Income Calculation Report

INCOME CALCULATION REPORT

This Income Calculation Report (the "Report") is prepared pursuant to an engagement between Client Name: and Service Provider: . Effective Date:

RECITALS

WHEREAS, Client has requested that Provider prepare a detailed income calculation for the Reporting Period described below and Provider has agreed to prepare such Report in accordance with the Scope of Work and terms set forth herein;

WHEREAS, the Report is to be prepared on the basis of documents, statements and representations supplied by Client and third-party records, and Provider will rely on such materials without independent verification except as expressly stated in this Report;

WHEREAS, the parties intend that this Report and the accompanying terms constitute the entire agreement between Client and Provider with respect to the services described herein.

SCOPE OF WORK

INCOME CALCULATION

Reporting Period Start:    End:

Itemized Sources of Income

1. Description:    Amount:

2. Description:    Amount:

3. Description:    Amount:

4. Description:    Amount:

5. Description:    Amount:

DEDUCTIONS AND ADJUSTMENTS

SUPPORTING DOCUMENTS

Paystubs (most recent)

Bank statements

Tax returns (relevant years)

Client contracts / invoices

ASSUMPTIONS AND METHODOLOGY

Provider's calculation method, assumptions relied upon, and limitations are set forth below. The Report reflects Provider's professional judgment based on documents and representations provided by Client. Provider has not audited or independently verified source documents except as expressly stated.

PAYMENT TERMS

TERM AND TERMINATION

Term Commencement:    Term End:

Either party may terminate this engagement for any reason upon written notice to the other party. Required notice period (days):

CONFIDENTIALITY

Provider agrees to hold confidential all non-public information provided by Client and not to disclose such information except (i) with Client's prior written consent, (ii) to Provider's professional staff on a need-to-know basis, or (iii) as required by law or valid legal process. Confidential obligations shall survive termination of this engagement. Provider may seek injunctive relief to prevent unauthorized disclosure where monetary damages would be inadequate.

GOVERNING LAW

This Agreement and any disputes arising hereunder shall be governed by the laws of the State of without regard to conflicts of law principles.

ENTIRE AGREEMENT

This Report, together with any engagement letter signed by the parties and accompanying schedules, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings or representations, whether oral or written. No amendment shall be effective unless executed in writing by both parties.

PREPARER CERTIFICATION

I certify that, to the best of my knowledge and belief, the calculations set forth in this Report accurately reflect the information provided and the methodology applied as described herein. Preparer Name:    Title:

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