City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email 

 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  

I am   [  ]  Petitioner 

[  ]  Petitioner’s Attorney 
[  ]  Petitioner’s Licensed Paralegal Practitioner 
[  ]  Respondent’s Licensed Paralegal Practitioner   

(Utah Bar #:__________) 

(Utah Bar #:__________) 

[  ]  Respondent 
[  ]  Respondent’s Attorney 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of (select one) 
 

[  ]  the Marriage of (for a divorce with or without 
children, annulment, separate maintenance, or 
temporary separation case) 

[  ]  the Children of (to establish custody, parent-

time or child support) 

[  ]  the Parentage of the Children of (for a 

paternity case) 

Financial Declaration 
(Utah Rule of Civil Procedure 26.1)  

_______________________________ 
Case Number 

_______________________________ 
Judge 

____________________________________ 
(name of Petitioner) 

_______________________________ 
Commissioner 

and  

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

You must fully and accurately disclose all assets and income in this document and 
provide attachments. If you fail to disclose all assets and income, you could be subject 
to sanctions under Utah Rule of Civil Procedure 37. Sanctions can include an award of 
non-disclosed assets to the other party, attorney’s fees or other sanctions. 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 1 of 14 

1.  

I am providing this form to the other party and (Choose one.): 

[  ]    I am not filing the Financial Declaration with the court because a 

hearing about child support, spousal support, property, debts, attorney 
fees and court costs is not scheduled, or because the court has not 
ordered me to file it.  

I am filing the separate Certificate of Service of Financial Declaration. 

[  ] 

I am filing the Financial Declaration with the court because a hearing 
about child support, spousal support, property, debts, attorney fees and 
court costs is scheduled, or the court has ordered me to file it. 

 

I am also filing the separate Certificate of Service of Financial Declaration. 

2. 

 

I am attaching the following documents, if available:  

Tax returns. For the two years before the petition was filed : 

• 

federal and state income tax returns – personal and for 
any entities in which I have a majority or controlling 
interest 

•  all documents used to prepare the tax returns 

[  ]  Attached 
[  ]  Not attached 
[  ]  Doesn’t apply 

Pay stubs or other proof of income. For the 12 months 
before the petition was filed: 

•  pay stubs 
•  other proof of all earned and un-earned income 

Loan applications. For the 12 months before the petition 
was filed:  

•  all loan applications 
• 

financial statements used to apply for the loans 

[  ]  Attached 
[  ]  Not attached 
[  ]  Doesn’t apply 

[  ]  Attached 
[  ]  Not attached 
[  ]  Doesn’t apply 

Real estate documents. Documents verifying the value of 
all real estate in which I have an interest. This includes the 
most recent appraisal, tax valuation, and refinance 
documents. 

[  ]  Attached 
[  ]  Not attached 
[  ]  Doesn’t apply 

Financial statements. For the 3 months before the petition 
was filed all financial statements. This includes, but is not 
limited to, checking, savings, credit cards, money transfer 
apps, money market funds, certificates of deposit, brokerage, 

[  ]  Attached 
[  ]  Not attached 
[  ]  Doesn’t apply 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 2 of 14 

investment, and retirement. 

You do not have to disclose all of the information above if your case does not 
involve dividing property or other valuables. This could include paternity, 
modification, and grandparents’ rights cases. If you are not dividing property or 
other valuables in your case you must only serve: 

• your last three current paystubs and the previous year tax return; 
• six months of bank and profit and loss statements if you are self-

employed; and 

• proof of any other assets or income that the court might need when 

deciding how much child support to order. 
 

You and the other party may be required to complete a full Financial Declaration 
later. 

[  ] 

I marked some documents above as “not attached” because: 

Document 

Reason 

 

 

 

 

 

 

3. 

Employment  (You must attach proof of amounts listed. If the proof is not available, estimate 
the amount and explain how you reached that amount.) 

