Form DR30 "Financial Statement (Short)" - Maryland

What Is Form DR30?

This is a legal form that was released by the Maryland Department of Human Services - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 8, 2000;
  • The latest edition provided by the Maryland Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DR30 by clicking the link below or browse more documents and templates provided by the Maryland Department of Human Services.

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Download Form DR30 "Financial Statement (Short)" - Maryland

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Circuit Court for
Case No.
City or County
Name
Name
VS.
Street Address
Apt. #
Street Address
Apt. #
( )
( )
City
State
Zip Code
Area
Telephone
City
State
Zip Code Area
Telephone
Code
Code
Plaintiff
Defendant
FINANCIAL STATEMENT
(Short)
(DOM REL 30)
I,
, state that:
My name
I am the
mother/
father or
State Relationship (for example, aunt, grandfather, guardian, etc.)
Check One
of the minor child(ren):
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
The following is a list of my income and expenses (see below*):
See definitions on back before filling out.
Total monthly income (before taxes)
$
Child support I am paying for my other child(ren) each month
Alimony I am paying each month to
Name of Person(s)
Alimony I am receiving each month from
Name of Person(s)
For the child or children listed above:
Monthly health insurance premium
Work-related monthly child care expenses
Extraordinary monthly medical expenses
School and transportation expenses
*To figure the monthly amount of expenses, weekly expenses should be multiplied by 4.3 and yearly expenses should be divided by 12.
.
If you do not pay the same amount each month for any of the categories listed, figure what your average monthly expense is
I solemnly affirm under the penalties of perjury that the contents of the foregoing paper are true to
the best of my knowledge, information and belief.
Date
Signature
Page 1 of 2
DR 30 - Revised 8 Nov 2000
Circuit Court for
Case No.
City or County
Name
Name
VS.
Street Address
Apt. #
Street Address
Apt. #
( )
( )
City
State
Zip Code
Area
Telephone
City
State
Zip Code Area
Telephone
Code
Code
Plaintiff
Defendant
FINANCIAL STATEMENT
(Short)
(DOM REL 30)
I,
, state that:
My name
I am the
mother/
father or
State Relationship (for example, aunt, grandfather, guardian, etc.)
Check One
of the minor child(ren):
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
The following is a list of my income and expenses (see below*):
See definitions on back before filling out.
Total monthly income (before taxes)
$
Child support I am paying for my other child(ren) each month
Alimony I am paying each month to
Name of Person(s)
Alimony I am receiving each month from
Name of Person(s)
For the child or children listed above:
Monthly health insurance premium
Work-related monthly child care expenses
Extraordinary monthly medical expenses
School and transportation expenses
*To figure the monthly amount of expenses, weekly expenses should be multiplied by 4.3 and yearly expenses should be divided by 12.
.
If you do not pay the same amount each month for any of the categories listed, figure what your average monthly expense is
I solemnly affirm under the penalties of perjury that the contents of the foregoing paper are true to
the best of my knowledge, information and belief.
Date
Signature
Page 1 of 2
DR 30 - Revised 8 Nov 2000
Total Monthly Income: Include income from all sources including self-employment, rent, royalties,
business income, salaries, wages, commissions, bonuses, dividends, pensions, interest,
trusts, annuities, social security benefits, workers compensation, unemployment benefits, disability
benefits, alimony or maintenance received, tips, income from side jobs, severance pay, capitol gains,
gifts, prizes, lottery winnings, etc. Do not report benefits from means-tested public assistance
programs such as food stamps or AFDC.
Extraordinary Medical Expenses: Uninsured expenses over $100 for a single illness or condition
including orthodontia, dental treatment, asthma treatment, physical therapy, treatment for any
chronic health problems, and professional counseling or psychiatric therapy for diagnosed mental
disorders.
Child Care Expenses: Actual child care expenses incurred on behalf of a child due to employment
or job search of either parent with amount to be determined by actual experience or the level required
to provide quality care from a licensed source.
School and Transportation Expenses: Any expenses for attending a special or private elementary
or secondary school to meet the particular needs of the child or expenses for transportation of the
child between the homes of the parents.
RESET FORM
Page 2 of 2
DR 30 - Revised 8 Nov 2000
Page of 2