Expense

Petitioner or Plaintiff

Respondent or Defendant

Residence

Rent or mortgage payment

$

$

Contract for deed payment

$

$

Real estate taxes

$

$

Insurance

$

$

Utilities

Heating fuel

$

$

Water, sewer

$

$

Electricity

$

$

Gas

$

$

Telephone

$

$

Waste disposal

$

$

Home maintenance

Housecleaning

$

$

Household repairs

$

$

Yard and landscaping

$

$

Snow removal

$

$

Laundry and dry cleaning

$

$

Food and other grocery store household items

$

$

$

$

$

$

Automobile

Gas and oil

$

$

Repairs and maintenance

$

$

Licenses

$

$

Insurance

$

$

Installment payments

$

$

Clothing

$

$

$

$

$

$

Grooming, cosmetics

$

$

$

$

Medical

Insurance

$

$

Unreimbursed doctor and hospital

$

$

Unreimbursed drugs

$

$

Unreimbursed dental and orthodontics

$

$

Counseling or therapy

$

$

Life insurance

$

$

Personal property insurance

$

$

$

$

$

$

Miscellaneous personal

Newspapers, magazines, books

$

$

Club or association dues

$

$

Vacations

$

$

Gifts

$

$

Education

Tuition

$

$

Room and board

$

$

Transportation

$

$

Books and supplies

$

$

Activities

$

$

Charitable contributions

$

$

$

$

Debt payments (list each separately with monthly payment)

$

$

$

$

$

$

$

$

Child care

$

$

$

$

$

$

Animal care

$

$

$

$

IRA contributions

$

$

$

$

Savings

$

$

$

$

Other (list each item)

$

$

$

$

$

$

Children's Expenses

Clothing

$

$

Grooming

$

$

Formula/diapers

$

$

Tuition

$

$

School lunches

$

$

Athletics/other activities

$

$

Allowances

$

$

Medical

$

$

Dental or orthodontic

$

$

Total expenses

$

$

Asset

Wife

Husband

Homestead

$

$

Other real estate (list separately)

$

$

$

$

$

$

$

$

$

$

Furniture

$

$

China, silver, etc.

$

$

Jewelry and furs

$

$

Automobiles

$

$

Boats

$

$

Other vehicles

$

$

$

$

$

$

Bank accounts

$

$

$

$

$

$

Stock

$

$

Deferred comp.

$

$

Life insurance cash value

$

$

Other retirement assets

$

$

Debt

$

$

$

$

$

$

Business

$

$

Cash equalizer

$

$

Grand total

$

$