Collections MSC Financial Statement Worksheet-Attachment {RI-ADR13-A}

(Defendant, spouse listed separately): (Defendant, spouse listed separately): List bank name and amount (Do not include payroll deductions you already listed In 1b.) plus 1d): d. To list any other facts about your financial situation, such as unusual medical expenses, family emergencies, etc., attach a sheet of paper, and write "Financial Information" and your name and case number at the top. Clothing $ m. Any other monthly expenses (list each below): Paid to: 1) 2) How Much? $ $ You must bring written proof of these facts to your Mandatory Settlement Conference. I declare under penalty of perjury under the laws of the State of California that the information I have provided on this form and all attachments is true and correct. Date: RI- 3 American LegalNet, Inc. www.FormsWorkFlow.com