IN THE CIRCUIT COURT FOR
                                   COUNTY,                               (STATE)

                                                        , Petitioner, being first duly sworn on oath, states as follows:

1. I am the Petitioner in this action, and I am making this Affidavit in support of my Motion for Temporary Relief.

2. It is in the best interest of our children that I be awarded temporary custody. I have been the primary parent for the children since they were born. (State other reasons):
                                                                                                           
                                                                                                            .

3. I am in need of financial assistance from Respondent to provide for the support of our children.

4. I am in need of temporary spousal maintenance from Respondent to provide support for me. (Give details regarding present financial circumstances):
                                                                                                           
                                                                                                            .

5. I do not have adequate funds at my disposal to pay my own attorney fees and costs, and I need financial assistance from Respondent to allow me to proceed with this action.

6. Respondent and I have the following debts. (Present financial circumstances regarding debts and obligations):
                                                                                                           
                                                                                                           .

7. I am asking the Court to award to me the temporary exclusive occupancy of the homestead for the following reasons. (State present circumstances):
                                                                                                           
                                                                                                           .

8. I am requesting temporary use and possession of the                           
                                             automobile because                                 
                                                                                                           .

          Subscribed and sworn to before me this          day of                    ,         .