[  ] 

I am employed as (Choose all that apply): 

[  ]  an hourly employee (Form W-2) 

[  ]  a salaried employee (Form W-2) 

[  ]  self-employed (Form 1099, Form K-1, Schedule C, etc.) 

[  ]  other (Explain): _____________________________________________ 

Name of employer 

Employer's address and 
phone number 

Job title 

Hourly 
rate or 
annual 
salary 

Hours per 
week 
(If hourly) 

 
 

 
 

 
 

 

 

 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

 

 

 

$ 

$ 

$ 

 

 

 

Financial Declaration 

Page 3 of 14 

[  ] 

I have estimated the amounts in paragraph 3.  

Item estimated 

Basis for estimation 

 

 

4. 

Gross Monthly Income  (You must attach proof of amounts listed. If the proof is not 
available, estimate the amount and explain how you reached that amount.) 

[  ] 

I have the following monthly income before tax deductions:  
(Print your pre-tax income in the boxes below. For income that changes from month to 
month, calculate the annual total and divide by 12 months to list a monthly average.) 

Source of income 

Monthly amount 

Work  (Including self employment, wages, salaries, commissions, 
bonuses, tips and overtime) 

[  ] 

I am unemployed because:  

     

 

 

Rental income 

Business income 

Interest 

Dividends 

Retirement income (Including pensions, 401(k), IRA, etc.) 

Worker’s compensation 

Private disability insurance  

Social Security Disability Income (SSDI) 

Supplemental Security Income (SSI) 

Social Security (Other than SSDI or SSI) 

Unemployment benefits 

Education benefits (Including grants, loans, cash scholarships, etc.) 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

Veteran’s benefits 

Alimony 

Child support 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 4 of 14 

Source of income 

Monthly amount 

Payments from civil litigation 

Victim restitution 

Public assistance (Including AFDC, FEP, TANF, welfare, etc.) 

Financial support from household members 

Financial support from non-household members 

Trust income 

Annuity income 

Other (Describe) 

Other (Describe) 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

Total gross monthly income  $ 

[  ] 

I have estimated the amounts in paragraph 4.  

Item estimated 

Basis for estimation 

 

 

[  ] 

I have no income because: 

 

 

     

5. 

Monthly Tax Deductions  (You must attach proof of amounts listed. If the proof is not 
available, estimate the amount and explain how you reached that amount.) 

[  ] 

I have no monthly tax deductions because I have no income. 

[  ] 

I have the following monthly tax deductions. 

Type of tax deduction 

Amount 

Federal income tax 

State income tax 

Municipal income tax 

FICA 

Medicare 

$ 

$ 

$ 

$ 

$ 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 5 of 14 

Type of tax deduction 

Amount 

Total monthly tax deductions  $ 

[  ] 

I have estimated the amounts in paragraph 5.  

Item estimated 

Basis for estimation 

6. 

After Tax Income 

[  ]  My monthly income is: 

 

 

$ 

- $ 

 
 
= $ 

 

 

 

 

 

 

 

 

  Gross monthly income from section 4 

  Minus monthly tax deductions from section 5 

  Equals after-tax monthly income 

[  ]    I have no income. 

7. 

Monthly Expenses  (You must attach proof of amounts listed. If the proof is not available, 
estimate the amount and explain how you reached that amount. Include amounts you pay for 
yourself and any spouse, children or other dependents in your household.) 

[  ]   No party has requested alimony so I am only completing the "Current 

Amount" column, which represents the amount I pay now. 

[  ]  One of the parties has requested alimony so I am completing both the 

"Current Amount" and the "Marital Expenses" column, which represents 
the amount paid during the marriage prior to separation. 

Monthly expense 

Current 
Amount 

Marital 
Expenses 

Rent or mortgage 

Real estate taxes (if not included in mortgage) 

Real estate insurance (if not included in mortgage) 

Real estate maintenance 

Food and household supplies 

Clothing 

Automobile payments 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

Financial Declaration 

Page 6 of 14 

Monthly expense 

Current 
Amount 

Marital 
Expenses 

Other transportation costs  (public transportation, parking, etc.) 

