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Financial Statement (Long) Form. This is a Maryland form and can be use in Circuit Court Statewide.
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Tags: Financial Statement (Long), DR-31, Maryland Statewide, Circuit Court
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
:
Plaintiff(s)
-against-
Calendar No.
JUDICIAL SUBPOENA
:
Circuit Court for
Case No.
:
City or County
:
Name
Name
Defendant(s) VS. :
. . . . . . . . .Street Address . . . . . . . . . . . . . . . . . . . . #. . . . . . . . . . . . . . . . .Street Address
........
Apt.
Apt. #
( )
City
State
Zip Code
Area
Code
( )
Telephone
City
THE PEOPLE OF THE STATE OF NEW YORK
Plaintiff
State
Zip Code
Area
Code
Telephone
Defendant
FINANCIAL STATEMENT OF
TO
(Long)
(Name)
(DOM REL 31)
GREETINGS:
Children
Age
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
MONTHLY EXPENSES
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
SELF
CHILDREN
TOTAL
result of your failure to comply. ITEM
Witness, Honorable
Court in A. PRIMARY RESIDENCE
County,
day of
, one of the Justices of the
, 20
Mortgage
Insurance (homeowners)
(Attorney must sign above and type name below)
Rent/Ground Rent
Attorney(s) for
Taxes
Gas & Electric
Electric Only
Office and P.O. Address
Heat (Oil)
Telephone
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
Trash Removal
Water Bill
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Page 1 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
Cell Phone/Pager
:
Repairs
:
Lawn & Yard Care (snow removal)
Defendant(s)
:
......................................................
Replacement
Furnishings/Appliances
Condo Fee
THE PEOPLE OF THE STATE OF NEW YORK
(not included elsewhere)
TO
Painting/Wallpapering
Carpet Cleaning
Domestic Assistance/Housekeeper
GREETINGS:
Pool
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
Other:
located at
County of
in room SUB TOTAL
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
B. SECONDARY RESIDENCE
(i.e. Summer Home/Rental)
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Mortgage
result of your failure to comply.
Insurance (homeowners)
Witness, Honorable
Rent/Ground Rent
Court in
County,
Gas & Electric
, one of the Justices of the
day of
, 20
Electric Only
(Attorney must sign above and type name below)
Heat (Oil)
Telephone
Attorney(s) for
Trash Removal
Water Bill
Cell Phone/Pager
Office and P.O. Address
Repairs
Lawn & Yard Care (snow removal)
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
Replacement
Furnishings/Appliances
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Page 2 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
Calendar No.
:
JUDICIAL SUBPOENA
-against-
:
Condo Fee
(not included elsewhere)
:
:
Painting/Wallpapering
Defendant(s)
:
Carpet . . . . . . .
. . . . . . . . . . . . . . . Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Domestic Assistance/Housekeeper
Pool
THE PEOPLE OF THE STATE OF NEW YORK
Other:
TO
SUB TOTAL
GREETINGS:
C. OTHER HOUSEHOLD NECESSITIES
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Food
,
the Honorable
at the
Court
located at
County of Drug Store Items
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
Household Supplies give evidence as a witness in this action on the part of the
or adjourned date, to testify and
Other:
SUB TOTAL
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
D. MEDICAL/DENTAL
Witness,Insurance
Health Honorable
Court in
County,
Therapist/Counselor
, one of the Justices of the
day of
, 20
Extraordinary Medical
(Attorney must sign above and type name below)
Dental/Orthodontia
Ophthalmologist/Glasses
Attorney(s) for
Other:
SUB TOTAL
Office and P.O. Address
E. SCHOOL EXPENSES
Tuition/Books
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
School Lunch
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Page 3 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
Calendar No.
:
JUDICIAL SUBPOENA
-against-
:
Extracurricular Activities
:
Clothing/Uniforms
:
Room & Board
Defendant(s)
:
......................................................
Daycare/Nursery School
Other:
THE PEOPLE OF THE STATE OF NEW YORK
SUB TOTAL
TO
F. RECREATION & ENTERTAINMENT
Vacations
GREETINGS:
Videos/Theater
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
Dining Out
located at
County of
in room Cable TV/Internet day of
, on the
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Allowance
Camp
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Memberships
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Dance/Music Lessons
result of your failure to comply. etc.
