Domestic Relations Financial Affidavit - Superior Court Of Gwinnett County Page 6
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7Other Educational
Expenses (list type &
amount):
Entertainment
Activities (including extra-
curricular, school, religious,
cultural, etc.)
Summer Camps
Total Children's Expenses
$
INSURANCE
Health
Child(ren)’s portion-health
Dental
Child(ren)’s portion – dental
Vision
Child(ren)’s portion – vision
Life Insurance
Beneficiary – Life
Disability
Other Insurance (specify)
Total Insurance Expenses
$
Total Child(ren)’s Portion
$
OTHER EXPENSES
Dry cleaning & laundry
Publications
Clothing
Dues, Clubs
Medical/Dental/Prescription (out
of pocket uncovered expenses)
Religious & Charities
Your Gifts (special holidays)
Pet expenses
Entertainment
Alimony paid to former spouse
Recreational Expenses (e.g.
Child support paid for other
fitness)
children
Vacations
Date of initial CS order:
Travel expenses for visitation
Other (attach sheet to list)
Total Other Expenses
$
5(A)
TOTAL MONTHLY EXPENSES (add
household, transportation, children’s,
insurance, and other expenses)
$
Domestic Relations Financial Affidavit – Revised May 2016
6
Provided by the Gwinnett Family Law Clinic
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