top of page
FINANCIAL INFORMATION - INCOME
EMPLOYMENT
Employer Name:
Address:
Job Start Date:
Hours work per week:
Phone Number:
Occupation:
If unemployed, last day of job:
Gross Income (before taxes):
$
AGE AND EDUCATION
Age:
Have you completed High School or Equivalent?
If no, highest grade completed:
Degrees Obtained:
Years of College Completed:
Degrees Obtained:
Years of Graduate School Completed:
Degrees Obtained:
Do you have a:
Please specify:
Need Copies of last 2 months paystubs, and Income Tax Returns
SALARY INCOME
Salary/Wages:
$
Overtime:
$
Public Assistance:
$
Spousal Support:
$
Partner Support:
$
Pension/Retirement:
$
Social Security Retirement (Not SSI):
$
$
Unemployment:
$
Worker’s Comp:
$
Other: (Military Allowances, royalties, etc):
$
INVESTMENT INCOME
Dividends/Interest:
$
Property Rental:
$
Trust Income:
$
Other:
$
SELF-EMPLOYMENT INCOME
Are you a/an:
Years in Business:
Years in Business:
Business Type:
Income from Self-Employment (after buss. Exp.):
$
Need P&L for last 2 years or Schedule C from Income Tax
TAX INFORMATION
Last year of tax filed:
Tax Status:
Did you file them in California?
Specify:
Number of exemptions, including yourself:
how much do you estimate the other party's gross income per month is?
$
How do you base this estimate?
Please attach copies of paystubs for the last two months and a copy of your latest federal tax return. Black out your SSN
ADDITIONAL INCOME
Did you receive a one-time money (lottery, inheritance, etc.) in the last 12 months?
Please specify:
CHANGE IN INCOME
Have your financial situation changed in the last 12 months?
Please specify:
ASSETS
Cash and checking Accounts, savings, credit union, money market and other accounts:
$
Stock, bonds, and other assets you could sell:
$
All other property:
(FMV minus debts you owe):
$
Summons
Civil Restraining Orders
bottom of page