Income and Expense For Defendant Form

In the case of wanting to disclose the financial situation of a spouse who is involved in a divorce case but didn’t file for that divorce in the State of Hawaii, the following form has to be completed and submitted.

Extracted Text for Proper Search

STATE OF HAWAII 
FAMILY COURT 
      CIRCUIT INCOME AND EXPENSE STATEMENT 
 for DEFENDANT      CASE NUMBER 
      
FC-D NO. 
                                                                                              _______________________________________                                                                              PLAINTIFF 
 
                                                                          (Plaintiff’s Full Name) 
 
                         VS. 
 
                                                                                       
_______________________________________ 
                                                                                 DEFENDANT 
                                                                       (Defendant’s Full Name) This document is prepared by   Defendant       Atty. For Defendant 
_______________________________________ 
Name 
_______________________________________ 
_______________________________________ 
Address 
_______________________________________ 
City, State, Zip 
_______________________________________ 
Phone  
 
 
Occupation:  ______________________________________________________________________________Job Title 
Employer:   ______________________________________________________________________________ 
Address:       ______________________________________________________________________________ 
Length of Service:        months/years. 
 
Income Tax Withholding based on:        dependants. 
 
INCOME 
 
Gross income.  Paid       monthly,    2 times per month,    every 2 weeks,    weekly,   or other       
 
Gross per pay period …………………………………..  $                 Per Month ……………………….  $            
 
Payroll deductions per pay period: 
 
             Fed. Income tax ………………………………   $            
             State income tax ………………………………  $            
             FICA (Social Security) ………………………   $            
             Union dues ……………………………………  $            
a) Net per pay period ………………………  $                Per month ……..  $            
 
Other: 
Retirement/401K………………….………   $            
Credit Union………………………………   $            
Direct Deposit………………………….…   $            Income Assignments………………………   $            
Support Payments…………………………   $            
Medical Insurance…………………………   $            
b)  Take home per pay period……………  $                Per month ……..  $            
 
Other regular monthly income, (rental income, 2nd
 job, interest, child support, welfare, food stamps, and any 
other source.) 
Gross monthly receipt………………….…   $            
Taxes paid IRS and State on above…….…   $            
c) Total other income net………………….….…..   $            
 
Total Monthly Income (Add per month income from lines a and c above)  $

EXPENSES 
 
Do not list expenses which are paid by payroll deduction. 
 
Housing, expenses per month: 
Rent, mortgage, agreement of sale………………...   $            
Insurance if not included above ………………….    $            
Real Property taxes (if paid separately) ………….    $            
Utilities, gas, water, elec., telephone etc. …………   $            
Transportation, expenses per month: 
Car payment, lease, rental. ……………………….    $            
Insurance on vehicle.  …………………………….    $            
Maintenance (repairs)  ………………………..….    $            
Operating (gas, oil & tires)  ……………..……….    $            
 
Total Housing and Transportation expenses…………………………………………………….…….    $            
 
Debt service (all monthly payments, eg. credit cards, charges, finance company, personal loans) 
 
Personal Expenses per month:                                                             Self                                          Children No. (     ) 
Food……………………………………………...     $                                                   $            
Clothing………………………………………….     $                                                   $            
Medical and Dental .…………………………….     $                                                    $            
Laundry and Cleaning. ………………………….     $                                                    $            
Personal articles ………………………………...     $                                                     $            
Recreation (movies, etc.) ……………………….     $                                                     $            
School (include food)  ………………………….     $                                                     $            
Household. ………………………………..…….     $                                                     $            
Bus (on monthly basis)  ……………………..….     $                                                     $            
Other (               ). …………………….     $                                                     $            
Payment to others for dependent care ………….     $                                                     $            
 
Sub Totals …………………………….      $            
 
Total Personal expenses ……………………………………..…….      $            
 
Grand Total expenses:  Housing, Trans., Debt & personal ……………………………….      $            
 
Savings, :  Income minus Expenses. ……………………………………….      $            
 
Explain in detail where savings are invested, or if there is a deficiency, who provides the funds to maintain the level of spending indicated in this income and expense statement.  (Use separate sheet if more space is needed.) 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
CERTIFICATION 
I hereby declare under the penalty of perjury that I have supplied the information used in this Income and Expense Statement 
and have reviewed this statement and I certify that the information is accurate, complete and correct. 
 
 
 DATE 
       DEFENDANT’S SIGNATURE