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Get and Sign Financial Statement Form
Persons other than myself depend in whole or in part on me or my spouse for support MONTHLY TAKE-HOME NAME AGE RELATIONSHIP TO ME INCOME SOURCE a* Spouse b. c* d. e. 2. My monthly income a* My gross monthly pay is. 2a* b. My payroll deductions are specify purpose and amount 1 Federal and state withholding FICA and SDI. My TOTAL payroll deduction amount is add 1 through 4. c* My monthly take-home pay is a minus b. d. Other money I get each month from specify source is. e. TOTAL MONTHLY INCOME c...
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