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Financial Statement LBF-D - Maryland
| Financial Statement Form. This is a Maryland form and can be used in Bankruptcy Court Federal . |
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APPENDIX A UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF MARYLAND IN RE: : : Case No. : Chapter Debtor(s) : Adversary proceeding No. F I N A N C I A L S T A T E M E N T Expenses Now MONTHLY INCOME MONTHLY EXPENSES: Party Children Paid by Spouse GROSS: $ Rent LESS DEDUCTIONS: House Payment Federal Tax Utilities: Heat Gas & Light State Tax FICA or Retirement Telephone Food All other deductions Medical, Dental Transportation NET INCOME: $ Insurance: Life Income from Health property Auto Other Income from any other sources Child Care Expense Tax Refund Recreation Monies from spouse Incidentals Periodic Pymts. TOTAL MONIES (attach list) RECEIVED: TOTAL EXPENSES: A S S E T S L I A B I L I T I E S $ $ TOTAL ASSETS: $ TOTAL LIABILITIES $ I HEREBY SWEAR OR AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE ABOVE FINANCIAL STATEMENT IS TRUE AND CORRECT. ________________________________________________________ (Party) (Date) Local Bankruptcy Form D
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