Nevada > Statewide > District Court > Divorce
Short Form Financial Declaration - Nevada
| Short Form Financial Declaration Form. This is a Nevada form and can be used in Divorce District Court Statewide . |
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1 Code: Name: ______________________________ 2 Address: ____________________________ 3 ____________________________________ Telephone:___________________________ 4 5 6 IN THE _______________ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 7 IN AND FOR THE COUNTY OF __________________ 8 9 __________________________________, ) Plaintiff/Petitioner ) Case No. ____________________ 10 ) vs ) Dept. No. ___________________ 11 ) 12 __________________________________, ) Defendant/Respondent) 13 ____________________________________) 14 SHORT FORM FINANCIAL DECLARATION 15 STATE OF NEVADA ) 16 ) 17 County of ________________) 18 I, __________________________________, being duly sworn and under the pe nalties of (print your name) 19 perjury, depose and state as follows: 20 21 I have read the contents of this Financial Declaration and am competent to testify as to the 22 contents, and the contents are true of mown knowledge except for those my atters stated on 23 information and belief, and as to those matters, I believe them to be true. 24 25 SUBSCRIBED and SWORN to before me _____________________________________ 26 ( signature) 27 this _______day of _____________________, 20____. 28 ____________________________________________ NOTARY PUBLIC MONTHLY INCOME EXHIBIT P 1 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 1 2 If you are presently unemployed, answer questions 1 2 and then go on to the rest of the 3 questions. If you are employed, print not applicable in questions 1 2 and go on to the rest of the questions. 4 5 1. __________ I am presently unemployed and have been unemployed since 6 _______________________________________ 7 (date of your last employment) 8 2. My last employer was ________________________________________________ and I 9 earned $__________________ per hour / week / month (circle one) 10 Answer all of the following questions. If the question is not applicable in your particular 11 circumstances, print N/A in the spaces. 12 Monthly Money Earned and Received 13 3. I am employed and earn the following wages: 14 15 I am paid by the hour and my hourly wage is: $ __________________ I work __________ hours per week. 16 17 I am paid (circle one) every week; every 2 weeks; 1x a month 2x a month and without anything being deducted from it, each 18 check is for (attach last 3 paystubs): $ _________________ 19 I work overtime approximately __________ hours per month at the rate of $ _____________ per hour for an 20 average monthly overtime earning of: $ _________________ 21 I receive commissions each month in the amount of: $ ________________ 22 (averaged over a year) I receive tips each month in the amount of: $ ________________ 23 (averaged over a year) 24 I receive bonuses each month in the amount of: $ ________________ (averaged over a year) 25 Income Other Than Wage Earnings 26 4. I receive child support each month from the other party in the 27 amount of (amount of court order $_____________): $ ________________ 28 EXHIBIT P 2 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3 1 5. I receive child support each month from someone else in the amount of (amount of court order $_____________): $_________________ 2 3 6. I receive alimony/spousal support each month from the other party in the amount of 4 (amount of court order $_____________): $ ________________ 5 7. I receive alimony/spousal support each month from 6 someone else in the amount of (amount of court order $_____________) : $_________________ 7 8 8. I receive the following government assistance: 9 I receive Social Security Benefits each month in the amount of: $ ________________ I receive Non Social Security Disability each month in the 10 amount of: $ ____________ _____ I receive State or County assistance (welfare, TANF, SIIS, etc.) 11 each month in the amount of: $ ________________ 12 I receive unemployment each month in the amount of: $ ________________ 13 9. I receive retirement benefits each month in the amount of: $ ________________ 14 10. I receive investment income each month in the amount of: $ ________________ 15 11. I receive income from rental properties 16 (excluding depreciation) each month in the amount of: _________________ $ 17 12. I live with someone (friend, relative, significant other) who 18 contributes to the living expenses each month in the amount of: _________________ $ 19 13. I am receiving educational or school benefits in the amount of: _________________ $ 20 14. I am receiving money from friends, relatives, others each month 21 in the amount of: $________ __________ 22 15. I am receiving other sources of income, including but not limited to monthly distributions from a trust or will in the 23 amount of: $________ __________ 24 25 MY TOTAL MONTHLY INCOME FROM ALL SOURCES IS: $ __________ ________ (this amount is your gross income) 26 27 HOW MUCH IS BEING WITHHELD FROM YOUR INCOME EACH MONTH? 28 Federal income taxes: $ _______________ EXHIBIT P 3 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 4 1 Social Security $ _______________ 2 Medicare taxes $ _______________ 3 Child support for children with the other party $ _______________ 4 5 Child support for children with someone else $________________ Alimony/spousal support paid to the other party $_________________ 6 Alimony/spousal support paid to someone else: $_________________ 7 8 Retirement, 401K, etc. $ _________________ 9 Health insurance total: $_________________ Of this amount, $__________ is the 10 amount paid for your and the other partys children. 11 12 Any other garnishments or withholdings, please list: 13 _________________________________ $ _______________ 14 15 _________________________________ $ _______________ 16 _________________________________ $ _______________ 17 TOTAL WITHHOLDING EACH MONTH: $ _______________ 18 19 YOUR TOTAL EXPENSES EACH MONTH (REPORT ONLY THE AMOUNT YOU 20 ACTUALLY PAY) 21 1. Each month I pay rent or mortgage or I contribute to the 22 rent or mortgage wherel Iive in the am ountof: $ _____ ____________ 23 2. For food each month, I spend or contribute to the family with 24 whom I am living thaem ount of: $ ____________ _____ 25 3. For house/apartment utilities (gas, power, water, garbage, sewer) I pay or contribute to my household the amount of: $ _________________ 26 27 4. Life insurance $_________________ 28 5. I have a vehicle and pay the following each month: Vehicle payment each month in the amount of: __
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