Financial Affidavit Page 2
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1
2INDIVIDUAL MONTHLY EXPENSES
SELF
CHILD
CHILD
CHILD
TOTALS
Name ____________________
Name ___________________
Name _____________________
Age ___________
Age ___________
Age ___________
School & Work Lunch
Medical/Dental
Drugs
Clothing
Grooming
Laundry/Cleaning
Entertainment
Recreation
Reading Material
Church Donations
Gifts, Christmas, etc.
Club Dues
Education
Allowances
Vacation
Gasoline
Car Repair &
Maintenance
Eating Out
Other
Other
Other
TOTALS
ASSETS AND DEBTS
Asset
Value
Debt
Balance Due
Monthly Payment
Real Estate
Real Estate/Mortgage
Vehicles
Vehicle
Stocks & Bonds
Loans
Accounts & Cash
Credit Cards
Other
Other
TOTALS
I certify that the aforementioned is true, complete and accurate to the best of my ability.
Sworn to and subscribed to before me
this ____ day of ____________, 20_______.
_________________________________
Affiant
___________________________________
Notary Public
My Commission Expires:
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