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Statement Of Income And Expenses Form. This is a Missouri form and can be use in 11th Circuit (St Charles County) Local Circuit Courts.
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Tags: Statement Of Income And Expenses, Missouri Local Circuit Courts, 11th Circuit (St Charles County)
IN THE ________ COURT OF _________________________, MISSOURI
(Type of court)
(County where court is located)
In re the Marriage of
_________________
(First)
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Petitioner,
-and_________________
(First)
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Respondent.
)
)
)
)
)
)
)
)
)
)
)
Cause No. ____________
Division No. ____________
WARNING: Read Carefully
You are encouraged to consult with a lawyer in the preparation of this document and the
presentation of your case to the court. A dissolution of marriage proceeding can substantially
affect your financial and personal life for many years. A lawyer is trained to assist you in
protecting your rights.
STATEMENT OF INCOME AND EXPENSES
I am the (You must check one of the following two boxes)
Petitioner. (The party that filed the original petition)
Respondent. (The party that answers the original petition filed by his or her spouse)
INSTRUCTIONS
NOTE: You should read these instructions carefully. If you do not understand them, you should
consult with a lawyer. When you go to court, the judge may ask you questions concerning your
knowledge of the information contained in these instructions.
You must fill in the amounts for both you and your husband or wife. If you do not know the exact amount
for your spouse, you should estimate the amount to the best of your ability. DO NOT LEAVE THESE
AMOUNTS BLANK.
Why does the court require this information? The amount of income and expenses of each party is
significant in a dissolution of marriage proceeding for several reasons. First, if there are unemancipated
children born of the marriage, the court must determine the amount of child support to be paid by one
party to the other party. Missouri Supreme Court Rule 88.01 and Form 14 provide the basis for the
calculation of a presumed amount of support. The amounts you enter on this “Statement of Income and
Expenses” may be used by the court in calculating the amount of child support.
Statement of Income and Expenses - Page 1 of 6
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Second, the amounts entered on this “Statement of Income and Expenses” may be used by the court in
determining whether one party is entitled to maintenance. Maintenance is spousal support paid by one
party to the other. Maintenance was formerly called alimony. If a party does not receive maintenance at
the time of dissolution, and the judgment is not subject to modification, the party cannot come back to
court to request maintenance in the future. A party may be entitled to maintenance if the party lacks
sufficient property to provide for his or her reasonable needs or if the party is unable to support him or
herself through appropriate employment. See RSMo. §452.335.
Third, income and expense amounts may be used by the court in determining the amount of attorney’s
fees to be awarded a party. The court has the power to order one party to pay the other party’s attorney’s
fees. RSMo. §452.355.
If you cannot accurately estimate the income and expenses of your spouse, there are methods available
to discover exactly how much your spouse earns and spends. These methods are usually beyond the
ability of non-lawyers, and it is strongly suggested that if you do not have an accurate estimate of how
much your spouse earns and spends, and these issues would be relevant to your case, then you should
contact a lawyer to assist you.
The court may require you to file a more complete “Statement of Income and Expenses”. This would
include a more detailed analysis of income and expenses.
Please type or print clearly in black ink. A copy of this form MUST be sent to your spouse. The information in this form is open to the
public.
All pleadings that you file with the court are required to contain the cause number and division number (if applicable). Failure to include
the cause number on your pleading may cause your pleading to be filed in the wrong case. If your case has not yet been filed, then you do
not have to enter the cause number on this form.
YOU MUST FILL IN ALL BLANKS FOR HUSBAND AND WIFE WITH AN AMOUNT
EVEN IF THE AMOUNT IS ZERO.
1. INCOME
WIFE
HUSBAND
MONTHLY GROSS INCOME – Enter one-twelfth of the party’s yearly
gross income (Income before any taxes or other withholding). This is
the amount of money you earn BEFORE any deduction or taxes.
Instructions to Question 1 - “Gross income” includes, but is not limited to, salaries, wages, commission, dividends, severance pay,
pensions, interest, trust income, annuities, partnership distributions, social security benefits, retirement benefits, workers’ compensation
benefits, unemployment compensation benefits, disability insurance benefits, veterans’ benefits, and military allowances for subsistence
and quarter.
Overtime compensation, bonuses, earning from secondary employment, recurring capital gains, prizes, retained earning and
significant employment-related benefits may be included in whole or in part.
If a party is unemployed or found to be underemployed, “gross income” may be based on imputed income.
Excluded from “gross income” is temporary assistance for needy families (TANF) payment, Medicaid benefits, supplemental security
income (SSI) benefits, food stamps, general assistance benefits, other public assistance benefits have eligibility based on income and
child support received for children not the subject of this proceeding.
If a party receives rents or royalties or is self-employed, in a sole proprietorship, or business with joint ownership, “gross income” is
gross receipts minus the ordinary and necessary expenses incurred to produce such receipts. Depreciation, investment tax credits and
other noncash reduction of gross receipts may be excluded from such ordinary and necessary expenses.
