Fill and Sign the Jennifer Kay Shipman Vs Jason William Shipman 10 3 00961 1 Form

FINANCIAL DECLARATION (FNDCLR) - Page 1 of 6WPF PS 01.0550 (9/2000) - RCW 26.18.220 (1)SUPERIOR COURT OF WASHINGTONCOUNTY OFIn re the Parentage of:(DOB) Child(ren), Petitioner, and Respondent:Presumed FatherAlleged Father(s)Mother NO. FINANCIAL DECLARATION[ ] PETITIONER[ ] RESPONDENT(FNDCLR)Name: Date of Birth: Social Security Number: I. SUMMARY OF BASIC INFORMATION Declarant’s Total Monthly Net Income (from § 3.3 below) $ Declarant’s Total Monthly Household Expenses (from § 5.9 below) $ Declarant’s Total Monthly Debt Expenses (from § 5.11 below)$ Declarant’s Total Monthly Expenses (from § 5.12 below)$ Estimate of the other party’s gross monthly income (from § 3.1f below)[ ]$ [ ]unknown II. PERSONAL INFORMATION 2.1 Occupation:2.2The highest year of education completed:2.3Are you presently employed? [ ] Yes [ ] Noa. If yes: (1)Where do you work (name and address)? FINANCIAL DECLARATION (FNDCLR) - Page 2 of 6WPF PS 01.0550 (9/2000) - RCW 26.18.220 (1) (2) When did you start work there (month/year)? b. If no: (1)When did you last work (month/year)? (2) What were your gross monthly earnings? $(3)Why are you presently unemployed? III. INCOME INFORMATION If child support is at issue, complete the Washington State Child Support Worksheet(s), skip Paragraphs 3.1 and 3.2. If maintenance, fees, costs or debts are at issue and child support is NOT an issue this entire section should be completed. (Estimate of other party’s income information is optional.)3.1 GROSS MONTHLY INCOME.If you are paid on a weekly basis, multiply your weekly gross pay by 4.3 to determine your monthly wages and salaries. If you are paid every two weeks, multiply your gross pay by 2.15. If you are paid twice monthly, multiply your gross pay by 2. If you are paid once a month, list that amount below. Petitioner Respondent a.Wages and Salaries $ $ b.Interest and Dividend Income $ $ c.Business Income $ $ d.Spousal Maintenance From Other Relationships $ $ e.Other Income $ $ f.Total Gross Monthly Income (add lines 3.1a through 3.1e) $ $ g.Actual Gross Income (Year to date)$ $ 3.2MONTHLY DEDUCTIONS FROM GROSS INCOME. a.Income Taxes $ $ b.FICA/Self-employment Taxes $ $ c.State Industrial Insurance Deductions $ $ d.MANDATORY Union/Professional Dues$ $ e.Pension Plan Payments $ $ f.Spousal Maintenance Paid $ $ g.Normal Business Expenses $ $ h.Total Deductions from Gross Income $ $ (add lines 3.2a through 3.2g) 3.3MONTHLY NET INCOME. (Line 3.1f minus line 3.2h or $ $ line 3 from the Child Support Worksheet(s).) FINANCIAL DECLARATION (FNDCLR) - Page 3 of 6WPF PS 01.0550 (9/2000) - RCW 26.18.220 (1)3.4 MISCELLANEOUS INCOME. a.Child support received from other relationships $ $ b.Other miscellaneous income (list source and amounts) $ $ $ $ $ $ $ $ $ $ c.Total Miscellaneous Income (add lines 3.4a through 3.4b)$ $ 3.5Income of Other Adults in Household $ $ 3.6If the income of either party is disputed, state monthly income you believe is correct and explain below: IV. AVAILABLE ASSETS 4.1Cash on hand $ 4.2On deposit in banks $ 4.3Stocks and Bonds, cash value of life insurance $ 4.4Other liquid assets: $ V. MONTHLY EXPENSE INFORMATION Monthly expenses for myself and ____________ dependents are: (Expenses should be calculated for the future, after separation, based on the anticipated residential schedule for the children.)5.1HOUSING.Rent, 1st mortgage or contract payments $ Installment payments for other mortgages or encumbrances $ Taxes & insurance (if not in monthly payment) $ Total Housing $ 5.2UTILITIES. Heat (gas & oil) $ FINANCIAL DECLARATION (FNDCLR) - Page 4 of 6WPF PS 01.0550 (9/2000) - RCW 26.18.220 (1) Electricity $ Water, sewer, garbage $ Telephone $ Cable$ Other$ Total Utilities$ 5.3FOOD AND SUPPLIES. Food for ___________ persons $ Supplies (paper, tobacco, pets) $ Meals eaten out $ Other$ Total Food Supplies$ 5.4CHILDREN. Day Care/Babysitting $ Clothing$ Tuition (if any)$ Other child related expenses $ Total Expenses Children $ 5.5TRANSPORTATION. Vehicle payments or leases $ Vehicle insurance & license $ Vehicle gas, oil, ordinary maintenance$ Parking$ Other transportation expenses $ Total Transportation $ 5.6HEALTH CARE. (Omit if fully covered) Insurance $ Uninsured dental, orthodontic, medical, eye care expenses$ Other uninsured health expenses $ Total Health Care $ 5.7PERSONAL EXPENSES (Not including children). Clothing $ Hair care/personal care expenses $ FINANCIAL DECLARATION (FNDCLR) - Page 5 of 6WPF PS 01.0550 (9/2000) - RCW 26.18.220 (1) Clubs and recreation $ Education$ Books, newspapers, magazines, photos$ Gifts$ Other$ Total Personal Expenses$ 5.8MISCELLANEOUS EXPENSES. Life insurance (if not deducted from income) $ Other _____________________________________________ $ Other _____________________________________________ $ Total Miscellaneous Expenses $ 5.9 TOTAL HOUSEHOLD EXPENSES (The total of Paragraphs 5.1 through 5.8) $ 5.10INSTALLMENT DEBTS INCLUDED IN PARAGRAPHS 5.1 THROUGH 5.8. DescriptionMonth of Creditorof DebtBalanceLast Payment 5.11OTHER DEBTS AND MONTHLY EXPENSES NOT INCLUDED IN PARAGRAPHS 5.1 THROUGH 5.8. Description Month ofAmount of Creditor of DebtBalanceLast Payment Monthly Payment $ $ $ $ $ $ Total Monthly Payments for Other Debts and Monthly Expenses $ 5.12TOTAL EXPENSES (Add Paragraphs 5.9 and 5.11) $ VI. ATTORNEY FEES 6.1 Amount paid for attorney fees and costs to date: $ 6.2The source of this money was: FINANCIAL DECLARATION (FNDCLR) - Page 6 of 6WPF PS 01.0550 (9/2000) - RCW 26.18.220 (1)6.3 Fees and costs incurred to date: $ 6.4Arrangements for attorney fees and costs are:6.5Other:I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.Signed at ______________________________________ on _________________________. [Place] [Date] SignaturePrint or Type Name THE OTHER PARTY MUST BE SERVED COPIES OF YOUR TAX RETURNS FROM THE LAST TWO YEARS AND COPIES OF YOUR PAYSTUBS FOR THE LAST SIX MONTHS TO VERIFY YOUR INCOME. YOU SHOULD ALSO BRING COPIES OF YOUR TAX RETURNS FROM THE LAST TWO YEARS AND COPIES OF YOUR PAYSTUBS FOR THE LAST SIX MONTHS TO YOUR COURT HEARINGS.