Illinois > Local County > Kane > Family Court
Comprehensive Financial Statement Pursuant To Local Rule 15.24(c) P2-D-34 - Illinois
| Comprehensive Financial Statement Pursuant To Local Rule 15.24(c) Form. This is a Illinois form and can be used in Family Court Kane Local County . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. Plaintiff(s) Defendant(s) File Stamp COMPREHENSIVE FINANCIAL STATEMENT PURSUANT TO LOCAL RULE #15.13 (c) INSTRUCTIONS (1) All questions require a written response. If you do not have the information requested or do not know the answer to a particular question, indicate that as your answer. (2) Use additional sheets if necessary. (3) Attach copies of all supporting documentation in your possession. Petitioner/Respondent, , being duly sworn, states that the following is an accurate 12/6/08 statement as of , of his/her net worth (assets of both parties), a statement of income from all sources, a statement of monthly living expenses, a statement of health insurance coverage, and a statement of assets transferred of whatsoever kind and nature and wherever situated: Name: Address: Date of Marriage: Date of Separation: Children of this marriage: age age age age Current Employer: Self Employment: Other Employment: Check if unemployed Number of Paychecks per year (Please Select One) Number of Exemptions Claimed: Number of Dependents: Gross income from all sources last year: Gross income from all sources this year: 12 24 26 52 Other residing with residing with residing with residing with Address: Address: Address: Telephone No.: Social Security No. (last 4 digits only): Date of Birth: Date of Dissolution of Marriage: (if applicable) P2-D-034 (11/08) Page 1 of 10 American LegalNet, Inc. www.FormsWorkflow.com COMPREHENSIVE FINANCIAL STATEMENT (CONT) Case No. STATEMENT OF INCOME as of GROSS MONTHLY INCOME Salary/wages/base pay Overtime/commission Bonus Draw Pension and retirement benefits Annuity Interest income Dividend income Trust income Social Security Payments Unemployment benefits Disability payments Worker's Compensation Public Aid/Food Stamps Investment income Rental income Business income Partnership income Royalty income Fellowships/stipends Other income (specify) SUBTOTAL GROSS MONTHLY INCOME (Total of lines 1-21) Additional Cash Flow (monthly) Maintenance received (payments received prior to judgment or support orders in other actions) Line 1 Line 2 Line 3 Line 4 Line 5 Line 6 Line 7 Line 8 Line 9 Line 10 Line 11 Line 12 Line 13 Line 14 Line 15 Line 16 Line 17 Line 18 Line 19 Line 20 Line 21 Line 22 Line 23 Line 24 Line 25 Line 26 Child support received (payments received pursuant to Court order or voluntarily in this or other actions) SUBTOTAL ADDITIONAL CASH FLOW (Total of line 23 and 24) TOTAL MONTHLY GROSS INCOME FROM ALL SOURCES (Total of line 22 and 25) P2-D-034 (11/08) Page 2 of 10 American LegalNet, Inc. www.FormsWorkflow.com COMPREHENSIVE FINANCIAL STATEMENT (CONT) Case No. REQUIRED MONTHLY DEDUCTIONS Federal Tax (based on exemptions) Line 27 Line 28 Line 29 Line 30 Line 31 Line 32 Line 33 Line 34 State Tax (based on exemptions) FICA (or Social Security equivalent) Medicare Tax Mandatory retirement contributions required by law or as conditions of employment Union Dues (Name of Union Health/Hospitalization Premiums Prior obligation(s) of support actually paid pursuant to Court