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Statement Of Income And Expenses - Tennessee

Statement Of Income And Expenses Form. This is a Tennessee form and can be used in Parenting Plan Chancery Court Williamson Local County .
 Fillable pdf Last Modified 8/17/2006
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IN THE _________________ COURT OF ________________ COUNTY, TENNESSEE __________________________, Plaintiff, vs. __________________________, Defendant. ) ) ) ) ) ) ) No. __________________ STATEMENT OF INCOME AND EXPENSES Comes now (Name of Party), the (Plaintiff/Defendant), who would show to the Court as follows: REGULAR INCOME: A. 1. Gross Wages and commission: Twice Monthly____________ Weekly___________ Monthly___________ $________________ 2. Deductions each pay period: FICA____________; Fed. Tax__________ Other_____________ -________________ 3. B. Net take-home earnings on a ____________ basis $ ________________ $ ________________ TOTAL$________________ (Weekly/Monthly) Other income (from any source) NET TAKE HOME ______________ 1 American LegalNet, Inc. www.USCourtForms.com He/she submits the following as an estimate of the necessary monthly expenses for support of him/herself (and children where applicable): A. General Expenses: 1. Rent or mortgage, including taxes and insurance 2. Utilities: Water__________; Gas_____________ Elec.__________; Tel._____________ TOTAL UTILITIES 3. 4. 5. $____________ $____________ Car Operation (gas, oil, repair, ins.) $____________ Insurance (life and other) $____________ Installment contracts and monthly payments: Personal loans____________; Auto_________________ Household _______________; Other _________________ _______________________________________________ TOTAL INSTALLMENTS CONTRACTS $____________ GENERAL EXPENSE TOTAL $____________ B. Other Expenses (monthly): Myself Children 1. Food ____________ __________ 2. Clothing ____________ __________ 3. Medical, Dental & Drugs ____________ __________ 4. Laundry & Cleaning ____________ __________ 5. Recreation (specify) ____________ __________ 6. School expenses ____________ __________ 7. Babysitting/Other Child Care ____________ __________ 8. Beauty or Barber Shop ____________ __________ 9. Other (specify) ____________ __________ 10. Other________________ ____________ __________ 11. Other________________ ____________ __________ Subtotals $____________ $__________ TOTAL $____________ EXPENSE $____________ (Weekly/Monthly) NET INCOME LESS EXPENSES $____________ I need $_____________ (Weekly/Monthly) Under penalty of perjury, I make oath that the information set forth above is true and 2 American LegalNet, Inc. www.USCourtForms.com correct to the best of my knowledge. This the _____ day of _____________, 20___. _____________________________________ Plaintiff/Defendant STATE OF TENNESSEE COUNTY OF __________________ Sworn to and subscribed before me on this the ______ day of ______________, 20___. _________________________________ Notary Public My Commission Expires____________________ CERTIFICATE OF SERVICE I hereby certify that a true and accurate copy of the foregoing has been furnished to ______________________ (attorney for the Plaintiff/Defendant) on this the ______ day of ___________________, 20_____. _______________________________ Attorney 3 American LegalNet, Inc. www.USCourtForms.com
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