Support Account Sheet Example

Expense and Income Statement

Wife’s Employment:
Wife’s gross salary: _____ Per _____ Net _____ Per _____
Wife’s other income:
Husband’s Employment:
Husband’s gross salary: _____ Per _____ Net _____ Per
Husband’s other income:
Number of children you must support:
Children Adult

Rent or house note, taxes, insurance, etc. __________ __________
Utilities, cable __________ __________
Telephone __________ __________
Maid, lawn service, gardener __________ __________
Yardwork, maintenance __________ __________
Repair & replacement of appliances __________ __________

Groceries and meals out __________ __________
Tuition and books, etc. __________ __________
School lunches __________ __________
Work lunches __________ __________

Automobile note and insurance __________ __________
Gasoline, licenses, parking, etc. __________ __________
Clothing, shoes __________ __________
Laundry and dry cleaning __________ __________
Haircuts, beauty parlor __________ __________
Babysitter, nursery fees __________ __________

Medical insurance __________ __________
Life insurance __________ __________
Homeowner’s insurance __________ __________
Hospitals, doctors’ and dentists’ bills __________ __________
Drugs, etc. __________ __________
Lessons, tutoring, reading __________ __________
Furniture, notes/replacement __________ __________
Pets, hobbies, sports equipment __________ __________
Entertainment __________ __________

Allowances __________ __________
Christmas, birthday presents, toys __________ __________
Vacation __________ __________
Contribution to church/charity __________ __________
Clubs, dues __________ __________
Other expense __________ __________
Future expenses (repairs to house, medical,
dental, etc.) __________ __________
DEBTS: Attorney’s Fees $__________
__________ $__________ __________ __________
__________ $__________ __________ __________
__________ $__________ __________ __________
__________ $__________ __________ __________
__________ $__________ __________ __________

TOTAL __________ __________
NET INCOME __________ __________
MONTHLY SURPLUS / SHORTFALL __________ __________

Support Account Sheet Example

SPOUSE VS. SPOUSE

Support due per Pendente Lite Order: $500/month, ½ medical expenses, $250 attorney’s fee
Date 4/30/11

Date
Due
Date
Paid
Amount
Owed
Amount
Paid
Balance
Owed

Notes
05/01/11

250.00

250.00
Attorney’s fee
05/01/11
05/10/11
500.00
350.00
400.00
Check #556
05/03/11

125.00

525.00
Medical emergency for son $250.00
06/01/11
06/02/11
500.00
400.00
625.00
Check #715 — Short. Account is in name of husband and Suzie Smith at East Mississippi Bank.
07/01/11
07/01/11
500.00
600.00
525.00
Check #780 — promises to make up balanced in August.
08/01/11
08/01/11
500.00
1,000.00
25.00
Check #800 — back balance owed and $125.00 on attorney’s fee.

08/14/11

125.00
-100.00
Check #812 — on attorney’s fee

-100.00

-100.00

-100.00

TOTAL

2,375.00
2,475.00
-200.00

Support Account Sheet

_______________________ VS. ______________________

Support due per Pendente Lite Order:______________________________________
Date of Order: ______________________________

Date
Due
Date
Paid
Amount
Owed
Amount
Paid
Balance
Owed

Notes*

*If you need more than one line for Notes, please take them. The information could be critical to your case.

Categories: