Domestic Relations Financial Affidavit - Dekalb County Superior Court Page 5
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6CHILDREN’S EXPENSES
Child Care (total monthly cost)
$
Allowance
$
School Tuition
$
Children’s Clothing
$
Tutoring
$
Diapers
$
Private lessons
Medical, Dental, Prescriptions
(e.g., music, dance)
$
$
(out-of-pocket uncovered expenses)
School Supplies / Expenses
$
Grooming / Hygiene
$
Lunch Money
$
Gifts from children to others
$
Other Educational Expenses (list type & amount):
Entertainment
$
Activities
(including extra-curricular,
______________________
$
$
school, religious, cultural, etc.)
______________________
$
Summer Camps
$
OTHER INSURANCE
Health Insurance
$
Life Insurance
$
Children’s portion:
$
Relationship of Beneficiary:
Dental Insurance
$
Disability Insurance
$
Children’s portion:
$
Other Insurance (specify)
$
Vision Insurance
$
$
Children’s portion:
$
$
YOUR OTHER EXPENSES
Dry Cleaning & Laundry
$
Publications
$
Clothing
$
Dues, Clubs
$
Medical / Dental / Prescription
$
Religious & Charities
$
(out-of-pocket uncovered expenses)
Your Gifts (special holidays)
$
Pet expenses
$
Entertainment
$
Alimony Paid to Former Spouse
$
Recreational Expenses
$
Child Support Paid for other children
$
(e.g., fitness)
Vacations
$
Date of initial CS order:
Travel Expenses for Visitation
$
Other (attach sheet to list)
$
TOTAL ABOVE MONTHLY EXPENSES (also write on first line of 2C on page one)
$
Domestic Relations Financial Affidavit -
Page 5 of 6
rev. January 8, 2007 - Tech. Rev. 10-2015
Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society
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