Complaint For Divorce Page 23
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37Entertainment
$__________
Other (attach sheet)
$__________
Activities (including extra-curricular,
$__________
school, religious, cultural, etc.)
Summer Camps
$__________
OTHER INSURANCE
Health
$__________
Child(ren)’s portion:
$__________
Dental
$__________
Child(ren)’s portion:
$__________
Vision
$__________
Child(ren)’s portion:
$__________
Life
$__________
Relationship of Beneficiary:
____________
Disability
$__________
Other(specify):
$__________
TOTAL ABOVE EXPENSES
$ ________________
B. PAYMENTS TO CREDITORS
(please check one)
To Whom:
Balance Due Monthly
Joint
Plaintiff
Defendant
Payment
TOTAL MONTHLY PAYMENTS TO CREDITORS: $ ___________________
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