Utilities  (such as electricity, gas, water, sewer, garbage) 

Automobile insurance 

Automobile fuel 

Automobile maintenance 

Telephone 

Internet 

Paid television, cable, satellite 

Credit card payments  

Loans and other debt payments 

Alimony 

Child support 

Child care 

Extracurricular activities for children 

Education (children) 

Education (self) 

Health care insurance  

Other insurance (describe) 

Entertainment 

Laundry and dry cleaning 

Donations 

Gifts 

Union and other dues 

Other (describe) 

Other (describe) 

Health care expenses  (excluding insurance listed above) 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

Garnishment or income withholding order 

Retirement deposits (including pensions, 401(k), IRA, etc.) 

[  ] 

I have estimated the amounts in paragraph 7.  

Total monthly expenses  $ 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 7 of 14 

Item estimated 

Basis for estimation 

8. 

Business Interests  (You must attach proof of amounts listed. If the proof is not available, 
estimate the amount and explain how you reached that amount. Add additional sheets if needed.) 

[  ] 

I have no business interests. 

[  ] 

I have the following business interests. 

Current value of the 
business 

Date of 
formation: 

Percent owned by 

_____% Petitioner      _____% Respondent 

 

 

 

 

 

 

Business name 

Address & phone 

Nature of business 

Business name 

Address & phone 

Nature of business 

$ 

 

$ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current value of the 
business 

Date of 
formation: 

Percent owned by 

_____% Petitioner      _____% Respondent 

[  ] 

I have estimated the amounts in paragraph 8.  

Item estimated 

Basis for estimation 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 8 of 14 

9.  

Financial Assets  (You must attach proof of amounts listed. If the proof is not available, 
estimate the amount and explain how you reached that amount. Add additional sheets if needed.) 

[  ] 

I have no financial assets. 

[  ] 

I have the following financial assets. 

Asset 

Name & address of institution 

Names on account 

Current 
balance 

Bank or credit union  
Account number: 
_______________ 
Date opened: 
_______________ 
Type: 
[  ]  checking 
[  ]  savings 
[  ]  other  
_______________ 

Bank or credit union  
Account number: 
_______________ 
Date opened: 
_______________ 
Type: 
[  ]  checking 
[  ]  savings 
[  ]  other 
_______________ 

Stocks, bonds, 
securities, money 
market account  
Account number: 
_______________ 
Date opened: 
_______________ 

Retirement account 
Account number: 
_______________ 
Date opened: 
_______________ 
Plan name: 
_______________ 
Plan representative: 
_______________ 

 

 

 

 

 

 

 

 

$ 

$ 

$ 

$ 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 9 of 14 

Asset 

Name & address of institution 

Names on account 

Current 
balance 

Profit sharing plan 
Account number: 
_______________ 
Date opened: 
_______________ 
Plan name: 
_______________ 
Plan representative: 
_______________ 

Annuity 
Account number: 
_______________ 
Date opened: 
_______________ 
Plan name: 
_______________ 
Plan representative: 
_______________ 

Life insurance 
Account number: 
_______________ 
Date opened: 
_______________ 
Plan name: 
_______________ 
Plan representative: 
_______________ 

Money owed to me 
Date of loan: 
_______________ 

Cash 

Money transfer app 
(describe, e.g. Paypal, 
Venmo, Zelle, etc.) 

 

 

 

 

 

 

 

 

 

 

 

 

$ 

$ 

$ 

$ 

$ 

Term life 
benefit 
amount: 

$_________  

Whole life 
benefit 
amount: 

$_________ 

Cash value: 

$_________ 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 10 of 14 

Asset 

Name & address of institution 

Names on account 

Current 
balance 

Other (describe) 

 

 

$ 

[  ] 

I have estimated the amounts in paragraph 9.  

Item estimated 

Basis for estimation 

10.  Real Estate  (You must attach proof of amounts listed. If the proof is not available, estimate 
the amount and explain how you reached that amount. Add additional sheets if needed.) 

