Fill and Sign the In the District Court for the Judicial Ada County Form

AFFIDAVIT VERIFYING INCOME PAGE 1CAO 1-11 2/25/2005Full Name of Party Filing This DocumentMailing Address (Street or Post Office Box)City, State and Zip CodeTelephone Number IN THE DISTRICT COURT OF THE JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF _____________________________________, Plaintiff, vs. _____________________________________, Defendant. Case No.: ___________________ AFFIDAVIT VERIFYING INCOMESTATE of Idaho ) ) ss. County of )I hereby state under oath that the following information is true:A. GROSS INCOME FATHERMOTHER 1. Wages, salary, commissions, bonuses, etc. ________ 2. Rent, royalties, trade, or business income, etc. ________ (Net of ordinary & necessary expenses) 3. Interest, dividends, pensions, annuities, etc. ________ 4. Social security, worker's compensation, unemploymentbenefits, disability, veterans' benefits, etc. ________ 5. Public assistance, welfare for self (not children) ________ 6. Alimony ________ 7. Grants, distributions from trusts, etc. ________ 8. Other ________ 9. SUBTOTAL ________ B.DEDUCTIONS FROM GROSS INCOME (I.C.S.G. Sections 6 and 7) 1. Straight line depreciation on assets ________ 2. One-half of self-employment Social Security taxes ________ 3. Child support & alimony from another relationship ________ 4. Support for child of another relationship livingin the home ________ 5. DEDUCTIONS SUBTOTAL ________ AFFIDAVIT VERIFYING INCOME PAGE 2CAO 1-11 2/25/2005 FATHER MOTHER C.GROSS INCOME, AS ADJUSTED ________ (line B5 subtracted from line A9)D. IN-KIND BENEFITS (I.C.S.G. Section 6(b)) ________ (Housing, food, transportation, recreation) E.POTENTIAL INCOME (I.C.S.G. Section 6(c)) ________ Potential earned income + Potential unearned incomeF.GUIDELINES INCOME (C + D + E) ________ G.MONTHLY I.C.S.G. INCOME (F12 months) ________ ___________________________________ __________________________________Typed/Printed Name of Person Signing Signature Subscribed and sworn to before me on , 20______. __________________________________________ Notary Public for Idaho Residing at:_____________________________My commission expires: ___________________