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IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT

IN AND FOR MIAMI-DADE COUNTY, FLORIDA

Case Number: 2017-16674


J. M., Division: FC 18
Petitioner,
and
A. D.,
Respondent.
FINANCIAL AFFIDAVIT (LONG FORM)
($ 50,000 or more Individual Gross Annual Income)

I, J. M., being sworn, certify that the following information is true.

SECTION I. INCOME

1. My age is: 45
2. My Occupation is: Communications Consultant
3. I am currently [ X all that apply]
a. Unemployed
Describe your efforts to find employment, how soon you expect to be employed, and the pay you expect to receive.

x b: Employed by: Self-employed - SHW Partners LLC Telephone :


Address: , , FL
Pay rate: $ 0.00 Varies Pay Period : Monthly
If you are expecting to become unemployed or change jobs soon, describe the change you expect and why and
how it will affect your income:

Check here if you currently have more than one job. List the information above for the second job(s)
on a separate sheet and attach it to this affidavit.

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
c. Retired.
Date of Retirement :
Employer from whom retired :
Address :
City, State and Zipcode :
Telephone Number :

LAST YEAR'S GROSS INCOME: Your Income Other Party's (If Known)
$ $563,518 $ Unknown
Year Income was generated : 2018 2018
SECTION I. PRESENT MONTHLY GROSS INCOME:
Footnote No.
1. $ 0.00 Monthly gross salary or wages
2. 0.00 Monthly bonuses, commissions, allowances, overtime, tips, and similar payments

Monthly business income from sources such as self-employment, partnerships,


3. 23,956.00 close corporations, and/or independent contracts (Gross receipts minus ordinary 1
and necessary expenses required to produce income. ) ( Attach sheet itemizing
such income and expenses.)
4. 0.00 Monthly disability benefits/SSI
5. 0.00 Monthly Workers' Compensation
6. 0.00 Monthly Unemployment Compensation
7. 0.00 Monthly pension, retirement, or annuity payments
8. 0.00 Monthly Social Security benefits
Monthly alimony actually received
9a. From this Case: $ 0.00
9. 0.00 9b. From other case(s): 0.00 Add 9a and 9b
10. 0.00 Monthly interest and dividends
Monthly rental income (gross receipts minus ordinary and necessary expenses
11. 0.00 required to produce income) ( Attach sheet itemizing such income and expense items)

12. 0.00 Monthly income from royalties, trusts, or estates


Monthly reimbursed expenses and in-kind payments to the extent that they
13. 0.00 reduce personal living expenses
14. 0.00 Monthly gains derived from dealing in property (not including nonrecurring gains)
15. 0.00 Any other income of a recurring nature (source)
16.
17. $ 23,956.00 TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1 - 16)

Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15) Page 2
17.$ 23,956.00 PRESENT MONTHLY GROSS INCOME (From prior Page)

PRESENT MONTHLY DEDUCTIONS:


All amounts must be MONTHLY.
Monthly federal, state and local income tax (corrected for filing status and
allowable dependents and income tax liabilities)
Footnote No.
a. Filing Status JTM
18. 5,284.92 * b. Number of dependents claimed 2
19. 2,076.09 Monthly FICA or self-employment taxes

20. 0.00 Monthly Medicare payments


21. 0.00 Monthly mandatory union dues
22. 0.00 Monthly mandatory retirement payments
Monthly health insurance payments (including dental insurance), excluding
23. 0.00 portion paid for any minor children of this relationship
Monthly court-ordered child support actually paid for children from another
24. 0.00 relationship

Monthly court-ordered alimony actually paid


25a. from this case: $ 0.00
25b from other case(s): 0.00
25. 0.00 Add 25a and 25b
TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30,
26. $ 7,361.01 FLORIDA STATUTES (Add lines 18 through 25)

27. $ 16,594.99 PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17)

* This amount includes Federal income tax , Virginia state tax and local business tax.

