L:Financial Information Statement - Rowlett Family Law

Cause No. ___________

}

IN THE DISTRICT COURT

v.

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OF ________ COUNTY, TEXAS

}

________JUDICIAL DISTRICT

FINANCIAL INFORMATION STATEMENT

(REQUIRED IN ALL FINANCIAL HEARINGS)

MONTHLY EXPENSES:

MONTHLY EXPENSES (cont.)

PRESENT

PRESENT

YOUR CHILDREN

HOUSING

House Mortgage/Rent Utilities

(Gas, water, etc) Maintenance & Repair Other _____________

TRANSPORTATION

Gas, Oil, Maintenance Car Payment/Lease Parking Tolls

_ ________

________

Child Care School Tuition, Fees Lunches Supplies Medical Expenses (not covered by ins):

Drugs Doctors, Dentists Grooming Entertainment Sports, Lessons, et. Other:__________________ __________________

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______

_______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______

INSURANCE

Auto(s) Life Other _____________

GROCERIES

Food & Household Supplies

YOUR PERSONAL

Work Expenses: Lunches, etc. Dues, Fees, etc. Medical Expenses (not paid by ins):

Drugs Doctors, Dentists Clothing Cleaning, Laundry Grooming Entertainment Current Child Support Other: __________________ __________________

CREDIT CARD/DEBTS

__________________ __________________ __________________ __________________

Monthly Attorney Fees

________ ________ ________

TOTAL EXPENSES:

_______ _______

==============================================

INCOME: (attach current pay stubs)

[ ] paid monthly

[ ] paid semimonthly

[ ] paid weekly

[ ] paid every two weeks

==============================================

GROSS INCOME

_______ _______

________ ________ ________

________

________ ________

_______ _______ _______ _______

_______ _______ _______ _______

_______ _______ _______ _______

_______ _______

DEDUCTIONS Withholding Tax FICA Mandatory Retirement Medical Insurance

Children Other Family Life Insurance Other

_______ _______ _______ _______ _______ _______ _______ _______

_______ _______ _______ _______ _______ _______ _______ _______

OTHER INCOME

_______ _______

NET INCOME

_______ _______

LIQUID ASSETS:

_______ _______

==============================================

I hereby certify that the answers to the above questions as listed are true and correct.

___________________ Date

_________________________________________ Signed

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