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Fill and Sign the Wpf Uh 020110 Order to Proceed Without Payment of Fees Oralff Washington Form

Fill and Sign the Wpf Uh 020110 Order to Proceed Without Payment of Fees Oralff Washington Form

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Case Name : _____________________________ Case Number : __________________ Financial Statement - Harassment (Attachment) 1. My name is: 2. [ ] I provide support to people who live with me: How many? Age(s): 3. My Monthly Income : 6. My Monthly Household Expenses : Employed [ ] Unemployed [ ] Rent/Mortgage: $ Employer’s Name: Food/Household Supplies: $ Gross pay per month (salary or hourly pay): $ Utilities: $ Take home pay per month: $ Transportation: $ 4. Other Sources of Income Per Month in my Household : Ordered Maintenance actually paid: $ Source: $ Ordered Child Support actually paid: $ Source: $ Clothing: $ Source: $ Child Care: $ Source: $ Education Expenses: $ Sub-Total: $ Insurance (car, health): $ [ ] I receive food stamps. Medical Expenses: $ Total Income, lines 3 (take home pay) and 4 : $ Sub-Total: $ 5. My Household Assets : 7. My Other Monthly Household Expenses : Cash on hand: $ $ Checking Account Balance: $ $ Savings Account Balance: $ $ Auto #1 (Value less loan): $ $ Auto #2 (Value less loan): $ Sub-Total: $ Home (Value less mortgage): $ 8. My Other Debts with Monthly Payments : Other: $ $ /mo Other: $ $ /mo Other: $ $ /mo Other: $ $ /mo Other: $ Sub-Total: $ Total Household Assets : $ Total Household Expenses and Debts, lines 6, 7, and 8 : $ Date : Signature : Financial Statement - Harassment (Attachment) - Page 1 of 1 UH 2.0110 (07/2011) GR 34, RCW 10.14.060

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How to Sign a PDF Using Google Chrome How to Sign a PDF Using Google Chrome

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How to Sign a PDF in Gmail How to Sign a PDF in Gmail How to Sign a PDF in Gmail

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How to Sign a PDF on a Mobile Device How to Sign a PDF on a Mobile Device How to Sign a PDF on a Mobile Device

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How to Sign a PDF on iPhone How to Sign a PDF on iPhone

How to fill out and sign documents on iOS

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How to Sign a PDF on Android How to Sign a PDF on Android

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