INCOME AND EXPENSE DECLARATION INSTRUCTIONS
This form is similar to a tax return. It is easy to become intimidated by this form, but it is quite simple if you look at one question a time and answer the question before moving on. Read each question carefully before answering.
PAGE 1: Information is about you. Answer as complete and accurate as possible. If you do not know the answer, simply write “UNKNOWN".
PAGE 2: This page deals with income. Items 5 deals with income received for the last month and a separate column for income received over the last twelve months. Use your W-2’s, pay stubs, taxes and any other documents to help you calculate your income during these two time periods. You may also obtain this information from your payroll department. Make sure that you break down the income and record in the appropriate location. For example, if you have a base salary and receive commission, these need to be recorded separate. Or if you receive additional income from disability, pension, military pay etc. also, record these in the appropriate column.
Item 6: record only if you received income for the last month, as well as the average of the last 12 months.
Item 7: This section is for self-employed business owners.
Item 8: Additional income not listed above. Specify amount AND source.
Item 10: List the necessary deductions from just the most recent pay stub.
Item 11: List current amounts, however, if you don’t know, write unknown.
NOTE THAT THIS FORM REQUIRES YOU TO ATTACH YOUR 2 MONTHS MOST RECENT PAYSTUBS. DO NOT FORGET TO ATTACH THESE COPIES, AS WE CANNOT COMPLETE, SERVE AND FILE THIS FORM WITHOUT THEM. IF YOU ARE SELF-EMPLOYED, PLEASE PROVIDE A PROFIT AND LOSS SHEET FOR THE LAST TWELVE MONTHS.
PAGE 3 MONTHLY EXPENSES
Item 12 Please answer all questions, included yourself, as well as all other people living in your home.
Item 13 a-s These are averages. For example, you may spend $240 in clothes one month and nothing for 2 more months. Your monthly average over 3 months would be $80.
Almost everyone has un-reimbursed medical and dental, even if it is just yearly deductibles. Do not include premium amounts, but include any other costs.
Children care is for anything that is not private school tuition. Education would include private school tuitions, tutors, special education classes etc.
Almost everyone has food expenses for eating out, even if it’s only lunch once per week, a snack at a local mini-mart or small items. Provide best estimate.
Laundry and cleaning includes laundry supplies, costs of Laundromat and dry cleaning.
Everyone has some entertainment costs, even if it is only small meals out occasionally or renting movies. Provide best estimate.
Savings and investments are expenses if part of your pay check is Transportation does NOT include car payments. Those are for item 14.
Item 14: INSTALLMENT PAYMENTS AND DEBTS
Do not include house or rent payments, those are listed above. List all monthly bills: cars, 2nd s on home loans, credit card, cable, loans etc.
Item 15: Make sure that you list amount you’ve paid, which includes the retainer plus any additional payments you’ve made. Also, make sure to note the source of money, which usually will be loan, credit card or savings.
PAGE 4 CHILDREN SUPPORT INFORMANTION
Item 19: regarding hardship deductions, include information for minor children of your marriage with special medical needs or children who are not minors but who have special needs or disabilities to the extent they cannot live on their own. In addition, if you have suffered a catastrophic loss through fire, earthquake, theft, flood etc or have a child with another person not involved in this case, you should complete this section.