Illinois > Local County > Sangamon > Family Law > Divorce
Affidavit Of Income Expenses Assets And Liabilities - Illinois
| Affidavit Of Income Expenses Assets And Liabilities Form. This is a Illinois form and can be used in Divorce Family Law Sangamon Local County . |
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In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon Cpunty, Springfield, Illinois (PetItIOner) vs. Case No. _ (Defendant} AFFIDAVIT OF INCOME AND EXPENSES, ASSETS AND LIABILITIES _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, PlaintifflDefendant, states as follows: Name: Address: _ Telephone number:. Date of Birth: _ Date of marriage (if applies): Dependent children of this relationship: _ Date of Separation: _ MlF MlF d/olb:. d/olb:. d/olb: d/olb: _ lives with lives with~ _ _ _ _ _ _ M/F M/F Current employer Other employer .lives with. ~-lives with, Address: Address: Number of paychecks per year (circle one): 12 Withholding status: Married Other dependents: Other dependents: Single 24 26 52 Other _ Number of exemptions claimed Relationship Relationship _ _ Form 25 American LegalNet, Inc. www.FormsWorkflow.com STATEMENT OF MONTHLY INCOME Gross income ti-c1111 all sources last calendar year: $ Gross income ii'om all sources year to date. through ,(date):$. _ _ Gross monthly income (if paid weekly, mUltiply be 4.33, if paid bi-weekly multiply by 2.17): S,t1ary: Bonus: Disability: U nem pi oylll en t: $- - - - - - - - $- - - - - - - $- - - - - - - - $------- -- Overtime: Draw: Social Secunty: Rental InCllmc: $ $ $ $ $ $ $ $ I)uhlic Aid: Business: Mall1tenanee: $ $ .$ _ _ _ Investment: Partnership: Other: Total gross monthly income: Additional· Child Support: $ Statutory deductions: reeler'll lax: Stale lax: Social Security: Medicare: Mandatory retircmcnt contrihutions: Medical Insurance: Union dues: Prior obligations of child support actually heing paid: Other (specify) $ $ $ . _ _ _ _ $ $ _ _ $. $ $ _ _ $ _ STATEMENT OF MONTHLY LIVING EXPENSES as 01' (Do not duplicate, list only under one category) 1. Household Expenses Mortgagelrental (circle one) $,-------------- _ American LegalNet, Inc. www.FormsWorkflow.com Household expenses (continued) Home equity loan/second mortgage Real estate taxes Homeowners or renter's insurance Heatlfue1 Electricity Telephone Cell phone Cable television Water and sewer Computer/internet Garbage removal Laundry/dry cleaning Household maintenance Food and household supplies Eating out Other (specify) Total household expenses: 2. TranspOliation (number ofvehicles Insurance/license Gasoline Repairs Other transportation Total transportation expenses: 3. Persona1 Clothing Grooming(hair care/cosmetics/etc.) Medical (after insurance) Doctor Dentist -----') $,------------- $ ------------- , $,-------------- $,-------------- $,-------------- $-------------- $,-------------- $,-------------- $--------------- $- - - - - - - - - - - - - - - - - $------------- $,------------- $ $,-------------- $-------------- $------------- _ $------------- $'-------------- $,------------ $- - - - - - - - - - - - - $- - - - - - - - - - - - - $,------------ $------------- $ ------------- $------------ $-------------- $,-------------- American LegalNet, Inc. www.FormsWorkflow.com Personal (continued) Prescribed medicine Counseling Life insurance premiums Medical insurance (not withheld from pay) Dental insurance (not withheld from pay) $, _ $, _ $, _ $, $, $, _ _ _ Total personal expenses: 4, Miscellaneous Clubs/entertainment Newspaper/magazines Gifts Donations Vacations Voluntary contributions to retirement pension Other (specify) $ $ _ _ $- - - - - - - - - - - - - - - $ $ _ _ $ $ $, _ _ _ Total miscellaneous expenses: 5. Children's separate expenses (identify special needs) Clothing Grooming Education Tuition Books/fees Lunches Transportation Activities Allowance Child care/before and after school care Lessons and supplies Summer camps $ $ _ _ $ $ $ _ _ $- - - - - - - - - - - - - - - $ $ _ _ $ $ $ _ _ _ $, _ American LegalNet, Inc. www.FormsWorkflow.com Children's expenses (continued) Vacation Entertainment $,-------------- $,------------- _ Other (specify) $-------------- $,-------------- $,---------------- Total children separate expenses: TOTAL MONTHLY LIVING EXPENSES STATEMENT OF DEBTS - use additional sheets if necessary Creditor Purpose Balance Due Monthly payment STATEMENT OF ASSETS· use additional sheets if necessary Real estate: Address Ownership Possessed by Value Motor vehicles: Vehicle Ownership Possessed by Value American LegalNet, Inc. www.FormsWorkflow.com Retirement accounts: Plan llame Type of plan Ownership Value Bank/credit union accollnts: Bank Typc of account Ownership Balance Life illsUl-ancc: Company Death bencfit Owner Beneficiary Whole/term I Value I Description Ownership Possessed by Value , I Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedurc, the undersigned hereby certifies that the statements set forth in the foregoing Affidavit are true and correct Datc: _ Affiant American LegalNet, Inc. www.FormsWorkflow.com
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