Family Court Financial Statements – Tips for Veterans

Tips for Veterans on How to Fill Out a Financial Statement for Probate and Family Court

To download these instructions as a PDF, click here.

The Probate and Family Courts require you to fill out a Financial Statement in divorce cases, separate support cases, child custody cases, and child support cases and in some other family law cases. The Financial Statement should be printed on pink paper which helps the court staff keep this document separate from the public court file. Remember that you are signing the Financial Statement under the pains and penalties of perjury and the court will make important decisions based on the information you provide. It is important to take your time and complete the form carefully and as accurately as possible.


MassLegalHelp has an excellent guide describing how to fill out the short form Financial Statement, for people whose gross income is less than $75,000 a year. This instruction sheet written by Veterans Legal Services’ (VLS) describes additional issues that you should consider as a veteran. It is meant to supplement MassLegalHelp’s information and is not a sub. VLS recommends referring to both this instruction sheet and MassLegalHelp’s website together when you fill out the pink Financial Statement the court requires.


It is best to bring a copy of all supporting documentation you used to complete the Financial

Statement with you when you go to court. (Paystubs, letters, bank statements, and so on).


Section 1. Personal Information

Fill in the information requested. Include your name and address, unless your address is impounded or protected under a restraining order, harassment prevention order or under the MA Secretary of State’s Address Confidentiality Program.


Occupation: Identify what you do. If you are disabled, work part-time, or are a student, list that information here.


Health Insurance: Identify your insurance provider. If you receive VA healthcare, note that even though VA healthcare is not technically insurance.


Section 2. Gross Weekly Income from All Sources

Here, you need to provide information about your weekly income. If you are paid once a month,

divide your monthly income by 4.3 to get your weekly income. If you are paid bi-weekly divide by 2.  If your pay changes from paycheck to paycheck, use the average of your last 3 paystubs and convert that to a weekly figure.


Any and all sources of income should be listed on your financial statement. This includes income that may not necessarily be counted for child support purposes or that you might have been told you do not need to report in other contexts. For example, it does not matter if your income is taxable or not, you still need to list it.





List any and all income you receive, including from the following sources:



  • active duty military pay (including any basic housing allowance);
  • active duty military allotments or allowances;
  • military retirement pay (a.k.a. a military pension);
  • disability retirement pay (a.k.a a military disability pension);
  • military survivor benefits,
  • combat special related compensation;
  • concurrent retirement and disability pay;
  • G.L. Ch. 115 benefits;
  • supplemental security income (SSI);
  • VA non-service connected “pensions”;
  • social security disability income (SSDI);
  • VA compensated work therapy (CWT) benefits;
  • any service-connected disability compensation.
  • VA vocational rehabilitation benefits; and
  • GI Bill benefits.




Sections 3. Itemized Deductions from Gross Income and Section 4. Adjusted Net Weekly Income

Look at MassLegalHelp’ s instruction sheet. You should be able to obtain this information from your pay stubs or your benefit award letter.


Section 5. Other Deductions from Salary/Wages

Line d: If the VA or anyone else is deducting money directly from your pay or benefits (such as for an overpayment), include that information here.


Section 6. Net Weekly Income

Look at MassLegalHelp’s instruction sheet.


Section 7. Gross Yearly Income from Prior Year

Look at MassLegalHelp’s instruction sheet. Use your best estimate if you do not have a copy

of your W-2 and 1099 forms. You can also refer to your Social Security statement if necessary. If you estimate, please make sure to indicate that on the form.


Section 8. Weekly Expenses

Look at MassLegalHelp’s instruction sheet. Again, this is for weekly expenses, so if you make a monthly payment, such as for rent, take that amount and divide it by 4.3 to get the amount you pay per week.  If you receive assistance for utilities or food, list what you actually pay per week and make a note that you receive assistance such as a housing voucher, SNAP, etc.


Line (s): Under “Other”, you should also include any expenses to maintain your pets, for a T-Pass, cable, storage unit, etc. that is not included in another category.


Section 9. Counsel Fees

Note that VLS and most other legal aid organizations do not charge fees for their services.  If you do not have an attorney, it is ok to write in 0s here.


Section 10. Assets

Look at MassLegalHelp’s instruction sheet. A few additional tips:


Line (a): You may use a website like Zillow to estimate the fair market value of any real estate you own.  However, this is not a substitute for obtaining an appraisal from a licensed agent which the Court may require in some cases.


Lines (b) and (g): Although the MassLegalHelp’s instruction sheet refers to automobiles and personal property that you or “your spouse” owns, this refers to anything you own individually or jointly with another person even if you are not married.


Line (b): You may look at Kelley Blue Book to determine the fair market value of your car, minus any outstanding loan on your vehicle.  If you lease a car, use this section to note the lease and any lease payments you make.


Lines (c) and (f): Under the Court rules, Financial Statements are not part of the public court file, but because the completed pink Financial Statement filed at court may accidentally be seen by members of the public, we recommend that you do not include full account numbers. Instead, just provide the bank name and the last four digits of all accounts you list.


Line (c): Remember to include any lump sum retroactive military or social security payments as assets.


Section 11. Liabilities

List all of your debts in this section, including any overpayments you owe to the VA, Ch. 115, or Social Security. Look at MassLegalHelp’s instruction sheet for more information. It may be helpful to obtain a copy of your credit report to complete this section.  You can request your credit report for free annually at



This Financial Statement is an important legal document and you need to take care to complete it accurately and to the best of your ability. The court will heavily rely on this document to make decisions in your case. You will be signing the document after certifying, under “penalties of perjury” that all the information you have included is true to the best of your knowledge. If you do not tell the truth, you can be punished by the court. And it is important to remember that it will be very difficult to regain your credibility if you give the court reason to distrust you.



By:      Pamela J. Meister, Esq., Access to Justice Fellow

Eve Elliott, Esq., Senior Staff Attorney, Veterans Legal Services





Veterans Legal Services’ Disclaimer

Each person’s situation is unique. This document is intended to provide helpful information to

the many veterans who need help to complete the Probate and Family Court’s Short Form

Financial Statement. VLS does not intend that you rely on this document as legal advice. If you

need legal advice, please consult an attorney.


Contact us

Veterans Legal Services

P.O. Box 8457
Boston, MA 02114

Tel: (857) 317-4474
Fax: (844) 621-2797