Horseback Riding
Witness, Honorable
Court in Other:
County,
, one of the Justices of the
day of
, 20
SUB TOTAL
(Attorney must sign above and type name below)
G. TRANSPORTATION EXPENSE
Automobile Payment
Attorney(s) for
Automobile Repairs
Maintenance/Tags/Tires/etc.
Office and P.O. Address
Oil/Gas
Automobile Insurance
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
Parking Fees
Bus/Taxi
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Page 4 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
Other:
:
SUB TOTAL
:
Defendant(s)
:
......................................................
H. GIFTS
Holiday Gifts
THE PEOPLE OF THE STATE OF NEW YORK
Birthdays
TO
Gifts to Others
Charities
SUB TOTAL
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
J.
,
the HonorableCLOTHING
at the
Court
located at
County of
in room Purchasing the
, on
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Laundry
Alterations/Dry Cleaning
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Other:
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
SUB TOTAL
result of your failure to comply.
Witness, Honorable
Court in K. INCIDENTALS
County,
, one of the Justices of the
day of
, 20
Books & Magazines
Newspapers
(Attorney must sign above and type name below)
Stamps/Stationary
Banking Expense
Attorney(s) for
Other:
SUB TOTAL
Office and P.O. Address
L. MISCELLANEOUS/OTHER
Alimony/Child Support (from a previous Order)
Religious Contributions
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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Page 5 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
Hairdresser/Haircuts
:
Manicure/Pedicure
:
Pets/Boarding
Defendant(s)
:
......................................................
Life Insurance
Other:
THE PEOPLE OF THE STATE OF NEW YORK
SUB TOTAL
TO
TOTAL MONTHLY EXPENSES:
GREETINGS:
Number of Dependent Children
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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Page 6 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
:
INCOME STATEMENT
Defendant(s)
:
. . . . . . . . . .GROSS.MONTHLY.WAGES: . . . . . . . . . . . . . . . . . .
...... .......... ........
$
Deductions:
Federal
THE PEOPLE OF THE STATE OF NEW YORK
$
State
$
Medicare
TO
$
F.I.C.A.
$
GREETINGS:
Retirement
$
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of Total Deductions:
$
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
NET INCOME and giveWAGES: as a witness in this action on the part of the
FROM evidence
or adjourned date, to testify
$
OTHER GROSS INCOME:(alimony,
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
part-time job, rentals, etc.) was issued for a maximum penalty of $50 and all damages sustained as a
the party on whose behalf this subpoena
result of your failure to comply.
Deductions:
a.
Witness, Honorable
Court in b.
County,
$
day of
, one of the Justices of the
,$20
c.
$
Total deductions from Other income:
$
(Attorney must sign above and type name below)
NET OTHER INCOME:
Attorney(s) for
TOTAL MONTHLY INCOME:
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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Page 7 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
ASSETS & LIABILITIES
:
Defendant(s)
ASSETS:
:
......................................................
Real Estate
$
THE PEOPLE OF THE STATE OF NEW YORK
Furniture (in the marital home)
$
TO
Bank Accounts/Savings
$
U.S. Bonds
$
GREETINGS:
Stocks/Investments
$
Personal Property
$
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
Jewelry
$
located at
County of
in room Automobiles
, on the
day of
, at
o'clock in the
noon, and at any recessed
$ , 20
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Boats
$
Other:
$
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
TOTAL ASSETS:
$
Witness, Honorable
Court in
County,
LIABILITIES:
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Mortgage
$
Automobiles
$
Notes Payable to Relatives
$
Bank Loans
$
Accrued Taxes
$
Balance of Credit Card
Accounts
$
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
a.
b.
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Page 8 of 9
DR 31 - 17 September 2001
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
:
Plaintiff(s)
-against-
Calendar No.
JUDICIAL SUBPOENA
:
c.
:
Other:
:
TOTAL LIABILITIES:
Defendant(s)
:
......................................................
$
TOTAL NET WORTH:
$
THE PEOPLE OF THE STATE OF NEW YORK
TO
SUMMARY:
TOTAL INCOME:
GREETINGS:
$
TOTAL EXPENSES:
$
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
EXCESS OR DEFICIT:
$
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
I solemnly affirm under the penalties of perjury that the contents of the foregoing Financial
Statement, Monthly Expense List and Assets and Liabilities Statement are true to the best of my
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
knowledge, information, and belief.
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in Date
County,
, one of the Justices of the
day of
,
Signature
20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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Page 9 of 9
DR 31 - 17 September 2001
