Financial Declaration Form (Page 5 of 5) in pdf

1. A recent paystub should be attached to the Financial Declaration. To compute Principal Earnings from Employment, first

determine whether you are paid semi-monthly, biweekly, or weekly. If you are paid semi-monthly, multiply the gross

amount of your pay check by two. If you are paid biweekly, multiply the gross amount of your pay check by 26 and then

divide by 12. If you are paid weekly, multiply the amount of your paycheck by 52 and divide by twelve. Round to the

nearest whole dollar.

2. To compute Overtime, Tips, Commission, and/or Bonuses, take an average of your monthly earnings from overtime, tips,

commission, bonuses, etc. from the past three years or the length of employment if employed less than three years (including

this year).

3. To compute State, Local, and Social Security Tax deductions, use the same formula used to compute principal earnings in

endnote 1 above, or consult or have your attorney consult an accountant.

4. Net monthly Income is equal to Total Gross Monthly Income minus Total Monthly Deductions.

5. Do not include any expense in the Monthly Expenses section that has already been included in the Deductions from Gross

Monthly Income on page one of the Declaration.

6. Food Expense is to include the cost of groceries, toiletries, cleaning supplies, and casual eating out.

7. Auto Expenses are to include gasoline, oil changes, tune-ups, tire replacement, maintenance, and related items.

8. Maintenance for Household is to include appliance and household repairs, landscaping, house cleaning, pest control, pool

service, alarm service, and other related items.

9. Clothing Expense is to include shoes and clothing purchases, clothing repair and alterations, and related items.

10. Laundry Expense is to include the cost of laundry service, dry cleaning, and related items.

11. Children’s Incidental Expenses are to include allowance, summer camp, baby sitters, lessons, activities, participatory sports,

and related items.

12. School Expense is to include tuition, supplies, field trips, dues, tutors, locker rentals, school lunches, and other related items.

13. Entertainment is to include movies, theater, vacations, sporting events, compact discs, digital video discs, and related items.

14. Adult Incidental Expenses are to include cosmetics, hair and nail care, books, magazines, newspapers, business dues,

memberships, pets, charity, religious dues or tithes, gifts, bank charges, hobbies, and related items.

15. All Installment Loan Payments is the total amount itemized in Installment Loan Payments Section, which should include all

loan payments not already listed as a monthly expense. Examples: home equity loan, credit cards, etc.

16. Indicate which spouse legally owes the payment (husband, wife, or joint).

17. Other property is to include automobiles (minus loan balance), boats (minus loan balance), furniture, furnishings, china,

silver, jewelry, collectibles, and other personal property.

18. Itemize Financial Accounts such as checking, savings, credit union, money market, or certificate of deposit accounts in the

Financial Accounts Section.

19. Itemize Publicly Held Stocks, Bonds, Securities, Stock Options and Mutual Funds (excluding retirement accounts) in the

Publicly Held Stocks, Bonds, Securities, Mutual Funds Section.

20. Itemize each parcel of Real Estate in the Real Estate Section.

SCCA 430 (12/2009)

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Financial Declaration Form Page 5