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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

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