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Income And Expense Declaration FL-150 - California

Income And Expense Declaration Form. This is a California form and can be used in Family Law - Dissolution - Legal Separation -Annulment Judicial Council .
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FL-150 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT: CASE NUMBER: INCOME AND EXPENSE DECLARATION 1. Employment (Give information on your current job or, if you're unemployed, your most recent job.) a. Employer: Attach copies b. Employer's address: of your pay c. Employer's phone number: stubs for last d. Occupation: two months (black out e. Date job started: social f. If unemployed, date job ended: security hours per week. g. I work about numbers). gross (before taxes) per month per week h. I get paid $ per hour. (If you have more than one job, attach an 8½-by-11-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1--Other Jobs" at the top.) 2. Age and education a. My age is (specify): b. I have completed high school or the equivalent: Yes c. Number of years of college completed (specify): d. Number of years of graduate school completed (specify): professional/occupational license(s) (specify): e. I have: vocational training (specify): 3. Tax information a. I last filed taxes for tax year (specify year): single head of household married, filing separately b. My tax filing status is married, filing jointly with (specify name): c. I file state tax returns in California other (specify state): d. I claim the following number of exemptions (including myself) on my taxes (specify): 4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain): (If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the question number before your answer.) Number of pages attached: I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct. Date: (TYPE OR PRINT NAME) Form Adopted for Mandatory Use Judicial Council of California FL-150 [Rev. January 1, 2007] (SIGNATURE OF DECLARANT) If no, highest grade completed (specify): No Degree(s) obtained (specify): Degree(s) obtained (specify): INCOME AND EXPENSE DECLARATION Page 1 of 4 Family Code, §§ 2030­2032, 2100­2113, 3552, 3620­3634, 4050­4076, 4300­4339 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com FL-150 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT: CASE NUMBER: Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax return to the court hearing. (Black out your social security number on the pay stub and tax return.) 5. 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.) a. Salary or wages (gross, before taxes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ b. Overtime (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c. Commissions or bonuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ d. Public assistance (for example: TANF, SSI, GA/GR) e. Spousal support from this marriage currently receiving . . . . . . . . . . . . . . . . . $ from a different marriage . . . . . . . . . . . . . . . . . . $ Average Last month monthly f. Partner support from this domestic partnership from a different domestic partnership $ g. Pension/retirement fund payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ h. Social security retirement (not SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ i. Disability: Social security (not SSI) State disability (SDI) Private insurance . $ j. Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ k. Workers' compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ l. Other (military BAQ, royalty payments, etc.) (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6. Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.) a. Dividends/interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ b. Rental property income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c. Trust income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ d. Other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Income from self-employment, after business expenses for all businesses. . . . . . . . . . . . . . . . . . . . . $ I am the owner/sole proprietor business partner other (specify): Number of years in this business (specify): Name of business (specify): Type of business (specify): Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your social security number. If you have more than one business, provide the information above for each of your businesses. 8. Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and amount): Change in income. My financial situation has changed significantly over the last 12 months because (specify): 7. 9. 10. Deductions Last month a. Required union dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ b. Required retirement payments (not social security, FICA, 401(k), or IRA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c. Medical, hospital, dental, and ot
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