Post-Decree Financial Affidavit - Oklahoma District Court Page 4

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Itemize pay period deductions from gross income:
FATHER
MOTHER
State income taxes
Federal income taxes
Number of exemptions taken
FICA
Income Assignment Withholding
Union or other dues
Retirement or pension fund
Savings plan
Medical Insurance
Dental Insurance
Life Insurance
Other
Other deductions
Other deductions
Other deductions
Credit Union (specify w hether for savings or loan paym ent)
TOTAL PAY PERIOD DEDUCTIONS FROM GROSS INCOME
$
$
NET PAY PERIOD INCOME (TAKE HOME PAY)
$
$
OTHER
FATHER
MOTHER
Monthly court-ordered child support paid in other cases*
Court-ordered visitation travel related expenses

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