Financial Affidavit Short Form Page 2
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4B. Personal Expenses
Food
Dry Cleaning/Laundry
Meals outside the home
Affiant’s beauty salon
Affiant’s Clothing
Cosmetics/Toiletries
Misc.
Total Personal Expenses–>
C. Automobile Expense
Gas and Oil
Repairs
Auto Tags and License
Car Insurance
Misc.
Total Auto Expenses–>
D. Medical Expenses
Medical Insurance
Co-Payments
Dental Insurance
Prescriptions
Misc.
Total Medical Expenses–>
E. Child Expenses
Day/After School care
School tuition
Lunch money
School Supplies
Allowance
Clothing
Activity fees
Grooming
Medical Insurance
Dental Insurance
Prescriptions
Co-Payments
Medical supplements
Misc.
Total Child Expenses–>
F. Other Expenses
Life insurance
Gifts to others
Professional dues
Membership dues
Social Dues
Tuition (for Affiant)
Vacations
Subscriptions
Entertainment
Charity
Religious donations
Misc.
Total other expenses–>
G. Assets
Cash on hand and in banks
Stocks/Bonds/Notes
Real Estate
Automobiles
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Parent category: Legal