Interim Monthly Income And Expenses Statement

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4A-212. Interim monthly income and expenses statement.
[For use with Rule 1-122 NMRA]
STATE OF NEW MEXICO
COUNTY OF ___________________________
___________________ JUDICIAL DISTRICT
_________________________________________,
Petitioner,
v.
No. __________
_________________________________________,
Respondent.
1
INTERIM MONTHLY INCOME AND EXPENSES STATEMENT
(fixed percentage for child expenses)
STATE OF NEW MEXICO
)
) ss.
COUNTY OF _____________
)
I, ___________________(Petitioner) (Respondent), state under penalty of perjury that the
following is true and correct at this time:
Husband
Wife
Combined
Column 1
Column 2
Column 3
2
1.
Gross monthly income
a.
Gross monthly wages
$_________ $_________ $_________
b.
Rental income
$_________ $_________ $_________
c.
Self-employment income
$_________ $_________ $_________
d.
Dividends and interest
$_________ $_________ $_________
e.
Other income
$_________ $_________ $_________
2.
Total gross monthly income
$_________ $_________ $_________
3
3.
Payroll deductions

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