Financial Disclosure Affidavit
Financial Disclosure Affidavit
I, [Your Name], residing at [Your Company Address], do hereby solemnly affirm and declare the following:
1. Personal Information:
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Name: [Your Name]
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Date of Birth: [Your Birthdate]
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Social Security Number: 123-45-6789
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Contact Information: [Your Company Number]
2. Financial Information:
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Income: My annual gross income is $75,000, derived from employment.
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Assets: I possess various assets including:
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Real Estate: Residential property valued at $250,000
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Vehicles: 2050 Toyota Camry valued at $15,000
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Bank Accounts: Wells Fargo - $10,000, Chase - $5,000
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Investments: Stocks and bonds valued at $50,000
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Liabilities: I have the following liabilities:
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Mortgages: Outstanding mortgage balance of $150,000
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Loans: Personal loan with an outstanding balance of $5,000
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Credit Card Balances: Total credit card balance owed is $3,000
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3. Monthly Expenses:
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Housing: $1,500 (mortgage payment)
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Utilities: $200
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Transportation: $300
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Food: $500
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Insurance: $150
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Other Expenses: $200
I hereby certify that the above-stated information is true and accurate to the best of my knowledge and belief. I understand that any false statements made herein are subject to penalties of perjury.
[Your Name]
[Date Signed]
