Affidavit Of Income And Expenses {116.70}

PROBATE COURT OF SHELBY COUNTY, OHIO GUARDIANSHIP OF CASE NO. , MINOR AFFIDAVIT OF INCOME AND EXPENSES STATE OF OHIO, COUNTY OF SHELBY, SS. Now comes (Name of Affiant) parent/guardian of (Name of Minor) who being duly sworn and cautioned, states as follows: 1. I am requesting the release of held in the name of 2. The purpose of the request for the release of funds is from the funds on deposit at 3. 4. 5. My marital status is I am employed with and the number of members in my household is and my annual salary is $ and his/her annual I state that my spouse is employed with salary is $ 6. My current monthly household expenses are as follows: Mortgage/Rent Utilities Food Clothing Medical Installment Loans Credit Cards Insurance Child Support Spousal Support TOTAL EXPENSES American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 H.C. FORM 116.70 - AFFIDAVIT OF INCOME AND EXPENSES 02/10/03 CASE NO. 7. Household Income: AFFIANT Net Wages Stock Dividends Interest Social Security Worker's Comp. VA Benefits Annuity/Pension Child Support Spousal Support TOTAL $ $ $ SPOUSE OTHER ADULTS TOTAL - ALL INCOME FOR HOUSEHOLD $ 8. I am unable to pay for the proposed expenditure because Affiant On this day of personally appeared before me name hereon. , who being properly sworn and cautioned, did affix h Notary Public Page 2 of 2 H.C. FORM 116.70 - AFFIDAVIT OF INCOME AND EXPENSES American LegalNet, Inc. www.FormsWorkFlow.com