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Financial Declaration - Washington
| Financial Declaration Form. This is a Washington form and can be used in General Superior Court Clark Local County . |
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IN AND FOR THE STATE OF WASHINGTON COUNTY OF CLARK ) ) Petitioner, ) No. ) vs. ) FINANCIAL DECLARATION ) (FNDCLR) ) Respondent. ) ________________________________) 1. GENERAL INFORMATION Name: Address (omit, if confidential): Telephone #: Employer Name: Employer Address: Spouses Name: Spouses Employer Name: Spouses Employer Address: 1.2 PERSONS (including children) WHOM YOU FINANCIALLY SUPPORTName Age Relationship Address 2. INCOME AND ASSETS Gross Monthly Income (personal): Other Income: Cash: Savings: FINANCIAL DECLARATION Page 1 <<<<<<<<<********>>>>>>>>>>>>> 2Current spouse or partner living in residence: Home (cash value less amount owing): Auto (cash value less amount owing): Furniture (approximate value): Notes, Mortgages, Trusts, Deeds: Stocks, Bonds (approximate value): Other Assets and Property: Any Indebtedness Owed to You: 3. MONTHLY EXPENSES Rent or Mortgage: Food: Utilities: Transportation: Installment payments (per month): Medical & Dental: Insurance: Other: Total Monthly Expenses: 3.1 DEBTS Name of Creditor: Amount Owed: Under the penalty of perjury I declare that I have examined this documentand the preceding information is true and accurate to the best of my knowledgeand ability. _____________________________ __________________________Signature DateFINANCIAL DECLARATION Page 2
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