COURT Post Separation/Alimony Financial Affidavit (page 1 of 3) Form 7 COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... . .. In The General Court Of Justice STATE. .OF .NORTH CAROLINA : Index No. Court Division District Wayne County Lenoir County GreeneCounty Family Court File No. : : Calendar No. Plaintiff: Plaintiff(s) VERSUS -against- JUDICIAL SUBPOENA Defendant: POST: SEPARATION SUPPORT/ALIMONY FINANCIAL AFFIDAVIT : The Undersigned deposes and says: Plaintiff Defendant, having been first duly sworn : to the truthfulness and completeness of this Affidavit, as Defendant(s) My average monthly financial needs and my average monthly income, while living separate and apart from my spouse, are as : ...................................................... follows: A. Individual Needs 1 Groceries & Household Goods 2 Food (School/Work lunches) Self Child(ren) Total THE PEOPLE OF THE STATE OF NEW YORK TO 3 Clothing 4 Personal care (includes laundry, dry cleaning, cosmetics, grooming) 5 Recreation/Entertainment GREETINGS: 6 Activies (Sports, Clubs) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , at the Court located at County 9 Child care of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 10 Educational expenses (includes school supplies) or adjourned date, to testify and give evidence as a witness in this action on the part of the 8 Uninsured Medical & Dental expenses the Honorable 11 Donations, dues & charity 12 Magazines, newspapers, books, etc. 13 Gifts - birthday, wedding, anniversaries,with this subpoena is punishable as a contempt of court and will make you liable to Your failure to comply funeral 7 Medical & Dental Insurance (if not withheld from earnings) the party on whose 14 Car - gas & maintenance behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 15 Other (Itemize) 16 17 18 19 20 21 Totals of Individual Needs Also put Totals on line 54 (Attorney must sign above and type name below) result of your failure to comply. Witness, Honorable County, , one of the Justices of the day of , 20 Court in B. Fixed Expenses: How much do you allocate for: 22 Rent or house payment 23 Property tax (excluded above) 24 Homeowner's or Renter's insurance 25 Household maintenance and repair 26 Yard maintenance Eighth Judicial District Family Court Form 7 3/01 Attorney(s) for Self Child(ren) Total Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Continued on next page American LegalNet, Inc. www.USCourtForms.com Form 7 - Post Separation/Alimony Financial Affidavit (page 2 of 3) COURT COUNTY .OF. . . much .do. you. allocate. for:. . . . . . . . . . . . . . . . . . . . .Self B. Fixed . . . . . . . . . Child(ren) . . Expenses: How . . . . . . . . . . . . . . : Index No. 27 Electricity 28 Water 29 Heat (gas, fuel oil, etc.) 30 Telephone 31 Car payment 32 Car insurance 33 Other: (Itemize) 34 35 36 37 38 Total : Plaintiff(s) -against: : : : Calendar No. JUDICIAL SUBPOENA Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK Totals of Fixed Expenses (Also put totals on line 55) C. Debt Payments (Itemize) To Whom Owed 39 40 41 42 43 44 45 46 47 48 49 50 51 53 Total Average Monthly Needs 54 Totals of Individual Needs (Line 21) 55 Total of Fixed Expenses (Line 38) 56 Total Monthly Debt payment (Line 51) 57 Total Average Monthly Needs Add lines 54, 55, and 56 Balance Monthly Payments TO GREETINGS: 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 Self Child(ren) (Attorney must sign above and type name below) Total Totals of Fixed Expenses (Also put totals on line 55) Attorney(s) for No debt payments can be allocated to children Office and P.O. Address Eighth Judicial District Family Court Form 7 3/01 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Continued on next page American LegalNet, Inc. www.USCourtForms.com COURT Form 7 - Post Separation/Alimony Financial Affidavit (page 3 of 3) COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. D. Income : Index No. 58 Wages 59 Overtime 60 Commissions 61 Bonuses 62 Interest 63 Dividends 64 Trust Fund 65 Social Security : Plaintiff(s) -against: : : : Defendant(s) : Calendar No. JUDICIAL SUBPOENA 66 Pension.or .Military Retirement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . ............. 67 Business Profit 68 Other: 69 70 71 72 73 I am employed at Total: (Add lines 58 through 71) Also put this figure on line 77 THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: 74 I have been employed there since: YOU, that all business and(date). WE COMMAND excuses being laid aside, you and each of you attend before If not now employed, my last regular job was at: the Honorable at the Court and County of I worked there until: located (date). at , room , on the day of 20 , at o'clock in the noon, and sam, recessed 75 I in have have not received substantially the same ,income for the past 12 months. If not substantially theat anyexplain the reason adjourned date, to testify and give evidence as a witness in this action on the part of the or for the change. 76 I do Employer: Rate of Pay: do not have a second job. If you do have a second job: Total monthly income from second job: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 77 Income from line 72 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 Monthly Income 78 (Add lines 76 and 77) Date Witness, Honorable Court in County, Signature Of Affiant Plaintiff, one of the Justices of the day of , 20 Defendant SWORN AND SUBSCRIBED BEFORE ME TH