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Wisconsin ___________________________ [Signature of Notary Public] Notary Public, for the County of ____________________ State of _______________ My commission expires _______________ Financial Statement - 4-and correct on personal knowledge and acknowledged that said document was signed as a free and voluntary act. Subscribed and sworn to before me this ________day of _________________, 20____. _________ho is personally known to me to be the same person whose name is subscribed to the foregoing document, and, being duly sworn, verified that the information contained in the foregoing document is true n this day, before me, the undersigned authority, in and for and residing in the above county and state, personally appeared ___________________________________________________ [Full name of spouse] w ________ day of _______________, 20 ___. _______________________________________ [Signature of spouse signing form] Financial Statement - 3- State of County of __________ ) ) __________ ) SS. O......................................................................... $ ________ Total Liabilities .......................................................................... $ ________ Dated this......................................... $ ________ Average Monthly Expenses: ....................................................... $ ________ SUMMARY OF ASSETS AND LIABILITIES: Total Assets: ....._____ ________ ________ ________ TOTAL LIABILITIES: .............................................................. $ ________ SUMMARY OF INCOME AND EXPENSES: Average Monthly Income: .................____________________________ _________________________________ Balance due: $ Balance due: $ Balance due: $ Balance due: $ Balance due: $ Balance due: $ Balance due: $ ________ ________ ________ ___ditor Creditor Creditor _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ __________ ________ ________ ________ ________ ________ TOTAL ASSETS: ...................................................................... $ ________ LIABILITIES: Creditor Creditor Creditor Creditor Crest) __________________________________________ _____________________________________________ _____________________________________________ $ $ $ $ $ $ $ $ $ $ ________ ________ ________ ________ ___........... Contents of home or apartment: .................................................. Jewelry: ...................................................................................... Other: (li........................ Real estate: ................................................................................. Automobiles: ................................................................................................... Stocks: ....................................................................................... Bonds: ................................................................______ ________ ________ ________ Financial Statement - 2- TOTAL AVERAGE MONTHLY EXPENSES: ......................... $ ________ ASSETS: Cash: .......................................................ent $ Monthly payment $ Monthly payment $ ________ ________ ________ ________ ________ ________ Monthly payment $ Monthly payment $ Monthly payment $ Monthly payment $ Monthly payment $ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ Monthly payment $ Monthly payment $ Monthly payment $ Monthly paym______________________ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ____________ Any other debts: Creditor _____________________________ Creditor _____________________________ Creditor _____________________________ Creditor _____________________________ Creditor ______________________ Creditor _____________________________ Creditor _____________________________ Creditor _____________________________ Creditor _____________________________ Creditor _________________________ _____________________________________________ _____________________________________________ _____________________________________________ Fixed debts on a monthly basis: Creditor ______________................. Other .............................................................................. Any other expenses (list) _______________________________ _______________________________________.............................................. Disability ........................................................................ Life .................................................................................................................................... Payments ........................................................................ Insurance: Health ................................................ Repairs ........................................................................... License ........................................................................... Insurance ....................................... Public transportation ................................................................... Automobile: Gasoline and oil .................................................................................................... Gifts or donations ....................................................................... Vacation expenses ............................................................................................................ Day care/baby sitter .................................................................... Entertainment ......................Clothing ..................................................................................... Medical, dental, prescriptions ..................................................... Education ................................... Food and grocery items .............................................................. Meals outside home .................................................................... ....................................... Pest control ................................................................................ Housewares .......................................................__ ________ ________ ________ ________ Financial Statement - 1- Cleaning and laundry .................................................................. Repairs and maintenance .................................................................................. Fuel oil and natural gas ............................................................... $ $ $ $ $ $ $ $ ________ ________ ________ ______bage, sewer ................................................................ Cable television .......................................................................... Telephone .............................. Homeowner's insurance ............................................................. Electricity ................................................................................... Water, gar______ AVERAGE MONTHLY EXPENSES Mortgage or rental payment ........................................................ Property taxes .................................................................... $ ________ $ $ $ $ $ ________ ________ ________ ________ ________ $ $ $ $ $ $ ________ ________ ________ ________ ________ ________ TOTAL AVERAGE MONTHLY INCOME: ............................. $ __....................... Rents, royalties ............................................................... Other monthly income .................................................... $ ________ $ ________mployment, welfare, etc. .......................................... Dividends, interest, etc. ................................................... Business income ........................................... Net monthly salary, wages .......................................................... Monthly income from other sources Commissions, bonuses, etc. ............................................ Une....................................... Union dues ..................................................................... Other .................................................................................................... Other deductions from paycheck on monthly basis Insurance ........................................................................ Credit Union ............................nthly salary or wages ................................................... minus Social Security ..................................................... minus income tax .................................xt pay day: ___________________________________________________ Rate of pay: ................................................................................ $ ________ AVERAGE MONTHLY INCOME Gross moEmployed by: ___________________________________________________ Address of Employer: _____________________________________________ Pay period: _____________________________________________________ Nel serious legal matters. Financial Statement ­ Information -2 - FINANCIAL STATEMENT OF ____________________ [Full name] EMPLOYMENT: Occupation: ____________________________________________________ any theory of liability, whether in contract, strict liability, or tort (including negligence or otherwise) arising in any way out of the use of these materials. An attorney should be consulted for alges Financial Statement ­ Information -1 - (including, but not limited to, procurement of substitute goods or services; loss of use, data, or profits; or business interruption) however caused and on its agents, partners, or affiliates, or ii) the providers, authors or publishers of the forms, be responsible or liable for any direct, indirect, incidental, special, exemplary, or consequential damamplied warranties of merchantability, suitability or completeness for any of the materials for your particular needs. The materials are used at your own risk. In no event will: i) FindLegalForms, Inc,egal advice. The purchase and use of these materials is subject to the "Disclaimers and Terms of Use" found at findlegalforms.com. These materials are provided "AS-IS." We do not give any express or ied on full knowledge of all of the facts relating to your property and income. Disclaimer No Attorney-Client relationship is created by use of these materials. FindLegalForms, Inc. does not provide lare an individual copy of this statement. This form assures that both you and your spouse are fully aware of each others economic circumstances and that you have made your decisions and agreements bases. Some states have similar state-supplied, mandatory financial statement forms. In those cases, this form will help you complete the mandatory state forms. Both you and your spouse will need to prepart of your marital settlement agreement and will also become a part of your final divorce papers. This Financial Statement is mandatory for you to fill out and is required, in some form, in most statperty and bills as you and your spouse have agreed to in your marital settlement agreement. Fill in only those items that apply to your circumstances. The Financial Statement will become a permanent pte from your spouse. If you have physical custody of any children, any expenses related to their care should also be included. The assets and liabilities listed should be your separate and marital proerived from child support payments or alimony from your current spouse. The expenses that you include on this statement should be based on your estimated or actual expenses while you are living separaomic situation immediately after your settlement agreement takes effect. The monthly income that you list should be based on your current job and sources of income, but should not include any income dIt details both your monthly income and expenses and your overall net worth (assets and liabilities). The information that you include on this form should be current and should be based upon your econse in conjunction with a marital settlement agreement, will be your record of the disclosures that you and your spouse have made to each other regarding your joint and individual economic situations. Information Financial Statement for Divorce Proceedings Provided under agreement with copyright holder, © Nova Publishing Company 2004 The following Financial Statement for Divorce Proceedings, for u Wisconsin