 

 

 

 

[  ] 

I have no real estate. 

[  ] 

I have the following real estate. 

  Name(s) on title 

  Original cost 

  Current value 

First mortgage or lien holder (name & address) 

Amount owed 

Monthly payments 

 
Second mortgage or lien holder (name & address) 

Amount owed 

Monthly payments 

  Name(s) on title 

  Original cost 

  Current value 

First mortgage or lien holder (name & address) 

Amount owed 

Monthly payments 

 
Second mortgage or lien holder (name & address) 

Amount owed 

Monthly payments 

[  ] 

I have estimated the amounts in paragraph 10.  

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 11 of 14 

 

 

 
 

 

 

 

 
 

 

$ 

$ 

$ 

$ 

$ 

$ 

 

$ 

  $ 
 

  $ 
 

 

$ 

  $ 
 

  $ 
 

 

  

 

  

 

 

 
Date acquired 
 

Home 

ddress 

  A

ther real estate 

ddress 

 
Date acquired 
 

  O

  A

Item estimated 

Basis for estimation 

 

 

 

 

 

 

 

 

11.  Personal Property  (Such as vehicles, boats, trailers, major equipment, furniture, jewelry, 
and collectibles. You must attach proof of amounts listed. If the proof is not available, estimate 
the amount and explain how you reached that amount. Add additional sheets if needed.) 

[  ] 

I have no personal property. 

[  ] 

I have the following personal property. 

Property description 
(if automobile, include 
year, make, and model) 

Debt owed to 
(name and 
address) 

Names on 
title 
(if applicable) 

Current 
value 

Amount 
owed 

Minimum 
monthly 
payments 

Vehicle 

Vehicle 

  

  

  

 

 

 

 

 

 

 

 

 

 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

[  ] 

I have estimated the amounts in paragraph 11.  

Item estimated 

Basis for estimation 

12.  Debts Owed  (Do not include amounts you owe on property reported in the Real Estate or 
Personal Property sections. You must attach proof of amounts listed. You must also attach 3 
months of credit/debit account statements. If the proof is not available, estimate the amount and 
explain how you reached that amount. Add additional sheets if needed.) 

[  ] 

I do not owe any debts. 

[  ] 

I owe the following debts. 

Type of debt 
(such as credit card, 
cash loan, or installment 
payment and account 
number, if any) 

Debt owed to 
(name and address and 
phone number) 

Names on debt 

Amount 
owed 

Minimum 
monthly 
payments 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 12 of 14 

Debt owed to 
(name and address and 
phone number) 

Names on debt 

Amount 
owed 

Minimum 
monthly 
payments 

 

 

 

 

 

 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

 

 

 

 

 

 

Type of debt 
(such as credit card, 
cash loan, or installment 
payment and account 
number, if any) 

Type of debt: 

ccount number: 

Type of debt: 

ccount number: 

Type of debt: 

ccount number: 

Type of debt: 

ccount number: 

Type of debt: 

ccount number: 

Type of debt: 

ccount number: 

  A

 

  A

 

  A

 

  A

 

  A

 

  A

 

[  ] 

I have estimated the amounts in paragraph 12.  

Item estimated 

Basis for estimation 

 

 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 13 of 14 

Item estimated 

Basis for estimation 

 

 

Warning 

If you do not fully disclose all assets and income in this document and provide 
attachments you could be subject to sanctions under Utah Rule of Civil Procedure 37. 

Sanctions can include an award of non-disclosed assets to the other party, attorney’s 
fees or other sanctions. 

etitioner or Respondent  

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

ttorney or Licensed Paralegal Practitioner of record (if applicable) 

Signature ► 

Printed Name 

Signature ► 

Printed Name 

 

 

 

 

1352FAJ Approved February 25, 2019 
/ Revised November 21, 2022 
 

Financial Declaration 

Page 14 of 14 

        P

    A

     

 
Date 

 
Date