DIVORCE INCOME & EXPENSE QUESTIONNAIRE
VI. Income & Expense Information : (this information us used for the Income and Expense Declaration, Child Support Calculation, and Motions to request Modification of Support.)
A. Income:
Client Spouse
Deductions:
Gross monthly income
Disability/unemployment insurance
Public Assistance
Child/Spousal Support (prior)
Dividends & interest
Rents
All other sources
Income taxes (state/federal)
Social Security
Medical or other insurance (SDI)
Union or other dues
Retirement or Pension Fund
Savings Plan, Credit Union
Other (specify)
B. Monthly Expenses:
Specify which party is the custodial parent and list name and relationship of all members of the household whose expenses are included.
Client Spouse
Client Spouse
Rent or mortgage payments
Real property taxes
Real property insurance
Maintenance
Food/Household supplies
Utilities
Household repairs
Telephone
Laundry / cleaning
Clothing
Medical
Dental
Orthodontist
Insurance (life/health/accid.)
Child Care
Other Expenses for children:
Clothing
School lunches, milk
Medical
Special
Prescriptions
Vitamins
Doctors / Dentist (not covered by ins.)
Allowances
Tuition (schooling)
Lessons (music etc.)
Recreation, summer camp
Payment of child/spousal support
Entertainment
Adult Education
Clubs, dues, etc.
Costs of Employment (dues)
Incidentals
Transportation (public)
Auto Expenses (ins., gas, etc.)
Auto Payments
Installment payments (insert total &
itemize under C. Debts & Obligations below
Other (specify)
C. Debts and Obligations:
Creditor
For
Monthly Pmt.
Balance
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