Statement of Income and Expenses - Page 2 of 6
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2. MAINTENANCE RECEIVED
WIFE
HUSBAND
A. MAINTENANCE RECEIVED EACH MONTH IN THIS CASE –
These are same numbers from Line 6A in different columns
B. MAINTENANCE RECEIVED EACH MONTH FROM OTHER
CASES
C. TOTAL MAINTENANCE RECEIVED EACH MONTH – Enter the
total monthly amount of court ordered maintenance that each party
actually receives. (Line A plus Line B)
Instructions to Question 2 – This amount refers to maintenance that either party receives. The amount of maintenance to be paid by
either Husband or Wife should be included in your answer to Question 6. LINE C SHOULD BE THE SUM OF LINE A AND LINE B.
3. CHILD SUPPORT RECEIVED FOR UNEMANCIPATED
CHILDREN NOT OF THIS MARRIAGE
How many children does each party have in his or her custody that
are not the subject of this proceeding?
WIFE
HUSBAND
CHILD SUPPORT RECEIVED EACH MONTH FOR
UNEMANCIPATED CHILDREN NOT OF THIS MARRIAGE – Enter
the monthly amount of any child support that each party actually
receives for unemancipated children not of this marriage.
Instructions to Question 3 – The first part of this question refers to child support that either party receives from some third person not a
party to this proceeding. Normally this would be child support received by Husband or Wife for children from a previous marriage or
relationship. THIS AMOUNT DOES NOT INCLUDE CHILD SUPPORT PAID FOR THE UNEMANCIPATED CHILDREN OF THIS
MARRIAGE. The second part of this question asks you for the number of the children in each person’s custody that are not children
involved in this case.
4. TOTAL MONTHLY INCOME
WIFE
HUSBAND
WIFE
HUSBAND
TOTAL INCOME
Instructions to Question 4 – Enter the total of the amounts you entered in Questions 1, 2c and 3.
5. OTHER CHILD SUPPORT OBLIGATIONS FOR
UNEMANCIPATED CHILDREN THAT ARE NOT OF THIS
MARRIAGE
OTHER CHILD SUPPORT OBLIGATIONS EACH MONTH – Enter
the monthly amount of any other court or administrative order for child
support to the extent of the amounts actually being paid toward the
current support of any child not the subject of this proceeding.
Instructions to Question 5 - Enter the amount of any court ordered child support amount that is actually being paid by one of the parties
for unemancipated children not of this marriage that are not in that party’s custody.
Statement of Income and Expenses - Page 3 of 6
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6. MAINTENANCE PAID
WIFE
HUSBAND
A. MAINTENANCE PAID EACH MONTH IN THIS CASE – These are
same numbers from Line 2A in different columns
B. MAINTENANCE PAID EACH MONTH IN OTHER CASES
C. TOTAL MAINTENANCE PAID EACH MONTH – Enter the total
monthly amount of court ordered maintenance that each party
actually pays for current maintenance. (Line A plus Line B)
Instructions to Question 6 – This amount refers to maintenance that either party pays. The amount of maintenance to be received by
either Husband or Wife should be included in your answer to Question 2.
NOTE: Questions 7 through 10 apply only if there are unemancipated children of
this marriage. If there are no unemancipated children of this marriage, then you
do not have to answer questions 7 through 10 inclusive. You must still answer
Questions 11 and 12.
7. CHILD CARE COSTS FOR UNEMANCIPATED CHILDREN OF
THIS MARRIAGE
CHILD CARE COSTS FOR UNEMANCIPATED CHILDREN OF THIS
MARRIAGE EACH MONTH – If there are unemancipated children of
this marriage, enter the monthly amount of work-related child care
costs incurred by each parent as a result of his or her employment.
WIFE
HUSBAND
Instructions to Question 7 - Do not answer this question unless you have unemancipated children of this marriage.
Enter the monthly amount of any reasonable work-related child care costs incurred or to be incurred by each parent for the
unemancipated children of this marriage.
It is preferable to include the reasonable work-related child care costs of the parent entitled to receive support in the calculation of
the presumed child support amount pursuant to Form 14. Include above ONLY the amounts you intend to include in your Form 14 child
support calculation.
However, the work-related child care costs may be excluded from calculation of the presumed child support amount if an event that
will significantly affect the amount paid for work-related child care, such as a child’s entry into school, will occur with predictability within
a short period of time.
8. HEALTH INSURANCE COSTS FOR UNEMANCIPATED
CHILDREN OF THIS MARRIAGE
HEALTH INSURANCE COSTS FOR UNEMANCIPATED CHILDREN
OF THIS MARRIAGE EACH MONTH – If there are unemancipated
children of this marriage, enter the monthly amount of health
insurance costs for these children only.
WIFE
HUSBAND
Instructions to Question 8 – Do not answer this question unless you have unemancipated children of this marriage.
Enter the monthly amount of any premium paid to be paid or deducted or to be deducted by an employer from gross monthly income
for health insurance policies for the unemancipated children of this marriage.
These amounts should be included on Form 14, Line 6c.