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below do not reflect what you
actually pay currently, you should write "estimate" next to each amount that is estimated.

HOUSEHOLD

1. 3,520.00 Mortgage or Rent Payments


2. 0.00 Property Taxes ( Not in Payment)
3. 0.00 Insurance on Residence (Not in Pmt.)
4. 0.00 Condo/Homeowner's Maint/Assoc Fees
5. 0.00 Electricity
6. 0.00 Water, Garbage and Sewer
7. 127.00 Telephone
8. 0.00 Fuel Oil or Natural Gas
9. 300.00 Repairs and Maintenance
10. 160.00 Lawn Care
11. 0.00 Pool Maintenance
12. 100.00 Pest Control
13. 0.00 Misc. Household
14. 200.00 Cable TV
15. 1,500.00 Food and Home Supplies
16. 750.00 Meals Outside Home
17. 53.00 Alarm Service Contract
18. 0.00 Service Contracts on Appliances
19. 473.00 Maid Service
20. 0.00 Internet Services
21. 20.00 Netflix
22. 10.00 iTunes
23. 20.00 SiriusXM
24. 7,233.00 SUBTOTAL (add lines 1 through 23)
AUTOMOBILE

25. 160.00 Gasoline and Oil


26. 50.00 Repairs
27. 7.00 Auto Tags and Emission Testing
28. 242.00 Auto Insurance
29. 1,517.00 Car Payments (Lease or Financing)
30. 0.00 Auto Rental/Replacement Cost
31. 200.00 Alternative Transportation

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below do not reflect what you
actually pay currently, you should write "estimate" next to each amount that is estimated.

AUTOMOBILE

32. 100.00 Tolls and Parking


33. 60.00 Car Wash Memberships
34. 2,336.00 SUBTOTAL (add lines 25 through 33)
CHILDREN'S EXPENSE FOR CHILDREN COMMON TO BOTH PARTIES

35. 0.00 Nursery, Babysitting or Daycare


36. 0.00 School Tuition
37. 0.00 School Supplies and Books, Fees
38. 0.00 After School Activities
39. 0.00 Lunch Money
40. 0.00 Private Lessons / Tutoring
41. 0.00 Allowance
42. 0.00 Clothing / Uniforms
43. 0.00 Entertainment-Movies, Parties, Etc.
44. 0.00 Health Insurance
45. 0.00 Medical, Dental, Prescriptions (NR)
46. 0.00 Psychiatric/Psychological/Counselor
47. 0.00 Vitamins
48. 0.00 Beauty Parlor/Barbershop
49. 0.00 Non-Prescription Medication
50. 0.00 Cosmetics/Toiletries and Sundries
51. 0.00 Gifts From Children to Others
52. 0.00 Vacation
53. 0.00 Camp or/and Other Summer Activities
54. 0.00 Clubs ( Boy/Girl Scouts, Etc)
55. 0.00 Time-Sharing Expense Non-Res Parent
56. 0.00 Orthodontic
57. 0.00 Miscellaneous
58. 0.00 SUBTOTAL (add lines 35 through 57)
CHILD(REN) ANOTHER RELATIONSHIP (OTHER THAN COURT-ORDERED CHILD SUPPORT)

59. 2,473.00 Nursery, Babysitting or Daycare


60. 0.00 School Tuition

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below do not reflect what you
actually pay currently, you should write "estimate" next to each amount that is estimated.

