Domestic Relations Financial Affidavit Page 6
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13Insurance
$ ________________
Other (Attach sheet)
$ ________________
OTHER EXPENSES
Life Insurance
$ ________________
Disability Insurance
$ ________________
Dry cleaning and laundry
$ ________________
Grooming
$ ________________
Clothing
$ ________________
Medical/dental (out of pocket/uncovered expenses)
$ ________________
Prescriptions (out of pocket/uncovered expenses)
$ ________________
Gifts (special holidays)
$ ________________
Entertainment
$ ________________
Vacations
$ ________________
Travel expenses necessary for parenting time/visitation
$ ________________
Retirement/401-K Contributions
$ ________________
Publications
$ ________________
School alumni dues
$ ________________
Union dues
$ ________________
Club membership dues and expenses
$ ________________
Religious and charities
$ ________________
Professional expenses (other than this proceeding)
$ ________________
Bank charges/credit card fees
$ ________________
Miscellaneous (attach sheet)
$ ________________
Other (attach sheet)
$ ________________
Alimony paid to former spouse(s)
$ ________________
Child support paid for other children
$ ________________
(Date of initial order: ___________________
County and State: __________________
Case number: __________________)
CHILDREN'S EXPENSES (Per child)
NAME
NAME
NAME
NAME
__________ __________ _________
_________
Child care- school year
$_________ __________ _________
_________
Child care- summer
$_________ __________ _________
_________
School tuition
$_________ __________ _________
_________
School uniform
$_________ __________ _________
_________
Other school expenses
$_________ __________ _________
_________
Private lessons (e.g. music,
dance, etc)
$_________ __________ _________
_________
Tutoring
$_________ __________ _________
_________
Lunch money
$_________ __________ _________
_________
Domestic Relations Financial Affidavit
Fulton County Family Division
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal