This is the small claims financial disclosure form which is called an “affidavit.” An affidavit is a sworn statement. You should use this form if at least one of the following is true:

• the court orders you to fill out a Financial Disclosure Affidavit
• someone has a judgment against you in small claims court and they have asked the court to enforce the judgment
• you have been sued in small claims court and agree you owe the money, but can’t pay the judgment
• you are being sued in small claims court and you want to let the court know that your income is protected

Do not use this small claims Financial Disclosure Affidavit if you want to start a case in small claims court. 

Information Checklist

Before you start, you will need:

• a copy of the Complaint or judgment, if there is one
• your income information, including information about any Reach Up, Social Security, Veterans Benefits or other public benefits you receive
• information about any valuable thing that you own (your assets)
• information about the income and benefits for any other person in your household
• information about the assets that people in your household own
• information about your expenses and bills you pay
• information about your household’s expenses and bills

You will need income and expense information for everyone in your “household.” A household is a group of people living together and sharing common living space and expenses. It doesn’t matter if they are related to you or not.

If you are living with someone and pooling resources together to pay for things like rent, food and utilities, you are both part of your household. Your dependent children are part of your household, too.

Adults who live together but have separate finances may have separate households. Examples of people who may not be included in your household could include:

• an adult child who only pays rent to you (then the rent will be part of your income)
• a person who only rents a room from you (this rent will be part of your income)
• an unrelated roommate who only splits the rent with you (then your expenses are only half the rent)
• divorcing spouses who have separated their finances

Before you start this form, you should pull together the household income and expenses information.

Small claims court is designed for people who are representing themselves. You can hire a lawyer if you want to, but you are not required to hire a lawyer. If you decide to represent yourself in small claims court, you can get more information about what you will need to do and how small claims court works by reading:

• our Small Claims Court page
• our Court Process: Small Claims Court page
• our Defend Yourself in Court page
• the Vermont Judiciary’s small claims pages

PDF of the Form to Print or Fill Out

This is a PDF of the Financial Disclosure Affidavit form.

Find more small claims court forms on the Vermont Judiciary website.