Affidavit For Proceeding In Forma Pauperis Under Minn. Stat. § 563.01

Exhibit 1: Debt and Expenses

(Pov. Law Form IFP Exh. 1)

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)