Pre-Decree Financial Affidavit - Oklahoma District Court Page 3
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10Unemploym ent Insurance Benefits
Disability Insurance Benefits
Gifts
Prizes
All other sources (Specify)
$
$
GROSS MONTHLY INCOME
YOU MUST DISCLOSE ALL GROSS INCOME (12 O.S. § 1170)
IF YOU ARE REQUIRED TO DO SO BY THE DISCOVERY CODE; COURT RULE; COURT ORDER IN THIS CASE,
PLEASE INDICATE IF YOU FILED TAX RETURNS FOR THE LAST THREE YEARS:
YES/NO (CIRCLE ONE).
IF REQUIRED TO DO SO BY THE DISCOVERY CODE; COURT RULE; COURT ORDER IN THIS CASE, ATTACH
COPIES OF YOUR FEDERAL AND STATE INCOME TAX RETURNS FOR THE LAST THREE (3) YEARS INCLUDING
ALL SCHEDULES AND ATTACHMENTS. COPIES SHOULD BE PROVIDED TO THE OTHER PARTY IN THE CASE
OR HIS/HER ATTORNEY AND THE COURT.
DID YOU OR THE OTHER PARTY IN THIS CASE RECEIVE THE EARNED INCOME TAX CREDIT FOR ANY OF THE
PAST THREE TAX YEARS _________YES _________NO (CHECK ONE).
DEDUCTIONS PER PAY PERIOD:
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
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