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