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Fill and Sign the California Family Law Form

Fill and Sign the California Family Law Form

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PETITIONER/PLAINTIFF: ––––– RESPONDENT/DEFENDANT: ––––– INCOME INFORMATION OF (name) : ––––– CASE NUMBER: ––––– 1. Total gross salary or wages, including commissions, bonuses, and overtime paid during the last 12 months: 1. $ ––––– 2. All other money received during last 12 months except welfare, AFDC, SSI, spousal support from this marriage, or any child support. Specify sources below: ––––– 2a. $ ––––– Include pensions, social security, disability, unemployment, military basic allowance for quarters (BAQ), spousal support from a different ––––– 2b. $ ––––– marriage, dividends, interest or royalty, trust income, and annuities. Include income from a business, rental properties, and reimbursement ––––– 2c. $ ––––– of job-related expenses. 4 Prepare and attach a schedule showing gross receipt less cash ––––– 2d. $ ––––– expenses for each business or rental property. 3. Add lines 1 through 2d. ...................................................................................................................................... 3. $ ––––– Divide line 3 by 12 and place result on line 4a. Average last 12 months: Last month: 4. Gross income: ........................................................................................................... 4a. $ ––––– 4b. $ ––––– 5. State income tax ..................................................................................................... 5a $ ––––– 5b $ ––––– 6 Federal income tax: .................................................................................................. 6a. $ ––––– 6b. $ ––––– 7. Social Security and Hospital Tax ("FICA" and "MEDI") or self-employment tax, or the amount used to secure retirement or disability benefits ......................... 7a. $ ––––– 7b. $ ––––– 8. Health insurance for you and any children you are required to support .................. 8a. $ ––––– 8b. $ ––––– 9. State disability insurance .......................................................................................... 9a. $ ––––– 9b. $ ––––– 10 Mandatory union dues .............................................................................................. 10a. $ ––––– 10b. $ ––––– 11. Mandatory retirement and pension fund contributions ............................................ 11a. $ ––––– 11b. $ ––––– Do not include any deduction claimed in item 7. 12. Court-ordered child support, court-ordered spousal support, and voluntarily paid child support in an amount not more than the guideline amount, actually being paid for a relationship other than that involved in this proceeding : ................ 12a. $ ––––– 12b. $ ––––– 13. Necessary job-related expenses (attach explanation) ............................................. 13a. $ ––––– 13b. $ ––––– 14. Hardship deduction (Line 4d on Child Support Information Form) .......................... 14a. $ ––––– 14b. $ ––––– 15. Add lines 5 through 14. . . . . . . . . . . . . . . . . . . . . . Total monthly deductions: 15a. $ ––––– 15b. $ ––––– 16. Subtract line 15 from line 4. . . . . . . . . . . . . Net monthly disposable income: 16a. $ ––––– 16b. $ ––––– 17. AFDC, welfare, spousal support from this marriage, and child support from other relationships received each month: . ....................................................................................................................................................... 17. $ ––––– 18. Cash and checking accounts: .............................................................................................................................. 18. $ ––––– 19. Savings, credit union, certificates of deposit, and money market accounts: ...................................................... 19. $ ––––– 20. Stocks, bonds, and other liquid assets: .............................................................................................................. . 20. $ ––––– 21. All other property, real or personal (specify below) : ............................................................................................ 21. $ ––––– 4 Attach a copy of your three most recent pay stubs. Page –– of –– Form Adopted by Rule 1285.50a Judicial Council of California INCOME INFORMATION (Family Law) electronic form ã 1999 WWW.LawCA.com Law Publishers 1285.50a [Rev. January 1, 1995]

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