AFFIDAVIT OF MONTHLY LIVING EXPENSES - EVENING DOMESTIC COURT 4005 (Rev. 01/07) UNITED STATES OF AMERICA STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT PLAINTIFF COUNTY OF DU PAGE CASE NUMBER vs DEFENDANT File Stamp Here AFFIDAVIT OF MONTHLY LIVING EXPENSES 1. I am employed. I bring home $ twice a month or 2. I not employed or monthly. I have own or deductions, or weekly, every two weeks. no deductions taken out of my pay. rent. 3 . I currently receive $ per month for child support. 4. I spend the following per month for myself and my child(ren). Rent, mortgage(s), real estate taxes and insurance $ Utilities, including gas, electric, sewer, water, other $ Cable/internet $ Food Day-care, before/after school care $ $ Car: payment, insurance, repairs and license plates $ Train ticket, tolls, etc. $ Clothing, shoes for me $ Clothing, shoes for children $ Medical insurance (not deducted from pay) $ Medical,dental and optical expenses (after insurance) for me $ Medical,dental and optical expenses (after insurance) for children $ $ Life insurance Subscriptions, club memberships, activity fees for the children $ $ School fees $ $ $ Other Signed and sworn to before me TOTAL PER MONTH $ Date Circuit Clerk or Notary Public Signature of Petitioner CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60189-0707 American LegalNet, Inc. www.FormsWorkflow.com