margo j. hart v. norman b. hart family law financial affidavit

8/14/2019 Margo J. Hart v. Norman B. Hart Family Law Financial Affidavit

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IN THE CIRCUn ~ O U R T OF THE THIRTEENTH JUDICIAt. CIRCUITIN AND FOR HILLSBOROUGH COUNTY, STATE OF FLORIDAFAMILY LAW DIVISIONIN RE: THE MARRIAGE OFMARGO J. HART,PetitionerlWife,andNORMAN B. HART, JR.,

RespondenYHusband______________________

CASE NO.: 04-009083

DIVISION: D

FAMILY LAW FINANCIAL AFFIDAVIT (short form)(Under $50,000.00 Annual Gross Income)I, NORMAN B. HART, JR., being duly sworn, certify that the following information t s ~ true:

MyOccupatidn: C()/1sultant

Pay Rate: e ~ ~ f ; , : ( \ " ~ 5 ; ~ * ~ k . i i . . . .. ~ ( : " . ; ( \ ) ; b i ~ ~ e ~ ~ l y - ( : } ~ . ~ . r n l - J 1 ' l 9 r : l ~ h I Y . ( ~ J J 1 ' l o . , , ~ ~ : l y .

f . ) g ~ i j ~ r : ' __ Check here if unemployed and explain on a separate sheet your efforts to findemployment.SECTION I. PRESENT MONTHLY GROSS INCOME:All amounts must be MONTHLY. See the instructions with this form to figure out moneyamounts for anything separately that is NOT paid monthly. Attach more paper, if needed.Items included under "other" should be listed with separate dollar amounts.1. Monthly gross salary or wages *Approximate2. Monthly bonuses, commissions, allowances, overtime, tips, andsimilar payments3. Monthly business income from sources such as self-employment,partnerships, close corporations, and/or independent contracts(gross receipts minus ordinary and necessary expenses required toproduce income) (Attach sheet itemizing such income andexpenses.)4. Monthly disability benefits/SSI5. Monthly Workers' Compensation6. Monthly Unemployment Compensation7. Monthly pension, retirement, or annuity payments


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8. Monthly Social Security benefits J'$b.;C>p . . , ' 9. Monthly alimony actually received. '.' .....9a. From this case: < .' ., ". $J;tOO. . ..., ....9b. From other case(s):

c . .... '. .. " $0.00... .' .'Add 9a. And 9b. $0.00 ..

.

10. Monthly interest and dividends $0.00 .' '. . .11. Monthly rental income (gross receipts minus ordinary and $0.00necessary expenses required to produce income) (Attach sheet Iitemizing such income and expense items.) .-- :.12. Monthly income from royalties, trusts, or estates $0.00

.'13. Monthly reimbursed expenses and in-kind payments to the $0.00extent that they reduce personal living expenses . ' ". :..14. Monthly gains derived from dealing in property (not including $0.00nonrecurring gains) '. .!.. .. . '. .

", '.15. Any other income of a recurring nature (list source) $(foO:. .. ...... .'16. Any other income of a recurring nature (list source) $O.pO . .'. .17. PRESENT MONTHLY GROSS INCOME TOTAL: , $ 3 , ~ 5 9 . 0 0 (Add lines 1-16) : ':PRESENT MONTHLY DEDUCTIONS:18. Monthly federal, state, and local income a . : ~ i l . i h 9 S t ~ t u s 8 $531 .60' . .. :.' '.' ...... ....24. Monthly court-ordered child support actually paid for children $0.00'from another relationship ,. "C .' ,i .25. Monthly court-ordered alimony actually paid25a. from this case:

.... 2i.'. ...... :c ..< . .:. . :': . .. i : . ' SQcQq'.'," ... , :. .25b.from other case(s): .... .: ".


