Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Financial Statement (Short) Form. This is a Maryland form and can be use in Circuit Court Statewide.
Loading PDF...
Tags: Financial Statement (Short), DR-30, 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 . . . . . . . . . . . . . . . . . . . . . Apt..#. . . . . . . . . . . . .Street Address
... .....
..
Apt. #
( )
City
State
Zip Code
Area
Code
( )
Telephone
City
State
Plaintiff
THE PEOPLE OF THE STATE OF NEW YORK
Zip Code Area
Code
Telephone
Defendant
FINANCIAL STATEMENT
TO
(Short)
(DOM REL 30)
I,
GREETINGS:
, state that:
My name
WE COMMAND YOU, that all businessor excuses being laid aside, you and each of you attend before
I am the mother/ father and
Check One
(for example, aunt, grandfather, guardian, etc.)
,
the Honorable
at the State Relationship Court
of the minor child(ren):
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
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Your failure to comply with this subpoenaDatepunishable as a contemptName
is of Birth
of court and will make you liable to
Name
Date of Birth
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 tofollowing is a list of my income and expenses (see below*):
The comply.
See definitions on back before filling out.
Witness, Honorable
Total monthly income (before taxes)
Court in
County,
day of
, 20
, one of the Justices of the
$
Child support I am paying for my other child(ren) each month
Alimony I am paying each month to
Name of Person(s)
Alimony I am receiving each month from
(Attorney must sign above and type name below)
Name of Person(s)
For the child or children listed above:
Monthly health insurance premium
Work-related monthly child care expensesAttorney(s) for
Extraordinary monthly medical expenses
School and transportation expenses
*To figure the monthly amount of expenses, weekly expenses should be multiplied by 4.3 and yearly expenses should be divided by 12.
Office and P.O. Address
If you do not pay the same amount each month for any of the categories listed, figure what your average monthly expense is.
I solemnly affirm under the penalties of perjury that the contents of the foregoing paper are true to
the best of my knowledge, information and belief.Telephone No.:
Date
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
Signature
American LegalNet, Inc.
www.USCourtForms.com
Page 1 of 2
DR 30 - Revised 8 Nov 2000
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
Total Monthly Income: Include income from all sources including self-employment, rent, royalties,
:
business income, salaries, wages, commissions, bonuses, dividends, pensions, interest,
trusts, annuities, social security benefits, workers compensation, unemployment benefits, disability
:
benefits, alimony or maintenance received, tips, income from side jobs, severance pay, capitol gains,
Defendant(s)
:
gifts, prizes, lottery winnings, etc. Do not report benefits from means-tested public assistance
......................................................
programs such as food stamps or AFDC.
Extraordinary Medical Expenses: Uninsured expenses over $100 for a single illness or condition
THE PEOPLE OF THE STATE OF NEWtreatment, asthma treatment, physical therapy, treatment for any
including orthodontia, dental YORK
TO
chronic health problems, and professional counseling or psychiatric therapy for diagnosed mental
disorders.
Child Care Expenses: Actual child care expenses incurred on behalf of a child due to employment
or job
GREETINGS: search of either parent with amount to be determined by actual experience or the level required
to provide quality care from a licensed source.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable
at Any
Court
School and Transportation Expenses: the expenses for attending a special or private elementary,
at
County of or secondary school tolocatedthe particular needs of the child or expenses for transportation of the
meet
in room child between the homes of the parents.20
, on the
day of
,
, 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.:
American LegalNet, Inc.
www.USCourtForms.com
Page 2 of 2
DR 30 - Revised 8 Nov 2000