Name: Default Divorce Forms Set C Squarespace | airSlate SignNow
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NO.______________________ IN THE MATTER OF § IN THE DISTRICT COURT THE MARRIAGE OF§§ §AND§_______ JUDICIAL DISTRICT §§AND IN THE INTEREST OF§ and ,§ COUNTY, TEXASCHILDREN§§ AFFIDAVIT OF INABILITY TO PAY COSTS STATE OF TEXAS§COUNTY OF § BEFORE ME, the undersigned authority, on this day personally appeared _____________, who by me being duly sworn, on oath stated: "My income, resources and expenses are set out in the schedule below: MONTHLY INCOME: Amount Source or Descriptiona) Public Benefits: _____________________________________b) Net Employment: _____________________________________c) Other Income: _____________________________________d) Spouse's Income: _____________________________________ (if applicable) _____________________________________ NUMBER OF DEPENDENTS: ____ PROPERTY:a)Cars or Trucks (Year/Make):1._____________________________2._____________________________ b) Checking and/or Savings Account: Bank:_____________________________Amount:_____________________________ c) Cash: _____________________________ MONTHLY EXPENSES:Rent/Mortgage:_____________Car Payment:_____________Transportation:_____________Insurance:_____________Clothing/Laundry:_____________Food:_____________Child Care: _____________Medical/Dental:_____________Utilities:_____________Other:_____________TOTAL MONTHLY EXPENSES: _____________ DEBTS AND CHILD SUPPORT OBLIGATIONS (exclude house and automobile): Creditors Monthly Payment1.____________________________________2.____________________________________3.____________________________________4.____________________________________5.____________________________________ "I am unable to pay the court costs in this cause. I verify that the statements made in this affidavit are true and correct." _______________________________ , AFFIANT SUBSCRIBED AND SWORN TO this __________ day of _________________, ______. __________________________________Notary Public, State of Texas

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