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Other: $0',00Other:Other: .. '.. . ....... c . . . . . . . . ; ~ ~ : ; r ......... . . ~ / y . .... .... ..... ..Ie , . : . . . ... . . '.' Column Totals: Column Totals: .. ; . ~ . f : . ;.. ...2.' " ' . . : . ;::':;Z:'i. . . , ' : . ; , i .;28. TOTAL MONTHLY EXPENSES

....29. TOTAL PRESENT MONTHLY NET INCOME (from l ine 27 ofSECTION I. INCOME) . 2,848.15.... .. .. ....30. TOTAL MONTHLY EXPENSES (from line 28 above) $3,813:42

. ...31. SURPLUS/DEFICIT

SECTION III: ASSETS AND LIABILITIESUse the nonmarital column only if this is a petition for dissolution of marriage and you believean item is "nonmarital," meaning it belongs to only one of you and should not be divided.You should indicate to whom you believe the item(s) or debt belongs. (Typically, you will onlyuse this column if property! debt was owned!owed by one spouse before the marriage. Seethe instructions with this form and section 61.075(1), Florida Statutes, for definitions of"marital" and "nonmarital" assets and liabilities.)

A. ASSETS:DESCRIPTION OF ITEM(S). List a description of each separate item owned by you (and!oryour spouse, if this is a petition for dissolution of marriage). Check the box next to anyasset(s) which you are requesting the judge award to you.ITEM:

Cash (on hand)Cash (in banks or credit unions)Stocks, Bonds, NotesReal estate: (Home)(Other)Automobiles

Current Fair MarketValue.'.

$ p b ~ Q o ............... ; .1:9;000" ":'. ...... . . .

:::r: ; - : . ~ : ; " , ' : . : ... , . . . ' , . , ' . ' .. ,; ... ,,

."" .

'.,,.$Q:QO .... '........

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Nonmaritalhusband wife


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Other personal propertyRetirement plans (Profit Sharing, Pension,IRA , 401 (k)s, etc.)OtherFurnitureCash taken by Wife (Approximate)

Check here if additional pages are attached.Total Assets (add column B)

B. LIABILITIES:

$O.0Q " 'J ................. . . . . . . . . .............. ".

. . . i : .:. . .. .


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Emergency Doctor (approximate)Cardiologist (approximate)Lakeland Regional HospitalAmbulance (approximate)Helicopter Ambulance (approximate)

, ' .Attending Physician $1,qPO.qo ",,'" ,',,',,',' ,' ,", "'.'Check here if additional pages are attached.Total Debts (add column B) $151,397.00 '

C. CONTINGENT ASSETS AND LIABILITIES

ITEM:

item:item:item:Total Contingent Assets

ITEM:

item:item:item:Total Contingent Liabilities

Contingent Assets:Possible Value

..... ,$0.00.< .. ,, '

Contingent Liabilities:Possible AmountOwed

.:

$o.()O .. .... ... .... . ...... ,.$Q.QOi,..., ,< ........ ........

Nonmaritalhusband wife

Nonmarital

husband wife

SECTION IV: CHILD SUPPORT GUIDELINES WORKSHEETA Child Support Guidelines Worksheet ( ) is ("') is not being filed in this case.

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I understand that I am swearing or affirming under oath to the truthfulness of theclaims made in this affidavit and that the punishment for knowingly making a falsestatement includes fines and/or imprisonment.

Date

STATE OF FLORIDACOUNTY OF HILLSBOROUGH

I hereby acknowledge that the foregoing financial affidavit was executed by NORMAN B.HART, JR., this ~ c l day of August, 2004, ( ) who is personally known to me or ( ~ ) whoproduced Florida Driver's License as identification and who ( ~ ) did ( ) did not take an oath.

~ ~ . ~ BAm AAHALL~ l ' i ; & ' ~ MY COMMISSION #DD.2899271 f ~ 7 EXPIRES: May ~ 7 , 2008' ~ P , f . , ~ , ~ Bonded Thru Notary Public UnderwritersSeal: NOTARY PUBLIC

CERTIFICATE OF SERVICEI HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by

[.1'] regular U.S. Mail [ ] facsimile [ ] hand delivery to GLENN E. BROWN, ESQUIRE, 2529West Busch Boulevard, Suite 600, Tampa, Florida 33618, this 3rd day of August, 2004.

BRETT R. RAHALL, ESQUIRERahall &Schaffer, P.A.120 South Willow AvenueTampa, Florida 33606(813) 258-8888FBN: 896901Attqrneys for Husband

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margo j. hart v. norman b. hart family law financial affidavit

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