CHILD(REN) ANOTHER RELATIONSHIP (OTHER THAN COURT-ORDERED CHILD SUPPORT)

61. 0.00
School Supplies and Books, Fees
62. 0.00
After School Activities
63. 0.00
Lunch Money
64. 0.00
Private Lessons / Tutoring
65. 0.00
Allowance
66. 0.00
Clothing / Uniforms
67. 0.00
Entertainment-Movies, Parties, Etc
68. 0.00
Health Insurance
69. 0.00 Medical, Dental, Prescriptions
70. 0.00 Psychiatric/Psychological/Counselor
71. 0.00 Vitamins
72. 0.00 Beauty Parlor/Barbershop
73. 0.00 Non-Prescription Medication (NR)
74. 0.00 Cosmetics/Toiletries and Sundries
75. 0.00 Gifts From Children to Others
76. 0.00 Vacation
77. 0.00 Camp or/and Other Summer Activities
78. 0.00 Clubs ( Boy/Girl Scouts, Etc)
79. 0.00 Time-Sharing Expense-Non-Res Parent
80. 0.00 Orthodontic
81. 0.00 Miscellaneous
82. 930.00 Other Expenses
83. 3,403.00 SUBTOTAL (add lines 59 through 82)
INSURANCE

84. 0.00 Health Insurance-Excluding Children


85. 0.00 Life Insurance
86. 0.00 Dental Insurance
87. 0.00 SUBTOTAL (add lines 84 through 86)
OTHER MONTHLY EXPENSES NOT LISTED ABOVE

88. 250.00 Dry Cleaning & Laundry


89. 250.00 Clothing

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below do not reflect what you
actually pay currently, you should write "estimate" next to each amount that is estimated.

OTHER MONTHLY EXPENSES NOT LISTED ABOVE

90. 500.00Medical/Dental/Prescriptions (NR)


91. 300.00Psychiatric/Psychological/Counselor
92. 150.00Non-Prescription Medications
93. 50.00Cosmetics, Toiletries, Sundries
94. 200.00Grooming
95. 250.00Gifts
96. 0.00Pet Expenses
97. 0.00Club Dues and Memberships
98. 150.00 Sports and Hobbies
99. 500.00 Entertainment
100. 50.00 Periodicals/Books/Tapes/CD's
101. 1,000.00 Vacations
102. 160.00 Religious Organizations
103. 25.00 Bank Charges/ Credit Card Fees
104. 0.00 Education Expenses
105. 0.00 Professional Expenses
106. 3,835.00 SUBTOTAL (add lines 88 through 105)

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below do not reflect what you
actually pay currently, you should write "estimate" next to each amount that is estimated.

PAYMENTS TO CREDITORS

107. 0.00 Wells Fargo Home Mortgage 4058 23


108. 0.00 TCS 8
109. 0.00 American Express 3004 (Included Prior) 9
110. 0.00 SunTrust LightStream Loan 5544 10
111. 0.00 Perez-Abreu & Martin-Lavielle, P.A. 11
112. 0.00 Bajo Cuva Cohen Turkel, Attorneys at Law 12
113. 0.00 Stripe Reputation 13
114. 0.00 Sandy T. Fox, P.A. 14
115. 0.00 Internal Revenue Service 15
116. 0.00 Commonwealth of Virginia 16
117. 0.00 Kaufman Rossin 17
118. 0.00 Suntrust Credit Card 2310 18
119. 0.00 Chase Credit Card 5930 19
120. 0.00 Virginia Hospital Bill 20
121. 0.00 MasterCard 3279 21
122. 0.00 SUBTOTAL (add lines 107 through 121)

123. 16,807.00 TOTAL MONTHLY EXPENSES:

SUMMARY

PRESENT MONTHLY NET INCOME


124. 16,594.99 (from line 27 of SECTION I. INCOME)

TOTAL MONTHLY EXPENSES


125. 16,807.00 (from line 123. above)

SURPLUS (if line 124 is greater than line 125)


126. (Subtract line 125 from line 124)

(DEFICIT) (if line 125 is greater than line 124)


127. -212.01 (Subtract line 124 from line 125)

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Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
SECTION III. ASSETS AND LIABILITIES
The box next to each description is checked with an X if any portion of the value is shown as going to this party on his/her
equitable distribution workscreen and indicates that he/she desires some or all of that asset or liability.
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item is all or part "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

