Domestic Relations Financial Affidavit Page 4
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45 A. AVERAGE MONTHLY EXPENSES
(Re-calculate weekly/annual expenses to a monthly average)
HOUSEHOLD
OTHER INSURANCE
Mortgage or rent payments
$
Health
$
Property taxes
$
Life
$
Insurance
$
Disability
$
Electricity
$
Other (specify)
$
Water
$
AFFIANT’S OTHER EXPENSES
Garbage& Sewer
$
Dry cleaning and laundry
$
Telephone
$
Clothing
$
Gas
$
Medical/Dental
$
Repairs & Maintenance
$
Prescriptions
$
Lawn care
$
Affiant’s gifts (special holidays)
$
Pest Control
$
Entertainment
$
Cable TV
$
Vacations
$
Misc. household/grocery items
Publications
$
$
$
Dues, Clubs
$
Meals outside home
$
Religious, Charities
$
Other
$
Miscellaneous (attach sheet)
$
AUTOMOBILE
Other (attach sheet)
$
Gasoline and oil
$
Alimony paid to former spouse
$
Repairs
$
Child support paid to another
$
Auto tags and license
$
Insurance
$
CHILDREN’S EXPENSES
0.00
Child care
$
TOTAL ABOVE EXPENSES
$
School tuition
$
School Supplies/expenses
$
Lunch money
$
Allowance
$
Clothing
$
Diapers
$
Medical, dental, prescription
$
Grooming/hygiene
$
Gifts
$
Entertainment
$
Activities
$
This
day of
, 20
.
Notary Public
Affiant
Page 4 of 4
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