Fill and Sign the Cc Dr 031 Form

Circuit Court for Case No. City or County Plaintiff Defendant Address City, State, Zip Name Address FINANCIAL STATEMENT OF (General) (CC-DR-031) vs. ITEM SELF CHILDREN TOTAL A. PRIMARY RESIDENCE Mortgage Insurance (homeowners) Rent/Ground Rent Taxes Gas & Electric Electric Only Heat (oil) Telephone Trash Removal Water Bill MONTHLY EXPENSES Page 1 of 6 CC-DR-031 (Rev. 09/2016) (Name) Name City, State, Zip (Md Rule 9-203 (a)) Telephone TelephoneCell Phone/Pager Repairs Children Age Lawn & Yard Care (snow removal) Replacement Furnishings/Appliances Condominium Fee (not included elsewhere) Painting/Wallpapering Carpet Cleaning Domestic Assistance/Housekeeper Pool Other: SUB TOTAL B. SECONDARY RESIDENCE (i.e. Summer Home/Rental) Mortgage Insurance (homeowners) Rent/Ground Rent Gas & Electric Electric Only Heat (oil) Telephone Trash Removal Water Bill Cell Phone/Pager Repairs Lawn & Yard Care (snow removal) Page 2 of 6 CC-DR-031 (Rev. 09/2016) C. OTHER HOUSEHOLD NECESSITIESReplacement Furnishings/Appliances Condominium Fee (not included elsewhere) Painting/Wallpapering Carpet Cleaning Domestic Assistance/Housekeeper Pool Other: SUB TOTAL FoodTaxes Drug Store Items Household Supplies Other: SUB TOTAL D. MEDICAL/DENTAL Health Insurance Therapist/Counselor Extraordinary Medical Dental/Orthodontia Ophthalmologist/Glasses Other: SUB TOTAL E. SCHOOL EXPENSES Tuition/Books School lunch Page 3 of 6 CC-DR-031 (Rev. 09/2016) Extracurricular activities Clothing/Uniforms Room & Board Daycare/Nursery School Other: SUB TOTAL F. RECREATION & ENTERTAINMENT Vacations Videos/Theater Dining Out Cable TV/Internet Allowance Camp Memberships Dance/Music Lessons etc. Horseback Riding Other: SUB TOTAL G. TRANSPORTATION EXPENSE Automobile Payment Automobile Repairs Maintenance/Tags/Tires/etc. Oil/Gas Automobile Insurance Parking Fees Bus/Taxi Page 4 of 6 CC-DR-031 (Rev. 09/2016) Other: SUB TOTAL H. GIFTS Holiday Gifts Birthdays Gifts to Others Charities SUB TOTAL I. CLOTHING Purchasing Laundry Alterations/Dry Cleaning Other: SUB TOTAL J. INCIDENTALS Books & Magazines Newspapers Stamps/Stationery Banking Expense Other: SUB TOTAL K. MISCELLANEOUS/OTHER Alimony/Child Support (from a previous Order) Religious Contributions Page 5 of 6 CC-DR-031 (Rev. 09/2016) Hairdresser/Haircuts Manicure/Pedicure Pets/Boarding Life Insurance Other: SUB TOTAL TOTAL MONTHLY EXPENSES: Number of Dependent Children, including children who have not attained t\ he age of 19 years, are not married or self-supporting, and are enrolled in secondary school: GROSS MONTHLY WAGES: Deductions: Federal State Medicare F.I.C.A. Retirement Total Deductions: NET INCOME FROM WAGES: OTHER GROSS INCOME: (alimony, part-time job, rentals etc.) INCOME STATEMENT Total deductions from Other income:Deductions: a. b. NET OTHER INCOME TOTAL MONTHLY INCOME c. Page 6 of 6 CC-DR-031 (Rev. 09/2016) Real Estate Furniture (in the marital house) Bank Accounts/Savings U.S. Bonds Stocks/Investments Personal Property Automobiles Boats Other: TOTAL ASSETS: LIABILITIES: Mortgage Automobiles Notes payable to relatives Bank Loans Accrued Taxes Balance of Credit Card Accounts a. b. ASSETS & LIABILITIES JewelryASSETS: c. Other: TOTAL LIABILITIES TOTAL NET WORTH: SUMMARY: TOTAL INCOME: TOTAL EXPENSES: EXCESS OR DEFICIT: I solemnly affirm under the penalties of perjury that the content\ s of the foregoing Financial Statement, Monthly Expense List, and Assets and Liabilities Statement are true to t\ he best of my knowledge, information, and belief. Date \ \ Signature