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Fl-150 - California Courts

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FL-150

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

To keep other people from

seeing what you entered on

your form, please press the

Clear This Form button at the

end of the form when finished.

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/CLAIMANT:

CASE NUMBER:

INCOME AND EXPENSE DECLARATION

Employment

(Give information on your current job or, if you're unemployed, your most recent job.)

Employer:

Attach copies

Employer's address:

of your pay

Employer's phone number:

stubs for last

Occupation:

two months

(black out

Date job started:

social

If unemployed, date job ended:

security

I work about

hours per week.

numbers).

I get paid

gross (before taxes)

per month

per week

per hour.

(If you have more than one job, attach an 8½-by-11-inch sheet of paper and list the same information as above for your other

jobs. Write "Question 1—Other Jobs" at the top.)

Age and education

My age is (specify):

If no, highest grade completed (specify):

I have completed high school or the equivalent:

Yes

Number of years of college completed (specify):

Degree(s) obtained (specify):

Number of years of graduate school completed (specify):

I have:

professional/occupational license(s) (specify):

vocational training (specify):

3. Tax information

I last filed taxes for tax year (specify year):

My tax filing status is

single

head of household

married, filing separately

married, filing jointly with (specify name):

I file state tax returns in

California

other (specify state):

I claim the following number of exemptions (including myself) on my taxes (specify):

4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $

This estimate is based on (explain):

(If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the

question number before your answer.)

Number of pages attached:

I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and

any attachments is true and correct.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

Page 1 of 4

Family Code, §§ 2030–2032,

Form Adopted for Mandatory Use

INCOME AND EXPENSE DECLARATION

2100–2113, 3552, 3620–3634,

Judicial Council of California

4050–4076, 4300–4339

FL-150 [Rev. January 1, 2007]

Fl-150 - California Courts

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