Order ) TOTAL REQUIRED DEDUCTIONS FROM MONTHLY INCOME (Add lines 27 through 34) NET MONTHLY INCOME (Line 26 minus line 35) Line 35 $0.00 Line 36 STATEMENT OF MONTHLY LIVING EXPENSES as of 1. Household a. Mortgage or rent (specify) b. Home equity loan/Second mortgage c. Real estate taxes, assessments d. Homeowners or renters insurance e. Heat/fuel f. Electricity g. Telephone (include long distance and cell) h. Water and Sewer i. Refuse removal j. Laundry/dry cleaning k. Maid/cleaning service l. Furniture and appliance repair/replacement m. Lawn and garden/snow removal n. Food (groceries, household supplies, etc.) o. Liquor, beer, wine, etc. p. Cable/Satellite/Internet q. Other (specify) SUBTOTAL HOUSEHOLD EXPENSES (Total of lines 37 through 53) Line 37 Line 38 Line 39 Line 40 Line 41 Line 42 Line 43 Line 44 Line 45 Line 46 Line 47 Line 48 Line 49 Line 50 Line 51 Line 52 Line 53 Line 54 P2-D-034 (11/08) Page 3 of 10 American LegalNet, Inc. www.FormsWorkflow.com COMPREHENSIVE FINANCIAL STATEMENT (CONT) Case No. MONTHLY LIVING EXPENSES CONTINUED 2. Transportation a. Gasoline b. Repairs c. Insurance/license/city stickers d. Payments/replacement e. Alternative transportation f. Other (specify) Line 55 Line 56 Line 57 Line 58 Line 59 Line 60 SUBTOTAL TRANSPORTATION EXPENSES (Total of line 55 through 60 3. Personal a. Clothing b. Grooming c. Medical (after insurance) 1. Doctor 2. Dentist 3. Optical 4. Medication d. Insurance 1. Life Insurance Premiums 2. Medical/Hospitalization Insurance Premiums 3. Dental/Optical Insurance Premiums e. Other (specify) Line 61 Line 62 Line 63 Line 64 Line 65 Line 66 Line 67 Line 68 Line 69 Line 70 Line 71 SUBTOTAL PERSONAL EXPENSES (Total of line 62 through 71 4. Miscellaneous a. Clubs/social obligations/entertainment b. Newspaper, magazines, books c. Gifts d. Donations, church or religious affiliation e. Vacations f. Other (specify) Line 72 Line 73 Line 74 Line 75 Line 76 Line 77 Line 78 SUBTOTAL MISCELLANEOUS EXPENSES (Total of line 73 through 78) P2-D-034 (11/08) Page 4 of 10 Line 79 American LegalNet, Inc. www.FormsWorkflow.com COMPREHENSIVE FINANCIAL STATEMENT (CONT) Case No. MONTHLY LIVING EXPENSES CONTINUED 5. Dependent children: Name Names and Ages Age Children's separate expenses a. Clothing b. Grooming c. Education 1. Tuition 2. Books/fees 3. Lunches 4. Transportation 5. Activities d. Medical (after insurance): 1. Doctor 2. Dentist 3. Optical 4. Medication e. Allowance f. Child care/after school care g. Sitters h. Lessons and supplies i. Clubs/summer camps j. Vacation k. Entertainment l. Other (specify) Line 82 Line 83 Line 84 Line 85 Line 86 Line 87 Line 88 Line 89 Line 90 Line 91 Line 92 Line 93 Line 94 Line 95 Line 96 Line 97 Line 98 Line 80 Line 81 SUBTOTAL CHILDREN'S EXPENSES: (Total of line 80 through 98) Line 99 TOTAL MONTHLY LIVING EXPENSES: (Add lines 54, 61, 72, 79 and 99) Line 100 P2-D-034 (11/08) Page 5 of 10 American LegalNet, Inc. www.FormsWorkflow.com COMPREHENSIVE FINANCIAL STATEMENT (CONT) Case No. STATEMENT OF CURRENT DEBTS/LIABILITIES (not previously listed on pages 1-5) Creditor's Name Purpose of Debt Balance Due Monthly Payment Monthly Debt Service RECAP NET MONTHLY INCOME (Line 36) TOTAL MONTHLY LIVING EXPENSES (Line 100) DIFFERENCE BETWEEN NET INCOME AND EXPENSES (Line 102 minus 103) LESS MONTHLY DEBT SERVICE (Line 101) INCOME AVAILABLE PER MONTH (Lin
|
|||||||
