Form #4 - Financial Affidavit - Pitt County General Court Of Justice Page 2

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Form #4
Part 1
Regular Recurring Fixed Monthly Expenses
Expense
Date of Separation
Current
Date:
Date:
Rent or Mortgage
nd
2
Mortgage Payment
Homeowners Insurance
Routine house & appliance
repair/maintenance
Electricity
Cable, digital television and
internet service
Cellular Phone
House cleaning service
Pest control services
Automobile payments
Auto insurance
Gasoline (auto)
Auto repair/maintenance,
registration, taxes
Food and household
supplies
Pets (insurance, vet, food,
kennel)
Other:
GRAND TOTALS FOR
PART 1:
2
Pitt County Family Court Domestic Forms, 2017

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