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3226 (Rev. 12/20)AFFIDAVIT FOR MAINTENANCE, CUSTODY ETC - DOMESTIC RELATIONS
AFFIDAVIT IN SUPPORT AFFIDAVIT IN RESPONSE TO
PETITION FOR MAINTENANCE, CUSTODY, CHILD SUPPORT, ATTORNEY'S FEES AND COURT COSTS (STRIKE OUT INAPPROPRIATE PORTIONS)
B. This child(ren) in the custody of at (location)
File Stamp Here
vsCASE NUMBER
being first duly sworn, states as follows:
UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
PETITIONER
RESPONDENT
IN RE THE MARRIAGE OF
Page 1 of 2
1. That is the in the above entitled matter.2. The parties have been married years; the wife's age is ; and the husband's age is .3. The parties have been separated months, during which the has paid $ to the
4. Facts concerning the child(ren) of the parties as follows:A. The child(ren) of the parties, aged respectively
C. For the best interest of the child(ren) custody should be awarded to
D. The has minor child(ren) by a previous marriage. 5. The property of the parties, its market value and encumbrances are:
ITEM
MARKET VALUE
he
wifehusband wife.
husband
she petitioner respondent
respondentpetitioner
HUSBAND WIFE JOINT TENANCY ENCUMBRANCES
HomesteadOther realtyHousehold goodsAutomobilesStock, bonds, notesCash and bank creditsClaims, accounts receivable
$
$
$
$
$
$
$
$
$
$
$
$
$
$ $
$
$
$
$
$
$
$
$
$
$
$
$
$
TOTALS
6. A. Unsecured debts of husband not included in above B. Unsecured debts of wife not included in above C. Unsecured joint debts not included in above
3226 (Rev. 12/20)AFFIDAVIT FOR MAINTENANCE, CUSTODY ETC - DOMESTIC RELATIONS
11. A. Husband's total income after deductions is monthly
Signed and sworn to before me
Date
Circuit Clerk or Notary Public
Page 2 of 2
7. The necessary weekly - monthly expenses are:
G. UtilitiesF. FoodE. FuelD. Personal contact paymentsC. Realty contract paymentsB. Realty TaxesA. Rent
H. InsuranceI. ClothingJ. TransportationK. Mecidal and dental
CHILD (IF SEPARATE)
$
$
$
$
$
$
$
$
WIFE
$
$
$
$
$
$
$
$
HUSBAND
$
$
$
$
$
$
$
$
$$$
$$$
$$$
TOTAL $ $ $
8. Husband's EmployerNameAddress Phone
Gross Income $ Itemized deductions $
10. The family home contains bedrooms; is by the parties and is now occupied by
12. A. Reasonable amount for support for child(ren) is $ per .
15. is reasonable for wife's temporary attorney fees plus for disbursements.16. State additional material facts. If any, respondent should set forth facts in answer thereto.
NameAddressGross Income $
PhoneItemized deductions $
rentedowned
weekly
B. Wife's total income after deductions is weekly monthly
$
C. Child(ren)'s total income after deductions is monthlyweekly$
$
month week
B. Reasonable amount for temporary alimony is $ per . monthweek C. The dates for payment should be
D. Husband's necessary living expenses will be .13. has been paid on husband's attorney fees and disbursements.14. has been paid on wife's attorney fees and disbursements.