A. ASSETS: Nonmarital
DESCRIPTION OF ITEM(S). List a description of each item owned by Current Fair ( x Correct Column)
you (and/or your spouse, if this is a petition for dissolution of marriage). FNN Market Value J. A.
Cash On Hand and In Banks
Cash 0
X Suntrust Personal Checking 0700 1 1,988 X
X Suntrust Business Checking 2436 2 8,694 X
Totals 10,682
Stocks and Bonds
Stock 0
Totals 0
Real Estate Assets
X 2305 Lincoln St. 23 761,300 X
Totals 761,300
Business Interests
RevUp Software 0 X
SHW Partners LLC UNK 0 X
Totals 0
Transportation Assets
Automobile 0
Totals 0
Retirement Assets
Retirement Plan 0
John Hancock Teneo Holdings 401(k) Plan 3 0 X
X Wells Fargo Advisors 1901 4 27 X
Ingham Retirement 5 0 X
Vanguard Retirement 6 0 X
X Metropolitan Life SC Optional Retirement Program 7 6,828 X
Totals 6,855

Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)

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A. ASSETS: Nonmarital
DESCRIPTION OF ITEM(S). List a description of each item owned by Current Fair ( x Correct Column)
you (and/or your spouse, if this is a petition for dissolution of marriage). FNN Market Value J. A.
Insurance Assets
Life Insurance 0
Totals 0
Furniture and Fixtures Assets
Furniture 0
Totals 0
Tangible Other Assets
Other Tangible 0
X Baseball Card Collection 22 10,000 X
Totals 10,000
Miscellaneous Assets
Miscellaneous 0
Totals 0
Total Assets 788,837

Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)

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Nonmarital
B. LIABILITIES:
Current Fair ( x Correct Column)
DESCRIPTION OF ITEM(S). List a description of each item owed by
you (and/or your spouse, if this is a petition for dissolution of marriage). FNN Market Value J. A.

X Wells Fargo Home Mortgage 4058 23 499,687 X

Totals For Secured Liabilities 499,687

X TCS 8 7,480 X
X American Express 3004 9 10,200 X
X SunTrust LightStream Loan 5544 10 43,340 X
X Perez-Abreu & Martin-Lavielle, P.A. 11 180,000 X
X Bajo Cuva Cohen Turkel, Attorneys at Law 12 40,000 X
X Stripe Reputation 13 10,000 X
X Sandy T. Fox, P.A. 14 78,163 X
X Internal Revenue Service 15 250,000 X
X Commonwealth of Virginia 16 65,000 X
X Suntrust Credit Card 2310 18 10,200 X
X Chase Credit Card 5930 19 5,979 X
X Virginia Hospital Bill 20 975 X

Totals For Unsecured Liabilities 701,337

Total Liabilities 1,201,024

C: NET WORTH ( excluding contingent assets and liabilities)

Totals Assets $ 788,837


Totals Liabilities 1,201,024

Total Net Worth (Assets minus Liabilities) $ -412,187

Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15)
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D. CONTINGENT ASSETS AND LIABILITIES:
INSTRUCTIONS:
If you have any POSSIBLE ASSETS (income potential, accrued vacation or sick leave, bonus, inheritance, etc.)
or POSSIBILE LIABILITIES (possible lawsuits, future unpaid taxes, debts assumed by another), you must list them here.

A B C
Contingent Assets Nonmarital
Check the line next to any contingent assets(s) which you are requesting the Possible ( x Correct Column)
judge award to you. FNN Value J. A.

Miller v. Gizmodo Media Group LLC 24 0


Totals 0

A B C
Contingent Liabilities Possible Nonmarital
Check the line next to any contingent debt(s) for which youbelieve you Amount ( x Correct Column)
should be responsible. FNN Owed J. A.

0
Totals 0
Total Net Contingent Assets / Liabilities 0

Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (01/15) Page 12
SECTION I. PRESENT MONTHLY GROSS INCOME
Schedule of Business and/or Rental Income J.

