Part 48
More forms, it may look sloppy but its worth posting them anyway.
MCOME AND EXPENSE DECLARATION
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1 have attached completed Income Information and Expense Information forms.
>tx/ must complete and attach rne expense information and ./icome information forms.
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Are you receiving or have you applied lor or do you intend to apply for warfare or AFDC?
1 1 Receiving 1 1 Applied for I 1 Intend to apply for F~l No.
Mark the rkghest year of education completed < 2 3 • 1 « Z * 9 10 11 12 1 13 14 IS 19 17 IB 19 2o|
Are you presently employed' rH ** 1 3 No
» If yes (11 Where do you workJ (name and address):
121 When did you start work there (month-year)'
b. It no 11) When did you last work tmonttvyearli
What is your social security number - -
Total monthly deductions Ifrom (me 12 of Income Information): t
Net monthly disposable income (from hne 13 of Income Information): |_» ]
[ \ Hardship deductions are requested m the total amount of. \ 1 )
(See item 21 of Expense Information)
1 1 Each parent has physical custody more than 30% of a 365-day period.
(See item 22 of Expense Declaration)
1 declare under penalty of perjury under the laws of the State of California that the foregoing
and the attached information forme are true and correct.
Data:
[Respondent
MCOME AND EXPENSE DECLARATION
1»>Km» .M,.. ISM,
PETITIONfK/PlAINTIFF
RtSPONDfNT WFENOAM
INCOMt XfOHMATION Of Inemel
1 Total gross salary or wage*, mciuding commissions, bonus**, and
patd during last 12 months:
2 Al other money racanwd dunng laat 12 months aacapt Spic/fy
.AFOC
Include pensions, gocMtl secunry dnab*ry unemployment
rn^ary oestf aabwance for QuerTars fA4Q/. jpousa/supry:
fmsr income, anrf aiKMtiaa.
Include income from a business and /enfa/ properties,
Aepe/e and match a acneoutr jnownp grot* rmcmrftx tug
casrt expense* ftx aacri ousnasi or nnttl propurr*
3 Add bws 1 through 2d
4 DrvMto the amount on hne 3 by 12 months
5 StaM ncoma ta> wnhhald: 5 •
6 Federal ixome tai withhak): 6. I
b Number o* exemptions claimed on lest federal ncome tax return
7 PICA ISociel Secumyl or l*M employment It* or en mmount not orttltr tor peaorm not
sub/eel to FKA. il the emounl a io*d to secure retnment or druofly benffra 7. I
8 Hearth insurance: . 8. I
9 Mandatory union dues 9. $
10 Mandatory retirement and pension fund contributions: X). $
Do not include any deduction ctetmed m item 7
11 Court ordered chM or spousal support actualy being paid for a retxionthcp other than
that roolved m this prooaedxg: 11. I
12 Add hnei 5 through 11 Mlej amattt lleillll «KH 112. »
13 Subtract kne 12 from kne 4 KM monthly dhpoeette •iinmi 113 $
14 Current gross monthly salary or wages t4. •
IS. AFOC. welfare, spousal support from thti marriage and chad support from other
relationships received each month: 151
16 Slate OHatxMy rourence withheld each month: IS »
18 Cash It chedung accounts: 18. I
19 Savings A credit union accounts: 19 I
20 Stocks, bonds, cash value of Me insurance, other kojad asaeti 20. •
21 A» other property, reel or personal Itpecify betowl: 21 *
