YourName: YourAddress: YourCity,State,ZIP: YourTelephoneNo: RepresentingSelf,WithoutanAttorneyINTHESUPERIORCOURTOFARIZONA,COUNTYIntheMatteroftheConservatorshipof:)CaseNo. ))INANCIALSTATEMENT)OFCUSTODIALPARENT(S)OFMINORMinor)Judge/Commissionermakesthefollowinganswersandstatementsoffact:1.Name,address,phonenumberofpresentemployer:2.Presentoccupationorposition.. Hiredate3.Ifnotemployed,why?4.Doyouexpecttowork?No Ifyes,whenandanticipatedoccupation?Yes1of3 02/01/002001 © American LegalNet, Inc.5.Namesandagesofminorchildrenresidingwithyou:6.Listallbankaccounts(checking,savings,creditunion,certificatesofdeposit,etc.)inyourname orinwhichyouhaveaninterest:7.Listallrealestate,stocks,bonds,shares,orcashinyournameorinwhichyouhaveaninterest:Theundersignedswearsoraffirmsthatthestatementssetforthaboveandonpagetwoofthis Affidavitaretrueandcorrect,subjecttothepenaltiesofmakingafalseaffidavitordeclaration.DateSigned2of3 02/01/002001 © American LegalNet, Inc.NECESSARYMONTHLYEXPENSES (Forallpersonsresidinginhousehold)HOUSEHOLD INCOMEGrossPaycheck.........HousingLess:Fed.TaxesUtilities:ElectricityStateTaxesG sFICACreditUnionWaterPhoneInsur nceG rb geUnionDuesFood/HouseholdSuppliesSavings/Etc.Work/SchoolLunchOtherMedic l/DentalSuppliesTotalDeductions$0.00$0.00Insur nce(notdeductedfromp y)NetPaycheckClothingChildCare/SitterOTHERMONTHLYINCOMESupportpaidforspouseand/or minorchild(ren)ofpriorm rriagePension/RetirementSocialSecurity/SSITransportation:CarRep ir/Maint.Dividends/InterestCarInsuranceGA/TANFG s/OilSpousalMaint./SupportBus/TaxiF resTotalOtherIncomeOther:TotalMo.Income--allsources$0.00TotalMonthlyExpensesTotalMo.IncomelessTotalMo. Expenses/Payments$0.00MONTHLYPAYMENTSCreditorBalancePaymentTotalMonthlyPaymentsTotalMo.Expenses/Payments3of3 02/01/002001 © American LegalNet, Inc.
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