This form is approved by the Illinois Supreme Court and is required to be used in all Illinois Circuit Courts.
STATE OF ILLINOIS,
CIRCUIT COURT
COUNTY
Additional Life Insurance Policies
(FINANCIAL AFFIDAVIT)
Pre-Judgment
Post-Judgment
For Court Use Only
Instructions
Petitioner (First, middle, last name)
v.
Respondent (First, middle, last name)
Enter above the
county name where
the case was filed.
Enter name of the
Petitioner, the
Respondent, and the
case number as listed
in the initial Petition
or Complaint.
Case Number
Enter the Case
Number given by the
Circuit Clerk.
IMPORTANT: If you intentionally or recklessly enter inaccurate or misleading information on this form, you may face
significant penalties and sanctions, including costs and attorney's fees.
Fill out this form only
15.
My Assets
if you have additional
Life Insurance
f.
Life Insurance Policies (list cash balance as of the date of this affidavit)
Policies. If you fill it
out, attach this form to
your Financial
Affidavit.
In 15f, enter
information about each
life insurance policy
you have for yourself,
the other party, or your
children.
Name of Insurance Company
Type of Policy
Death Benefit
Cash Value
4.
$
$
5.
$
$
6.
$
$
7.
$
$
8.
$
$
9.
$
$
10.
$
$
11.
$
$
12.
$
$
13.
$
$
14.
$
$
15.
$
$
16.
$
$
17.
$
$
18.
$
$
19.
$
$
20.
$
$
21.
$
$
22.
$
$
23.
$
$
24.
$
$
25.
$
$
DV-LI 130.2
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