Domestic Relations Financial Affidavit Page 6
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6Dental:
Children's Portion:
Vision:
Children's Portion:
Life:
Children's Portion:
Disability:
Other (specify):
TOTAL ABOVE EXPENSES
5B.
PAYMENTS TO CREDITORS
(please select one)
To Whom:
Balance Due
Monthly Payment
Joint
Husband
Wife
TOTAL MONTHLY PAYMENTS TO CREDITORS:
5C.
TOTAL MONTHLY EXPENSES
This
day of
,
.
Notary Public
Affiant
Domestic Relations Financial Affidavit
Page 6 of 6
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