BUSINESS INCOME WORKSHEET ANNUAL MONTHLY


SHW Partners LLC FNN INCOME INCOME
Monthly Gross Receipts 1 324,168.00 27,014.00
Monthly Returns and Allowances 0.00 0.00
Monthly Cost Of Goods Sold 0.00 0.00
Monthly Other Income 0.00 0.00

Total Gross Income 324,168.00 27,014.00

Monthly Administrative Support 0.00 0.00


Monthly Bad Debts From Sales/Service 0.00 0.00
Monthly Car and Truck Expenses 0.00 0.00
Monthly Commission 0.00 0.00
Monthly Employee Benefit Program 0.00 0.00
Monthly Freight 0.00 0.00
Monthly Health Insurance 0.00 0.00
Monthly Other Insurance 0.00 0.00
Monthly Interest: Mortgage 0.00 0.00
Monthly Interest: Other 0.00 0.00
Monthly Legal and Professional Services 0.00 0.00
Monthly Office Supplies and Presentations 0.00 0.00
Monthly Pension / Profit Sharing Plans 0.00 0.00
Monthly Rent: Machinery / Equipment 0.00 0.00
Monthly Rent: Office Space / Building 0.00 0.00
Monthly Repairs 0.00 0.00
Monthly Supplies 0.00 0.00
Monthly 0 0.00 0.00
Monthly Travel and Transportation -756.00 -63.00
Monthly Telecommunications 0.00 0.00
Monthly Meals and Entertainment -5,016.00 -418.00
Monthly Subscriptions 0.00 0.00
Monthly Website and Email Dev. and Maint. 0.00 0.00
Monthly Marketing -30,000.00 -2,500.00
Monthly Staffing 0.00 0.00
Monthly Parking -924.00 -77.00

Total Expenses -36,696.00 -3,058.00

Monthly Depreciation 0.00 0.00


Monthly Depletion 0.00 0.00

Net Profit or (Loss): 287,472.00 23,956.00

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SECTION I. PRESENT MONTHLY GROSS INCOME
Schedule of Business and/or Rental Income J.

BUSINESS INCOME WORKSHEET ANNUAL MONTHLY


SHW Partners LLC FNN INCOME INCOME

Total Depreciation / Depletion 0.00 0.00

Net Profit or (Loss): 287,472.00 23,956.00

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FOOTNOTES
Asset and Liability Footnotes
1 Balance as of March 31, 2020.
2 Balance per statement ending March 31, 2020.
3 This account was cashed out.
4 Value as of March 31, 2020.
5 This account was cashed out.
6 This account was cashed out.
7 Value as of March 31, 2020.
8 Balance as of February 29, 2020. Father is currently unable
to pay because of insufficient cash flow.
9 Balance per statement dated April 9, 2020.
10 Balance as of April 1, 2020.
11 Balance for family case as of February 29, 2020. Father is
currently unable to pay because of insufficient cash flow.
12 Balance as of April 17, 2020. Father is currently unable to
pay because of insufficient cash flow.
13 Balance as of February 29, 2020. Father is currently unable
to pay because of insufficient cash flow.
14 Balance per pre-bill on April 21, 2020 (amount subject to
change upon finalized invoices).
15 Father is currently unable to pay because of insufficient
cash flow.
16 Balance as of February 29, 2020. Father is currently unable
to pay because of insufficient cash flow.
18 Balance per statement dated April 4, 2020.
19 Balance per statement dated March 22, 2020.
20 Balance as of February 29, 2020.
21 Balance per statement dated April 10, 2020.
22 Value estimated per Father.
23 Value of real estate per Arlington County, Virginia
Department of Real Estate Assessments dated January 1, 2019.
Balance of mortgage per statement dated March 15, 2020.
24 Value unknown.
Income and Expense Footnotes
1 Estimated annualized average.

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