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Maryland Financial Statement Form

For assigning assets and debts for each of the spouses involved in a divorce case, the Maryland Financial Statement Form has to be used. The mentioned form has to be completed by each of the spouses and traded between them after their completion.

 

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Page 1 of 9   DR 31 - 1 7 September  2001	
Circuit Court for	                                                                   	  Case No.                                      	
City or County	
                  	                    	                               	 	      	      	                     	                               	   	Name                 Name
 
              	   	                                                     	    	VS.	                                                                        \
   	Street Address Apt. #                  Street Address	         	                       	Apt. #	
                                                                                  (    )                  	                                               (    )                 \
 	Cit y  S ta te        Z ip Code        Area   Telephone   Cit y         S ta te        Z ip Code   Area          Te lephone
                                         Code                                          Code	
Plaintiff      Defendant
FINANCIAL STATEMENT OF                                     	(Name)	
(Long)
(DOM REL 31)	
Children  Age	
MONTHLY EXPENSES	 	
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

Page 2 of 9   DR 31 - 1 7  September  2001	
Cell Phone/Pager
Repairs
Lawn & Yard Care (snow removal)
Replacement
Furnishings/Appliances
Condo 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)
Replacement
Furnishings/Appliances

Page 3 of 9   DR 31 - 1 7 September  2001	
Condo Fee
(not included elsewhere)
Painting/Wallpapering
Carpet Cleaning
Domestic Assistance/Housekeeper
Pool
Other:
SUB TOTAL
C.  OTHER HOUSEHOLD NECESSITIES  
Food
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 4 of 9   DR 31 - 1 7  September  2001	
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 5 of 9   DR 31 - 1 7  September  2001	
Other:
SUB TOTAL
H. GIFTS
Holiday Gifts
Birthdays
Gifts to Others
Charities
SUB TOTAL
J. CLOTHING
Purchasing
Laundry
Alterations/Dry Cleaning
Other:
SUB TOTAL
K. INCIDENTALS
Books & Magazines
Newspapers
Stamps/Stationary
Banking Expense
Other:
SUB TOTAL
L. MISCELLANEOUS/OTHER
Alimony/Child Support (from a previous Order)
Religious Contributions

Page 6 of 9   DR 31 - 1 7  September  2001	
Hairdresser/Haircuts
Manicure/Pedicure
Pets/Boarding
Life Insurance
Other:
SUB TOTAL
TOTAL MONTHLY EXPENSES:
Number of Dependent Children

Page 7 of 9   DR 31 - 1 7  September  2001
INCOME STATEMENT	
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.) $
Deductions:
a. $
b. $
c. $
Total deductions from Other income :$
NET OTHER INCOME:
TOTAL MONTHLY INCOME:

Page 8 of 9   DR 31 - 1 7  September  2001
ASSETS & LIABILITIES	
ASSETS:
Real Estate 
$
Furniture (in the marital home)  $
Bank Accounts/Savings $
U.S. Bonds $
Stocks/Investments $
Personal Property $
Jewelry $
Automobiles $
Boats $
Other: $
TOTAL ASSETS: $
LIABILITIES:
Mortgage $
Automobiles $
Notes Payable to Relatives  
$
Bank Loans $
Accrued Taxes $
Balance of Credit Card
Accounts  $
a.
b.

Page 9 of 9   DR 31 - 1 7  September  2001	
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 contents of th\
e foregoing Financial
Statement, Monthly Expense List and Assets and Liabilities Statement are\
 true to the best of my
knowledge, information, and belief.
                                                   	
                                                                        \
          	
   Date Signature
Next: Maryland Divorce Complaint Form Previous: Maryland Judgment of Divorce Form
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