $____________________
Social Security $____________________
Self-employment Tax $____________________
Health Insurance $____________________
Union Dues $____________________
Pension/Retirement $____________________
Support Orders $____________________
Other $____________________

TOTAL : $_______________

C. NET MONTHLY INCOME: (gross income minus total deductions)

$_______________

D. Assets & Liabilities

  Value Owe
Primary Home $_______________ $_______________  
Vacation Home $_______________ $_______________  
Other Home/Property $_______________ $_______________  
Vehicle(s) $_______________ $_______________  
Recreational Vehicle $_______________ $_______________  
Boat(s) $_______________ $_______________  
Furniture $_______________ $_______________  
Home Furnishings $_______________ $_______________  
Appliances $_______________ $_______________  
Artwork $_______________ $_______________  
Jewelry $_______________ $_______________  
Computer(s) $_______________ $_______________  
Personal Property $_______________ $_______________  
Cash $_______________ $_______________  
Stocks/Bonds/Funds $_______________ $_______________  
Stock Options $_______________ $_______________  
Checking Account(s) $_______________ $_______________  
Savings Account(s) $_______________ $_______________  
Retirement/Pensions $_______________ $_______________  
Profit Sharing $_______________ $_______________  
IRA(s) $_______________ $_______________  
Business(es) $_______________ $_______________  
Professional Practice $_______________ $_______________  
Life Insurance $_______________ $_______________  
Other Assets
Description Value

 




TOTAL ASSETS: $_______________

TOTAL LIABILITIES: $_______________

E. NET WORTH: (assets minus liabilities) $___________________________

F. Educational Degrees




See also:

Next Steps
Contact a qualified family law attorney to make sure
your rights are protected.
(e.g., Chicago, IL or 60611)

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