Cv100 Income And Expense Statement Of - Missouri Courts

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IN THE ________ JUDICIAL CIRCUIT COURT, _______________________, MISSOURI
Judge or Division:
Case Number:
In RE the Marriage of :
Petitioner:
vs.
SSN (Last Four Digits):
Respondent:
SSN (Last Four Digits):
(Date File Stamp)
Income and Expense Statement of __________________________________
I. My Income
A.
Gross wages or salary and commissions paid to me each pay period:
Paid:
Weekly __________ Bi-Weekly __________ Semi-Monthly _________ Monthly ________
B.
My monthly gross wages or salary:
C. My tax status claimed: Single __________ Married __________ Head/Household ___________
Number of persons claimed as deductions __________
D. Payroll deductions each pay period:
FICA (social security tax)
Federal withholding tax
State withholding tax
City earning tax
Union dues
Health insurance
Others: (specify)
My total deductions each pay period:
My net take home pay each pay period:
E.
My take home or net pay each month:
Amount
Source
F.
My total monthly average gross additional income from all sources
G. My total monthly gross income from wages (line B) and additional income (line F)
H. Total gross income from my tax returns for each of the last 3 calendar years:
Year
Income
OSCA (6-95) CV100
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