Fill and Sign the Financial Statement District of Columbia Form

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY DIVISION HUSBAND / WIFE'S FINANCIAL STATEMENT Monthly or Weekly Income: Monthly or Weekly Expenses: Gross: (Wages) $       Rent $       Less deductions: House payment $             $       Food $             $       Clothing $             $       Medical, dental $       Transportation $       Net income $       Recreation $       Insurance $       Income from properties: Realty taxes $             $       Light, gas, telephone $       Heat (average 52 weeks) $       Income from other sources (other than husband [wife]) (Please itemize): Incidentals $       Periodic payments required on bills:       $             $             $             $             $             $             $             $             $             $       TOTAL INCOME $       TOTAL EXPENSES $       SUMMARY Total income $       Less Total Expense $       Net income $       ASSETS LIABILITIES (List cash, bonds, bank accounts, real and personal property either owned separately by husband or jointly with wife). (Money owing by husband, to whom and in what amounts).       $             $             $             $             $             $             $             $             $             $             $             $       (If insufficient space, list on separate sheet and attach as an exhibit). TOTAL ASSETS $       TOTAL LIABILITIES $       SUMMARY Total assets $       Less Total liabilities $       Net worth $       ________________________________ Husband (Wife)