Domestic Relations Financial Affidavit (Page 2 of 6) in pdf

Domestic Relations Financial Affidavit Page 2

3A.

AFFIANT'S GROSS MONTHLY INCOME

(Complete this section or attach Child Support Schedule A)

(All income must be entered based on monthly average regardless of

date of receipt.)

Salary or Wages

ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS

Commisions, Fees,

Income from self employment, partnership, close

corporations and independent contracts

(gross

receipts minus ordinary and necessary expenses required

to produce income)

ATTACH SHEET ITEMIZING YOUR CALCULATIONS

Rental Income

(gross receipts minus ordinary and

necessary expenses required to produce income)

ATTACH SHEET ITEMIZING YOUR CALCULATIONS

Bonuses

Overtime Payments

Severance Pay

Recurring Income from Pensions or Retirement

Interest and Dividends

Trust Income

Income from Annuities

Capital Gains

Social Security Disability or Retirement Benefits

Workers' Compensation Benefits

Unemployment Benefits

Judgments from Personal Injury or Other Civil Cases

Gifts

(cash or other gifts that can be converted to cash)

Prizes / Lottery Winnings

Alimony and maintenance from persons not in this case

Assets which are used for support of family

Fringe Benefits

(that significantly reduce living expenses)

Domestic Relations Financial Affidavit

Page 2 of 6

Domestic Relations Financial Affidavit Page 2