Cv100 Income And Expense Statement Of - Missouri Courts Page 2
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4II. My Spouse’s Current Estimated Monthly Gross Income
Source
Amount
Total
III. My Anticipated Expenses (Monthly Average – Itemize)
A.
Rent or mortgage payments (include home association dues)
B.
Maintenance & repairs of residence
C. Utilities
1.
Gas
2.
Water
3.
Electricity
4.
Telephone
5.
Trash Service
6.
Other
Total Utility Expense
D. Automobiles
1.
Gas and oil
2.
Maintenance
3.
Tax and license
4.
Payment of Loan
5.
Other
Total Automobile Expense
E.
Insurance
1.
Life
2.
Health, accident & dental
3.
Disability
4.
Homeowners (if not in mortgage payment)
5.
Automobile
6.
Other
Total Insurance Expense
F.
Taxes
1.
Real estate (if not in mortgage payment)
2.
Personal property
3.
Automobile
4.
Other
Total Tax Expense
G. Payments I make on debts
H. Child support I pay to others for children not in my custody and not involved in this
proceeding
I.
Maintenance or alimony paid by me to persons other than my current spouse
J.
Church and charitable contributions
OSCA (6-95) CV100
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