Statement of Income and Expenses - Page 4 of 6
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9. UNCOVERED MEDICAL EXPENSES FOR UNEMANCIPATED
CHILDREN OF THIS MARRIAGE
UNCOVERED MEDICAL EXPENSES FOR UNEMANCIPATED
CHILDREN OF THIS MARRIAGE EACH MONTH– If there are
unemancipated children of this marriage, enter the monthly amount of
medical and/or dental expenses not covered by health insurance for
these children only.
WIFE
HUSBAND
Instructions to Question 9 – Do not answer this question unless you have unemancipated children of this marriage.
Enter the monthly amount of any uninsured extraordinary medical costs paid or to be paid by the parent by agreement or pursuant to
court order for the unemancipated children of this marriage. Include above ONLY the amounts you intend to include in your Form 14
child support calculation.
Uninsured medical costs” are reasonable and necessary medical and dental expenses, as defined by section 213 IRC, incurred for
the children who are the subject of this proceeding, to the extent that the uninsured portion of such expenses, including any deductibles
and co-payments, exceeds $250.00 per year per child. “Extraordinary medical costs” are predictable and recurring, such as expenses
for dental treatment, orthodontic treatment, asthma treatment and physical therapy. Medical and dental expenses incurred for single
occurrence illnesses or injuries that are not covered or fully paid under any health insurance policy should be handled by separate order
and should not be included above. See Form 14, Line 6d, Comment A.
10. EXTRAORDINARY EXPENSES OF UNEMANCIPATED
CHILDREN OF THIS MARRIAGE
EXTRAORDINARY EXPENSES OF UNEMANCIPATED CHILDREN
OF THIS MARRIAGE EACH MONTH – If there are unemancipated
children of this marriage, enter the monthly amount of any
extraordinary expense for these children only.
WIFE
HUSBAND
Instructions to Question 10 – Do not answer this question unless you have unemancipated children of this marriage.
Enter the monthly amount of any other extraordinary child-rearing costs paid or to be paid by the parent by agreement or pursuant to
court order for the unemancipated children of this marriage. Include above ONLY the amounts you intend to include in your Form 14
child support calculation.
“Other extraordinary child-rearing costs” may include, but are not limited to, post-secondary educational expenses and private or
parochial elementary, middle and high school expenses, the cost of tutoring sessions, special or private elementary and secondary
schooling to meet the particular educational needs of a child, camps, lessons, travel and other activities intended to enhance the
athletic, social or cultural development of a child.
An order may include the cost of tuition, room and board, books, fees and other reasonable and necessary expenses. In
determining the amount of these expenses, scholarships, grants, stipends and other cost-reducing programs available to the child
should be considered.” Form 14, Line 6e, Comment A
11. OTHER MONTHLY EXPENSES
WIFE
HUSBAND
OTHER MONTHLY EXPENSES Instructions to Question 11 – Enter the total amount of all other monthly expenses not listed above. This includes the following: Rent or
mortgage payments, home maintenance, condominium or subdivision fees, gas, electric, water, telephone, trash service, sewer, cable
television, internet service, home security, gas and oil for automobiles, automobile maintenance, taxes and licenses for automobile,
payments on automobile loans, life insurance, health insurance (other than health insurance for unemancipated children of this
marriage), disability insurance, automobile insurance, pension payments, install loan payments, church and charitable contributions,
food, clothing, medical and dental expenses, recreation, laundry and cleaning, personal care, educational expenses, other
transportation costs, union dues, additional tax liability, gifts, vacations, newspapers and other periodicals, pet expenses, counseling,
and any other miscellaneous expenses not listed above.
Statement of Income and Expenses - Page 5 of 6
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12. TOTAL EXPENSES
WIFE
HUSBAND
TOTAL MONTHLY EXPENSES
Instructions to Question 12 - Enter the total of the amounts you entered on Questions 5 through 11 inclusive.
I certify under oath that I have given my spouse a copy of this Statement of Income and Expenses
pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the following three boxes)
Serving a copy with the petition.
Mailing a copy to my spouse or his or her attorney on _______________, 20_____ at the
following address:
______________________________________________________________________
(Street)
_________________________
(City)
__________________
(State)
______________
(Zip)
Handing a copy to my spouse or his or her attorney on _______________, 20_____.
Sending a copy to my spouse or his or her attorney by fax to ___________________ (telephone
number) on _______________, 20_____ at ____________ (time).
Instructions: The following information MUST be filled in before a notary public. This Statement of Income and Expense is required to be verified
before a notary public. The “Affiant” is the person that is completing this document.
COUNTY OF __________
STATE OF ____________
)
) ss.
)
Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant named
herein and that the facts stated in this Statement of Income and Expenses are true according to his or her
best knowledge and belief.
__________________________________
Affiant – SIGN HERE
__________________________________
Affiant – PRINT YOUR NAME HERE
Subscribed and sworn to this _____ day of __________________, 20____.
________________________
Notary Public
My Commission Expires:
_____________________
Statement of Income and Expenses - Page 6 of 6
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