SAMPLE FINANCIAL INFORMATION SHEET
CAUSE NO: __________________________________________
DISTRICT COURT COUNT _____________________________
PETITIONER ________________________________________
RESPONDENT ______________________________________
ATTORNEY FOR PETITIONER ________________________________________________
ATTORNEY FOR RESPONDENT ________________________________________________
DATE OF MARRIAGE: ________________________________________________
DATE OF PRIOR ORDER: ________________________________________________
NAMES and AGES OF CHILDREN OF MARRIAGE:
1._________________________________________________________________________________
2._________________________________________________________________________________
3._________________________________________________________________________________
4._________________________________________________________________________________
MONTHLY EXPENSES:
HOUSING:
House payments/rent ....................................$_____________
Utilities [gas, water, elec., phone] ....................................................................$_____________
Maintenance, repair .....................................$_____________
Taxes and Insurance.....................................$_____________
Cell Phone....................................................$_____________
Cable............................................................$_____________
TRANSPORTATION:
Car payment .................................................$_____________
Car Insurance.................................................$_____________
Gasoline, Oil, Maintenance, etc. .....................$_____________
Parking and tolls ............................................$_____________
INSURANCE:
Life ................................................................$_____________
Health ............................................................$_____________
(parties included)
GROCERIES:...............................................$_____________
PERSONAL:
Work Expenses:
Lunches
Dues, fees
Medical (not covered by insurance)
Doctors/Dentists
Drugs
Clothing
Cleaning, Laundry
Grooming [haircuts, etc.]
Entertainment [cable television]
Current child support
Other
CHILDREN:
Child Care:
School:
Tuition, fees
Books (if private school)
Uniforms
Lunches
Supplies
Medical [not covered by insurance]
Doctors/Dentists
Drugs
Clothing
Cleaning, Laundry
Grooming [haircuts, etc.]
Entertainment, activities
Camp
Other
MISCELLANEOUS:
MONTHLY OUTSTANDING DEBTS:
ITEMIZE CONSUMER DEBT (credit card):
TOTAL MONTHLY EXPENSES:...................................................$________________
MONTHLY INCOME
[Pay period - ( ) Monthly ( ) Weekly ( ) Twice a Month]
GROSS MONTHLY INCOME: [attach 3 pay stubs)
DEDUCTIONS:
Federal withholding tax $
FICA
Retirement
Health, hospitalization, life ins.
Other: Business expenses,
including malpractice
NET INCOME:........................................................................................$_______________
CURRENT CHILD SUPPORT:
OTHER INCOME: Source
TOTAL MONTHLY INCOME:..............................................................$_______________
LIQUID ASSETS: [Cash, etc.]
I certify that the above answers to the questions as listed are
true and correct.
Signature__________________________________________________
_______________________________________________
John
C. Mallios & Associates, PC
|
5910
N. Central Expressway
Suite 760
Dallas, Texas 75206
214-373-6566
|
114
North Rogers Street
Waxahachie, TX 75165
972-938-1529 |
To
Send E-Mail: Information@MalliosLaw.com
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advice of an attorney. This website is not intended to be legal
advice. This website does not constitute an attorney client
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client relationship. For personal advice it is important to
phone the office of John C. Mallios and Associates, PC and set
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