Enclosed please find a FINANCIAL INFORMATION STATEMENT (FIS) which we will present to the Court for consideration.  There is a local rule for every family law case that we must present a FIS for a temporary orders hearing, final trial or mediation.  Even though it may not seem to apply to your particular case, the Court REQUIRES it and we do not want to show up without it.  Many times we will not have to present it, nor do we offer it to opposing counsel unless we absolutely have to and/or have to use it in a hearing.  We also use this document for negotiation with the other side or their attorney for the settlement you want us to pursue.

These things take time for us to review, put into final format, and discuss with you to see that we are all on the same page.  Please follow the instructions below and return it the next day, if possible, so we are prepared when and if we hear from his/her attorney.
 
INSTRUCTIONS:
            1.         This form requires only YOUR present and anticipated monthly expenses.  Don’t include expenses you are asking for the other party to pay or that you think the other party should be paying.  This is merely to see what expenses you anticipate you would be paying if you had no assistance from the other side.  We will then use this to show the Court that you either need help or that you have no/or limited spare funds to provide support.  If you are paying something quarterly, then divide it by 4 and put the monthly amount in the form.  You might want to write this on your copy or send some kind of explanation with it so we understand your figures.  If you don’t know quite how to calculate it, just give me some notes on how it works and I will call you and we will figure out the number.
2.         Mark any inapplicable category as “N/A”.
3.         Add any category not reflected on the form that reflects an expense you are regularly incurring.  This is a worksheet and we will do a final draft from here.
4.         Either calculate all expenses into a “Monthly Expense” total or specifically indicate that the expense is otherwise incurred, i.e. yearly, bi-monthly, etc. and we will calculate what it would then cost on a monthly basis.

All Courts REQUIRE that we tender this FIS with three (3) of your most recent paycheck stubs and your last two (2) income tax returns (with all schedules, W-2s and other attachments) when we turn in this form to the Court.  Please provide legible copies immediately.  

Please call if you have any questions or require assistance in completing this form.  I understand that sometimes these things are frustrating and a little explanation makes it a whole lot easier.

Cause No. 

FINANCIAL INFORMATION STATEMENT

_______________						________________________			
Petitioner							Respondent/Counterpetitioner:

Robby Neal							_______________________
Attorney for Petitioner					Attorney for Respondent

Monthly Expenses	
CATEGORY	MONTHLY EXPENSE	
HOUSEHOLD EXPENSES	
Mortgage		
Homeowner Insurance		
Property Taxes		
Utilities (water/electric/gas)		
Cable/Satellite TV		
Telephone		
Internet Service		
Housekeeper		
Lawn Service		
Pool Service		
Alarm System		
Total:		
FOOD/GROCERIES/SUPPLIES	
Food/Groceries – Party & Children		
Household Supplies		
Work Lunches – Party		
School Lunches - Children		
Total:		
TRANSPORTATION	
Car Payment – Party only		
Car Maintenance		
Car Repairs		
Gasoline/Parking/Tolls		
Car Insurance		
License and Inspection		
Car Washes		
Parking Fees		
Total:		

CLOTHING/LAUNDRY	
Clothing and shoes – Party 		
Clothing and shoes – Children		
Dry Cleaning		
Alterations		
Total:		
PERSONAL GROOMING	
Cosmetics 		
Hair/Nail Care – Party 		
Hair/Nail Care – Children		
Skin Care – Children 		
Toiletries 		
Total:		
MISCELLANEOUS	
Entertainment – Party only 		
Entertainment – Children only		
Cellular Expense – Children only		
Tuition		
Extracurricular Expense – Children only		
Pet Food/Veterinary Expense		
CDs, Videos, Movies		
Allowance – Children 		
Summer Camp – Children 		
Lessons – Children 		
Tutors- Children 		
Tax Preparation		
Non-reimbursed Business Expense		
Vacation Expense		
Membership Dues		
Gifts		
Total:		
HEALTH RELATED ITEMS	
Non-Prescription Medicines		
Prescription Medicines		
Health/Dental/Vision Insurance - 		
Respondent and Children		
Life Insurance		
Doctor		
Dentist		
Orthodontist		
Ophthalmologist		
Vitamins		
Counselor/Therapist		
Total:		
LOANS/OBLIGATIONS	
Credit Cards (List)	Minimum Monthly Payment: 	

		
		
Total:		
TOTAL KNOWN MONTHLY EXPENSES		

Employed: 	Employer:  	
I am paid bi weekly	My next check will be on:	
WITHHOLDINGS FROM PAY	
PER PAY PERIOD	MONTHLY	
Gross:					 	Gross:							
Deductions:                                                      	Deductions:	
Federal Income Tax                              	Federal Income Tax                                   	
Social Sec Tax                                        	Social Sec Tax                                           	
Medicare Tax                                          	Medicare Tax                                               	
 	 	
Other:	Other:	
Insurance - 	Insurance - 	
Accidental	Accidental	
Health, Dental & Vision	Health, Dental & Vision	

 	 	

 	 	
401(k) Contribution					401(k) Contribution					 	
401(k) Loan Repayment	401(k) Loan Repayment	 	
Total Deductions:	Total Deductions:	
Other Deductions:	Other Deductions:	
 	 	
Net pay to checking			       	Net pay to checking					
REQUEST OR PAYMENT OF SPOUSAL SUPPORT	
I am Requesting: 	I am Willing to Pay:  	
Spousal Support Per Month: 	Spousal Support Per Month: 	

INCOME INFORMATION FOR OTHER PARTY	
Employed:  	Employer:  	
My Spouse is Paid:  Weekly	My Spouse's Next Check Will Be On:	
WITHHOLDINGS FROM PAY	
PER PAY PERIOD	MONTHLY	
Gross:					        	Gross:							
Deductions:	Deductions:	
 	 	
Taxes:  SS & Fed.:	Taxes:  SS & Fed.:	
 	 	
Health Insurance:  approx. $	Health Insurance:  approx. $	
 	 	
Total Deductions:	Total Deductions:	
 	 	
Net Income:	Net Income:	
 	 	
Other Income:	Other Income:	

Date:  

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