Financial Disclosure Affidavit Form Page 6
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8Attachment 4
Step 8: ANNUAL EXPENSE AND LIABILITY INFORMATION
A. Expenses: In ordering support by the percentages the Court is not obligated to consider expenses. However,
if the Court varies from the percentages, expenses may be considered. List all expenses on an annual
basis:
1. Rent or mortgage payment
1. $_____________
2. Mortgage interest and amortization
2. $_____________
3. Realty taxes (if not included in mortgage payment)
3. $ _____________
4. Insurance on realty
4. $ _____________
5. Utilities: gas
electric/ water
telephone
cable _
5. $ _____________
6. Garbage collection
6. $_____________
7. Household repairs (specify:
7. $ _____________
8. Food
8. $ _____________
9. Auto expenses: gas
maintenance
insurance & fees
loan
9. $ _____________
10. Public transportation
10. $ _____________
11. Life insurance
11. $ _____________
12.Health insurance
12. $ _____________
13. Clothing: self $
others $
(explain:
)
13. $ _____________
14. Laundry and dry cleaning
14. $ _____________
15. Education and tuition (explain:
)
15. $ _____________
16. Child care
16. $ _____________
17. Contributions
17. $ _____________
18. Union dues (mandatory: yes
no
)
18. $ _____________
19. Entertainment
19. $ _____________
20. Miscellaneous personal expenses (specify:
)
20. $ _____________
21. Other (specify:
)
21. $ _____________
Total Expenses
$ _____________
(Go to B)
B. Liabilities, loans and debts: In ordering support by the percentages the Court is not obligated to consider
liabilities, loans, and debts. However, if the Court varies from the percentages, they may be considered.
List your liabilities, loans and debts as follows:
1. Creditor
2. Creditor
3. Creditor
Purpose
Purpose
Purpose
Date incurred
Date incurred
Date incurred
Total balance due $
__
Total balance due $
Total balance due $ ________
Total Liabilities, loans and debts = (1+2+3) $_______________
(Go to Step 9)
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