INCOME & EXPENSE DECLARATION

INCOME & EXPENSE DECLARATION

This information is required by the Court for all aspects of your case concerning financial issues such as support motions, requests for attorney's fees, and disclosure. Please call us at (559) 230-2600 if you have any questions about the information requested.
1. Employment (Give info on your current job or, if you're unemployed, your most recent job.)
Employer:
Employer's address:
Employer's phone number:
Occupation:
Date job started:
If unemployed, date job ended:
How many hours do you work per week?
How much do you get paid grossly (before taxes)?
per monthper weekper hour

2. Age and education
Your age is?
Have you completed high school or the equivalent?
If no, highest grade you've completed (specify):
Number of years of college completed (specify):
Degree(s) obtained (specify):
Number of years of graduate school completed (specify):
Degree(s) obtained (specify):
Do you have any vocational training? If so, please specify:
Do you have professional/occupational license(s)? If so, please specify:

3. Tax Information
When did you last file taxes? Please specify the year:
Your filing status:

singlehead of householdmarried, filing separatelymarried, filing jointly
If you checked "married, filing jointly," please specify with who (give name):
Do you file taxes in California?
If not, please specify state:
You claim the following number of exemptions (including yourself) on your taxes (specify):

4. Other party's income
You estimate the gross monthly income (before taxes) of the other party in this case at (specify): ($________)

5. Your Income

(For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.)
Salary or wages you received last month (gross, before taxes):
Average monthly:
Overtime you received last month (gross, before taxes):
Average monthly:
Commissions or bonuses you received last month (gross, before taxes):
Average monthly:
Public assistance (for example: TANF, SSI, GA/GR) you received last month (gross, before taxes):
Are you currently receiving?
Average monthly:
Are you receiving spousal support?

YesNo
If you checked yes, check all that applies:

From this marriageFrom a different marriageFederally taxable
Spousal support you received last month:
Average monthly of spousal support:
Do you receive partner support?
If so, please indicate if it's for this marriage or a different marriage:
Partner support you received last month:
Average monthly of partner support:
Pension/retirement fund payments you received last month:
Average monthly of pension/retirement fund payments:
Social security retirement (not SSI) you received last month:
Average monthly of social security:
Do you receive disability? If so, please indicate type of disability:

Social security (not SSI)State disabilityPrivate insuranceNone
Disability you received you received last month:
Average monthly of disability:
Unemployment disability you received last month:
Average monthly of unemployment disability:
Worker's compensation you received last month:
Average monthly of worker's compensation:
Other income (military allowances, royalty payments) you received last month:
Average monthly of other income:

6. Investment income
Dividends/interest you received last month:
Average monthly of dividends/interest:
Rental property income you received last month:
Average monthly of rental property income:
Trust income you received last month:
Average monthly of trust income:
Other investment income you received last month (specify):
Average monthly of other investment income:

7. Income from self-employment, after business expenses for all businesses:
Income you received last month:
Average monthly:
Please choose the option that describes you:

owner/sole proprietorbusiness partnerother
If you checked "other," please specify:
Number of years in this business:
Type of business:

8. Additional income
Have you received one-time money (lottery winnings, inheritance, etc.) in the last 12 months? If so, please specify and source amount:
ATTACH LAST THREE PAYSTUBS
ATTACH LAST TWO TAX RETURNS
ATTACH ALL FORMS 1099, W-2, K-1 FOR PAST YEAR

9. Change in income
Has your financial situation changed significantly over the last 12 months? If so, please specify how:

10. Deductions
Please check all that applies to you:

Required union duesRequired retirement payments (not Social Security, FICA, 401(k), or IRA)Medical, hospital, dental, and other health insurance premiums (total monthly amount)Child support that I pay for children from other relationshipsSpousal support that I pay by court order from a differentPartner support that I pay by court order from a different domestic partnershipNecessary job-related expenses not reimbursed by my employer
If you checked any of the boxes above, please list them here and the amount you received last month:

11. Assets

Please list total amount for each listed (if any):
Cash and checking accounts, savings, credit union, money market, and other deposit accounts:
Stocks, bonds, and other assets you could easily sell:
All other property:

12. The following people live with me:
Configurable list

13. Average monthly expenses:
Please select one before filling out:

Estimated expensesActual expensesProposed needs
Average monthly amount of Home expenses:
Average monthly amount of additional expenses:

14. Installment payments and debts not listed before
Configurable list

15. Attorney fees

(This is required if either party is requesting attorney fees.)

Child Support Information (NOTE: Fill out this page only if your case involves child support.)
16. Number of children
A. I have (specify number) blanks children under the age of 18 with the other parent in this case.
B. The children spend blank percent of their time with me and percent of their time with the other parent.
17. Children's health-care expenses:
Do you have health insurance available to you for the children through your job?
If yes, please specify the Insurance company:
The address of Insurance company:
The monthly cost for the children's health insurance is or would be (specify): $
18. Additional expenses for the children in this case:
Please list the amount per month, if any:
19. Special hardships

This is to ask the court to consider the following special circumstances:
Please specify if any:
20. Other information you want the court to know concerning support in your case
Please specify:

Please verify that you are human*
Signature
Should be Empty:

INCOME & EXPENSE DECLARATION

1. Employment (Give info on your current job or, if you're unemployed, your most recent job.)

2. Age and education

3. Tax Information

4. Other party's income

5. Your Income

6. Investment income

7. Income from self-employment, after business expenses for all businesses:

8. Additional income

9. Change in income

10. Deductions

11. Assets

12. The following people live with me:

13. Average monthly expenses:

14. Installment payments and debts not listed before

15. Attorney fees

Child Support Information (NOTE: Fill out this page only if your case involves child support.)

16. Number of children

17. Children's health-care expenses:

18. Additional expenses for the children in this case:

19. Special hardships

20. Other information you want the court to know concerning support in your case