Financial Disclosure Affidavit Form Page 2

ADVERTISEMENT

Attachment 4
Step 2: CURRENT EMPLOYMENT INFORMATION
A.
Are you currently employed?
Yes (Go to B)
No (Go to Step 3)
B.
I have attached one of the following:
A copy of my current paycheck stub(s)
A signed letter from my employer(s) stating the amount of income I am/will be
earning.
(Go to Step 3)
Step 3: BENEFIT INFORMATION
A. Are you currently receiving benefits?
Yes (Go to B)
No (Go to Step 4).
B. What benefits are you receiving?
Unemployment Insurance Benefits
Supplemental Security Income
Social Security Disability
Workers’ Compensation
Temporary Assistance or Care or Safety Net Assistance
Veterans’ Benefits
in lieu of retired military pay
not in lieu of military pay
Retirement / Pension benefits
Other (identify):
____________________________________________________________________________________________
____________________________________________________________________________________________
(Go to C)
C.
Attached is documentation from each benefit payer above, with the amount and frequency of each benefit.
(Go to Step 5).
Step 4: NON-EMPLOYMENT INFORMATION
A. If you are not working or collecting benefits, please explain why in the space provided:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
(Go to B)
B. If you are not working or collecting benefits, explain how you are paying your bills in the space provided:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
(Go to C)
2

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Financial Disclosure - Affidavit Of Indigency Form Financial Disclosure - Affidavit Of Indigency Form Legal
Form 100-00127 - Financial Disclosure Affidavit Form 100-00127 - Financial Disclosure Affidavit Legal
Form Opd-206r - Financial Disclosure / Affidavit Of Indigency Form Opd-206r - Financial Disclosure / Affidavit Of Indigency Legal
Form Dr 7.3 - Affidavit Of Income, Expenses And Financial Disclosure Form - Court Of Common Pleas, Ohio Form Dr 7.3 - Affidavit Of Income, Expenses And Financial Disclosure Form - Court Of Common Pleas, Ohio Legal
Form Dr-10 - Affidavit Of Financial Disclosure - In The Common Pleas Court Of Montgomery County, Ohio - 2011 Form Dr-10 - Affidavit Of Financial Disclosure - In The Common Pleas Court Of Montgomery County, Ohio - 2011 Legal
Financial Disclosure Report Form Financial Disclosure Report Form Legal
Financial Disclosure Affidavit - County Of Summit Financial Disclosure Affidavit - County Of Summit Legal
Financial Disclosure Affidavit - Nyc Financial Disclosure Affidavit - Nyc Financial
Financial Disclosure/affidavit Of Indigency - Divulgacion Financiera/declaracion Jurada De Indigencia Financial Disclosure/affidavit Of Indigency - Divulgacion Financiera/declaracion Jurada De Indigencia Legal
Financial Disclosure Affidavit Financial Disclosure Affidavit Legal

Related Categories

Parent category: Legal
Download
Go
Page of 8