Financial Statement Page 6
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72.
HOUSING EXPENSES. List all housing expenses. If any payment you list is a payment on a debt, show the section and item
number where that debt is listed in Part II, Section I, Debts, on page 4.
Use applicable period, either:
Weekly
Monthly
Yearly
Section and Item No. -|
a) Mortgage
$
$
$
b) Rent
$
$
$
c) Taxes on residence
$
$
$
d) Home/Furnishings insurance
$
$
$
e) Repairs and maintenance
$
$
$
f) Water and sewer
$
$
$
g) Electricity
$
$
$
h) Heating and cooking fuel/Gas
$
$
$
i) Telephone
$
$
$
j) Cable TV
$
$
$
k) Other (Specify)
$
$
$
TOTALS
$
$
$
3.
HOUSEHOLD EXPENSES. List all household expenses. If any payment you list is a payment on a debt, show the section and
item number where that debt is listed in Part II, Section I, Debts, on page 4.
Use applicable period, either:
Weekly
Monthly
Yearly
Section and Item No. -|
a) Groceries
$
$
$
b) Clothing (self and children)
$
$
$
c) Laundry and dry cleaning
$
$
$
d) Toiletries and sundries
$
$
$
e) Grooming
$
$
$
f) General household supplies
$
$
$
g) Other (Specify)
$
$
$
TOTALS
$
$
$
4.
TRANSPORTATION EXPENSES. List all your transportation expenses. If any payment you list is a payment on a debt, show
the section and item number where that debt is listed in Part II, Section I, Debts, on page 4.
Use applicable period, either:
Weekly
Monthly
Yearly
Section and Item No. -|
a) Vehicle payments
$
$
$
b) Vehicle insurance
$
$
$
c) License, registration, taxes
$
$
$
d) Maintenance
$
$
$
e) Gasoline, oil, inspections
$
$
$
f) Parking, tolls
$
$
$
g) Other (Specify)
$
$
$
TOTALS
$
$
$
Pursuant to M.R.Civ.P. 108(d)(3), the information on this form is not subject to public inspection.
Page 6
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