Financial Disclosure Affidavit

I, [Your Name], residing at [Your Company Address], do hereby solemnly affirm and declare the following:

1. Personal Information:

• Name: [Your Name]

• Date of Birth: [Your Birthdate]

• Social Security Number: 123-45-6789

• Contact Information: [Your Company Number]

2. Financial Information:

• Income: My annual gross income is $75,000, derived from employment.

• Assets: I possess various assets including:

  • Real Estate: Residential property valued at $250,000

  • Vehicles: 2050 Toyota Camry valued at $15,000

  • Bank Accounts: Wells Fargo - $10,000, Chase - $5,000

  • Investments: Stocks and bonds valued at $50,000

• Liabilities: I have the following liabilities:

  • Mortgages: Outstanding mortgage balance of $150,000

  • Loans: Personal loan with an outstanding balance of $5,000

  • Credit Card Balances: Total credit card balance owed is $3,000

3. Monthly Expenses:

• Housing: $1,500 (mortgage payment)

• Utilities: $200

• Transportation: $300

• Food: $500

• Insurance: $150

• 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]

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