Short Form Financial Statement Video Series

The following videos provide guidance on completing the Short Form Financial Statement for cases in the Probate and Family Court. The Short Form Financial Statement is used for people whose gross annual income is under $75,000.

These videos are intended only to provide general legal information about how to fill out a Short Form Financial Statement. The information in these videos are not intended to be relied upon as legal advice. For legal advice, you should consult an attorney. 

Table of Contents

Full Length Video

This is the full length Short Form Financial Statement Video. It is broken down into sections below.

How should I prepare to fill out the Short Form Financial Statement?

To prepare to fill out the Short Form Financial Statement, you should gather the documents you will need in order to report accurate financial information. This includes documents such as:

  • Pay stubs
  • Benefit statements (such as SSI, SSDI, and SNAP)
  • Credit card statements
  • Utility bills (such as gas, electricity, oil, cable, internet, and phone)
  • Mortgage or rental statements
  • Retirement account statements
  • Insurance policies
  • Estimates of the value of property, such as cars and real estate
  • Loan statements 
  • Tax returns
  • Bank statements 

Paragraph 1: Personal Information

This video will show you how to fill out your Personal Information on the Short Form Financial Statement including completing the case caption and limiting personal information in certain circumstances. 

Paragraph 2: Gross Weekly Income/Receipts from all Sources

This video will show you how to report your income and benefits on the Short Form Financial Statement.

Paragraphs 3 & 4: Itemized Deductions from Gross Income & Adjusted Net Weekly Income

This video will show you how to report your Itemized Deductions on the Short Form Financial Statement such as federal and state taxes, medical insurance and union dues, which may be subtracted from your Gross Income. It will also show you how to figure out and report what your Adjusted Net Weekly Income is after your Itemized Deductions are subtracted from your Gross Weekly Income.

Paragraphs 5, 6 & 7: Other Deductions from Salary/Wages, Net Weekly Income & Gross Yearly Income from Prior Year

This video will show you how to report all Other Deductions, calculate Net Income, and report Number of Years paid into Social Security.

Paragraph 8: Weekly Expenses

This video will show you how to report Weekly Expenses such as rent, childcare, and utility bills (such as gas, electricity, oil, cable, internet, and phone). Expenses must be reported as a weekly number and this video explains how to figure out a weekly amount from a bill that you may pay monthly, such as rent.

Paragraph 9: Counsel Fees

This video will show you how to report any fees you have paid or expect to pay to an attorney for services in your case.

Paragraph 10: Assets

This video will show you how to report your Assets, such as a car, home, or bank account, and their value on the Short Form Financial Statement.

Paragraph 11: Liabilities

This video will show you how to report all Liabilities (outstanding debt) that you have, along with weekly payments that you are making toward this debt.

I have completed my financial statement, now what?

  • Look over for errors and if all is correct, sign the form. Remember, you are signing this form “under the pains and penalties of perjury”. This means you are swearing that all of the statements made on the form are true.
  • Once it is completed and signed make two (2) copies:
    • File the original at the Registry of the Probate & Family Court where your case is located either by filing in person, mailing, or by using efilema.com. If you efile, keep the original copy.
    • Give a copy to the other party in the case or their attorney.
    • Keep a copy for your own records.

Final things to note:

  • You may be asked to explain in court how you arrived at the numbers on your financial statement.
  • You have a duty to update the form if your income has changed. This means you may have to complete a new financial statement every time you go to court.

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