Sworn Financial Statement Page 4
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74.
Debts (unsecured)
List unsecured debts such as credit cards, store charge accounts, loans from family members, back taxes owed
to the I.R.S., etc. Do not list debts that are liens against your property, such as mortgages and car loans,
because that payment is already listed as an expense above, and the total of the debt is shown elsewhere as a
deduction from value where that asset is listed, such as under Real Estate or Motor Vehicles.
For name on account, "P" = Petitioner, "C/R” = Co-Petitioner or Respondent, "J" = Joint.
Name of Creditor
Account
P
C/R
J
Date of
Balance
Minimum
Reason for
Number
Balance
Monthly
Which Debt
(last 4-
Payment
was Incurred
digits
Required
only)
$
$
→
Total
Unsecured Debt Balance
$
$
Minimum
Monthly
Payment
SWORN FINANCIAL STATEMENT SUMMARY
(INCOME/EXPENSES)
Total Income
$ _____________
A
(from Page 1)
Total Monthly Deductions
$ _____________
B
(from Page 2)
Total Monthly Net Income (A minus B)
$ _____________
$ _____________
C
Total Monthly Expenses
(from Page 3)
Total Minimum Monthly Payment Required - Debts Unsecured
$ _____________
D
(from Page 4)
Total Monthly Expenses and Payments
(C plus D)
$ _____________
(+/-)
$ ______________
Net Excess or Shortfall
(Monthly Net Income less Monthly Expenses and Payments)
JDF 1111 R4/10 SWORN FINANCIAL STATEMENT – FORM 35.2
Page 4 of 7
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