Free - Ohio

DR 602C Rev. 8/05

IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS BUTLER COUNTY, OHIO Judge Sharon L. Kennedy Judge Eva D. Kessler _____________________________________ Plaintiff/1st Petitioner/Petitioner DOB ________________________________ Address ______________________________ _______________________________ V. _____________________________________ Defendant/2nd Petitioner/Respondent DOB ________________________ Address Case No. ___________________

Affidavit of Expenses ________________________
(Name of Affiant) Date of Marriage __________________ Date of Separation_________________

______________________ _____________________

Note: This affidavit must be completed and exchanged in accordance with Local Rules of Court in every action for divorce, dissolution, legal separation, annulment and post decree motion that concerns modification of support. You will be required to provide proof of income per local rule and O.R.C. 3121. You are under a continuing legal duty to file an updated version of this form if you learn of any additional information. If more space is needed, attach additional page(s).

Affiant's Monthly Living Expenses:
List your ACTUAL expenses for your present household in the first column. Give estimated expenses if you don't have exact figures. If you expect changes soon, list your ANTICIPATED expenses in your household after the divorce case in the second column. Explain why you expect your expenses to change. Also, if you are living with your parents or someone is helping you with your living expenses, please explain.
Actual Monthly Expenses in My Present Household I am assisted with my living expenses by: Anticipated Future Monthly Expenses in My Household The reason I expect my household living expenses to change soon is: Anticipated

My Average Monthly Expenses adults and There are now in my present household. children living

A. Housing Rent or First Mortgage Real Estate Taxes (if not included above) Real Estate Insurance (if not included above) Second Mortgage, if any

Actual

Initialed

Expenses Affidavit Page 1

UTILITIES: · Electric (level billing or avg/month) · · · · · · Gas (if billed separately) Fuel Oil/Propane Water & Sewer ·Telephone (basic monthly charge) ·Water Softener ·Trash Collection

Telephone (average long distance) Cable Television Home Cleaning, Maintenance, Repair Lawn Service, Snow Removal Other: Housing Total (A) (A)

B. Other Necessary Living Expenses FOOD, ETC.: · Grocery (include food, paper & cleaning products, toiletries, etc.) · ·Restaurant TRANSPORTATION, ETC.: · Car Loan or Lease · · · Gasoline Car Maintenance & Repair Parking, Public Transit

Actual

Anticipated

CLOTHING, ETC.: · · Dry Cleaning, Laundry Personal Grooming

Other: Other Necessities Total (B) (B)

Initialed

Expenses Affidavit Page 2

C. Child-Related Expenses Child Care (work/ educational-related) Clothing School Lunches Children's Allowances Extra-Curricular Activities Other: Child-Related Expenses Total

Actual

Anticipated

(C)

(C)

Actual D. Educational Expenses for: Tuition Books Fees Tutor Activities College Loan Repayment Other: Education Total $ $ $ $ $ $ $ $ (D) You Child(ren)

Anticipated You Child(ren)

(D)

You E. Health Care Expenses Doctor Dentist Optical Orthodontist Prescriptions Other:

Child(ren)

You

Child(ren)

Initialed

Expenses Affidavit Page 3

Health Care Total

(E)

(E)

F. Insurance Life Auto Health Disability COBRA Insurance Coverage Personal Property Other: Insurance Total

Actual

Anticipated

(F)

(F)

G. Enrichment (Your expenses. Put child(ren)'s expenses under C or D, above) Entertainment Lessons Books, Newspapers, Magazines Sports Clubs Hobbies Donations Gifts Vacation Other: Enrichment Total

Actual

Anticipated

(G)

(G)

H. Miscellaneous Expenses (Include expenses and debts not previously listed.) 1.

Actual

Anticipated

Initialed

Expenses Affidavit Page 4

2. 3. 4. 5. 6. 7. 8. 9. 10. Miscellaneous Expenses Total Grand Total of Monthly Expenses (Sum of A - H in each column) (H) (H)

OATH OF AFFIANT

I, (print) hereby swear or affirm that the information set forth in this Affidavit of Expenses above is true, complete, and accurate. I understand that falsification of this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and that falsification of this document may also subject me to criminal penalties for perjury (O.R.C. 2921.22).
AFFIANT

Sworn to and subscribed before me this

Day of

,

.

Notary Public

Initialed

Expenses Affidavit Page 5