Petition For Dissolution Of Marriage Page 4
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9Length of Employment:
Present Position:
How Often Paid:
Gross Pay Per Pay Period (including overtime):
Net Pay Per Pay Period (including overtime):
2. Other/Additional Employer:
Address:
Length of Employment:
Present Position:
How Often Paid:
Gross Pay Per Pay Period (including overtime):
Net Pay Per Pay Period (including overtime):
3. Self-Employment:
Name of Business:
Type of Business:
Address:
Length of Self-Employment:
Present Position:
Gross Income Year to Date:
Ordinary and Necessary Business Expenses Year to Date (list and give totals):
Gross Income Last Year from Self-Employment:
Net Income Last Year from Self-Employment:
ATTACH COPIES OF LAST THREE PAY STUBS FROM EACH EMPLOYER, LAST YEAR’S W-2(S)AND
LAST THREE STATE AND FEDERAL TAX RETURNS.
C. ADDITIONAL INCOME RECEIVED IN LAST 12 MONTHS (Specify amounts):
1. Employment Benefits:
Amount
Commissions:
0.00
Bonuses, incentives, etc.:
0.00
Health Insurance paid by employer:
0.00
Housing expenses:
0.00
Automobile expenses:
0.00
Payment/lease:
0.00
Mileage:
0.00
Repairs:
0.00
Gas:
0.00
Insurance:
0.00
Phone/Mobile phone expenses:
0.00
Meals or allowance:
0.00
Club dues:
0.00
Others (list all and specify amount or value):
_________________2. Interest and Dividends:
Source
3.
Unemployment:
0.00
4.
Worker’s Compensation:
0.00
5.
Social Security/SSI:
0.00
6.
TANF: (TANF is "Temporary Assistance for
0.00
Needy Families")
7.
Child Support:
0.00
8.
Maintenance:
0.00
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