Civil Cover Sheet Page 19
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22Interest:___________________________________________________________________
Dividends:_________________________________________________________________
Pension and Annuities:________________________________________________________
Social Security Benefits:_______________________________________________________
Support Payments:___________________________________________________________
Disability Payments:_________________________________________________________
Unemployment Compensation &
Supplemental Benefits:
_____________________________________________________
Workmans’ Compensation: ____________________________________________________
Public Assistance:____________________________________________________________
Other:_____________________________________________________________________
(d) OTHER CONTRIBUTIONS TO HOUSEHOLD SUPPORT (state as dollar amounts)
(Wife) (Husband) (Friend) Name:_______________________________________________
If your (wife) (husband) (friend) is employed, state:
Employer: _________________________________________________________________
Salary/Wages
Per Month:
______________________________________________________________
Type of Work:______________________________________________________________
Contributions
From Children: _____________________________________________________________
Contributions
From Parents: ______________________________________________________________
Other Contributions:__________________________________________________________
(e) PROPERTY OWNED (state as dollar amounts)
Cash:______________________________________________________________________
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Parent category: Business