Family Law Financial Affidavit (Page 5 of 8) in pdf

Family Law Financial Affidavit Page 5

OTHER MONTHLY EXPENSES NOT LISTED ABOVE

Monthly dry cleaning and laundry

Monthly clothing

Anything insurance does NOT pay.

Monthly medical, dental and prescription (unreimbursed only)

Anything insurance does NOT pay.

Monthly psychiatric, psychological or counselor (unreimbursed only)

Monthly non-prescription medications,cosmetics,toiletries and sundries

Monthly grooming

Monthly gifts

Annual Vet: $_______, Monthly Food: $_____,

Monthly pet expenses

Monthly Medications: $______, Kenneling

$________, Any other expense: $_______

Monthly club dues and membership

Monthly sports and hobbies

Monthly entertainment

Monthly periodicals/books/tapes/CD's

Monthly vacations

Monthly religious organizations

Monthly bank charges/credit card fees

Monthly education expenses

NOTE: This section is for your PERSONAL

expenses. Please complete each line item in this

section even if it does not have a specific note

attached.

MONTHLY PAYMENT TO CREDITORS (only when payments are currently made by YOU on outstanding balances)

* Explanations

NAME OF CREDITOR AND ACCOUNT NUMBER

Student Loan:

Please list any and all creditors and how much

you pay each creditor each month.

Student Loan:

Credit Card:

Page 5 of 8

Florida Family Law Rules of Procedure Form 12.902(c) Family Law Financial Affidavit

Family Law Financial Affidavit Page 5