Affidavit For Proceeding In Forma Pauperis Under Minn. Stat. § 563.01
Exhibit 1: Debt and Expenses
Debt (Affidavit ¶ 15) |
Debt |
(Excluding Car Loans And Real Estate Mortgage/Loans) |
|
|
|
Credit Card |
|
Student Loan |
|
Other: |
|
Other: |
|
|
|
Total Debt (Affidavit ¶ 15) |
|
|
|
Expenses (Affidavit ¶¶ 11-13) |
Cost |
|
|
Child Support (Affidavit ¶ 11) |
|
Spousal Maintenance (Affidavit ¶ 12) |
|
Rent / Affidavit Mortgage Payment (¶ 13) |
|
|
|
Total Expenses (Affidavit ¶¶ 11-13) |
|
|
|
Other Expenses (Affidavit ¶ 16) |
Cost |
|
|
Contract For Deed / 2nd Mortgage |
|
Homeowner’s / Rental Insurance |
|
Property Taxes (If Not Included In Mortgage Payment) |
|
Heat |
|
Electricity |
|
Water And Sewer |
|
Telephone |
|
Cell Phone |
|
Cable / Dish TV |
|
Internet |
|
Food |
|
Clothing |
|
Household Supplies |
|
Bus / Taxi |
|
Car Loan Payment |
|
Gas |
|
Car Insurance |
|
Medical And Dental Expenses (Not Covered By Insurance) |
|
Child Care |
|
Credit Card Payment |
|
Student Loan Payment |
|
Other: |
|
Other: |
|
Other: |
|
|
|
Other Expenses (Affidavit ¶ 16) |
|
|
|
Total Monthly Expenses (Affidavit ¶¶ 11-13, 16) |
|