CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT 251 WHEATON, ILLINOIS 60187-0707 B. This child(ren) in the custody of at (location) File Stamp Here3226-1 (Rev. 06/07)AFFIDAVIT FOR MAINTENANCE, CUSTODY ETC - DOMESTIC RELATIONSvsAFFIDAVIT IN SUPPORT AFFIDAVIT IN RESPONSE TO PETITION FOR MAINTENANCE, CUSTODY, CHILD SUPPORT, ATTORNEY'S FEES AND COURT COSTS (STRIKE OUT INAPPROPRIATE PORTIONS)CASE NUMBER being first duly sworn, states as follows:UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT PETITIONER RESPONDENTIN RE THE MARRIAGE OFPage 1 of 21. That is the in the above entitled matter.2. The parties have been married years; the wife's age is ; and the husband's age is .3. The parties have been separated months, during which the has paid $ to the 4. Facts concerning the child(ren) of the parties as follows:A. The child(ren) of the parties, aged respectivelyC. For the best interest of the child(ren) custody should be awarded to D. The has minor child(ren) by a previous marriage. 5. The property of the parties, its market value and encumbrances are:ITEMMARKET VALUE he wife husband wife. husband she petitioner respondent respondent petitioner HUSBANDWIFEJOINT TENANCYENCUMBRANCESHomesteadOther realtyHousehold goodsAutomobilesStock, bonds, notesCash and bank creditsClaims, accounts receivable $$$$$$$ $$$$$$$$$$$$$$ $$$$$$$ TOTALS6. A. Unsecured debts of husband not included in above B. Unsecured debts of wife not included in above C. Unsecured joint debts not included in above $ $ $ $ $$$ American LegalNet, Inc. www.FormsWorkFlow.com CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT 251 WHEATON, ILLINOIS 60187-0707 11. A. Husband's total income after deductions is monthlySigned and sworn to before me DateCircuit Clerk or Notary PublicPage 2 of 2AFFIDAVIT FOR MAINTENANCE, CUSTODY ETC - DOMESTIC RELATIONS3226-2 (Rev. 06/07)7. The necessary weekly - monthly expenses are:G. UtilitiesF. FoodE. FuelD. Personal contact paymentsC. Realty contract paymentsB. Realty TaxesA. RentH. InsuranceI. ClothingJ. TransportationK. Mecidal and dentalCHILD (IF SEPARATE) $$$$$$$$WIFE $$$$$$$$HUSBAND $$$$$$$$ $ $ $ $ $ $ $ $ $TOTAL $ $ $ 8. Husband's EmployerNameAddressPhoneGross Income $Itemized deductions $10. The family home contains bedrooms; is by the parties and is now occupied by12. A. Reasonable amount for support for child(ren) is $ per . 15. is reasonable for wife's temporary attorney fees plus for disbursements.16. State additional material facts. If any, respondent should set forth facts in answer thereto. 9. Wife's EmployerNameAddressGross Income $PhoneItemized deductions $ rented owned weekly B. Wife's total income after deductions is weekly monthly $ C. Child(ren)'s total income after deductions is monthly weekly $ $ month week B. Reasonable amount for temporary alimony is $ per . month week C. The dates for payment should be D. Husband's necessary living expenses will be .13. has been paid on husband's attorney fees and disbursements. 14. has been paid on wife's attorney fees and disbursements.$ $ $ $ monthly weekly$Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Pro SeEmail: American LegalNet, Inc. www.FormsWorkFlow.com