Financial Declaration {131}

Superior Court of Washington, County of In re: Petitioner/s (person/s who started this case): No. Financial Declaration of (name): (FNDCLR) And Respondent/s (other party/parties): Financial Declaration 1. Your personal information Name: Highest year of education you completed: Are you working now? Yes. List the date you were hired (month / year): No. List the last date you worked (month / year): What was your monthly pay before taxes: $ Why are you not working now? Your job/profession is: 2. Summary of your financial information (Complete this section after filling out the rest of this form.) 1. Total Monthly Net Income (copy from section 3, line C. 3.) 2. Total Monthly Expenses After Separation (copy from section 7, line I.) 3. Total Monthly Payments for Other Debts (copy from section 9) 4. Total Monthly Expenses + Payments for Other Debts (add line 2 and line 3) Gross Monthly Income of Other Party (copy from section 3. A.) $ $ $ $ $ RCW 26.18.220(1) Mandatory Form (09/2016) FL All Family 131 Financial Declaration p. 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 3. Income List monthly income and deductions below for you and the other person in your case. If your case involves child support, this same information is required on your Child Support Worksheets. If you do not know the other person's financial information, give an estimate. Tip: If you do not get paid once a month, calculate your monthly income like this: Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2 A. Gross Monthly Income (before taxes, deductions, or retirement contributions) You Monthly wage / salary Income from interest / dividends Income from business Spousal support / maintenance received (Paid by: Other income Total Gross Monthly Income (add all lines above) Total gross income for this year before deductions (starting January 1 of this year until now) B. Monthly Deductions You Income taxes (federal and state) FICA (Soc.Sec. + Medicare) or self-employment taxes State Industrial Insurance (Workers' Comp.) Mandatory union or professional dues Mandatory pension plan payments Voluntary retirement contributions (up to the limit in RCW 26.19.071(5)(g)) Spousal support / maintenance paid Normal business expenses Total Monthly Deductions (add all lines above) C. Net Monthly Income You 1. Total Gross Monthly Income (from A above) 2. Total Monthly Deductions (from B above) 3. Net Monthly Income (Line 1 minus Line 2) Other Party Other Party ) Other Party RCW 26.18.220(1) Mandatory Form (09/2016) FL All Family 131 Financial Declaration p. 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 4. Other Income and Household Income Tip: If this income is not once a month, calculate the monthly amount like this: Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2 A. Other Income (Do not repeat income you already listed on page 2.) You Child support received from other relationships Other income (From: Other income (From: Total Other Income (add all lines above) B. Household Income (Monthly income of other adults living in the home) Your Home Other adult's gross income (Name: Other adult's gross income (Name: Total Household Income of other adults in the home (add all lines above) Other Party's Home ) ) Other Party ) ) 5. Disputed Income ­ If you disagree with the other party's statements about anyone's income, explain why the other party's statements are not correct, and your statements are correct: 6. Available Assets List your liquid assets, like cash, stocks, bonds, that can be easily cashed. Cash on hand and money in all checking & savings accounts Stocks, bonds, CDs and other liquid financial accounts Cash value of life insurance Other liquid assets Total Available Assets (add all lines above) $ $ $ $ RCW 26.18.220(1) Mandatory Form (09/2016) FL All Family 131 Financial Declaration p. 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 7. Monthly Expenses After Separation Tell the court what your monthly expenses are (or will be) after separation. If you have dependent children, your expenses must be based on the parenting plan or schedule you expect to have for the children. A. Housing Expenses Rent / Mortgage Payment Property Tax (if not in monthly payment) Homeowner's or Rental Insurance Other mortgage, contract, or debt payments based on equity in your home Homeowner's Association dues or fees Total Housing Expenses B. Utilities Expenses Electricity and heating (gas and oil) Water, sewer, garbage Telephone(s) Cable, Internet Other (specify): Total Utilities Expenses C. Food and Household Expenses Groceries for (number of people): _____ Household supplies (cleaning, paper, pets) Eating out Other (specify): Total Food and Household Expenses D. Children's Expenses Childcare, babysitting Clothes, diapers Tuition, after-school programs, lessons Other expenses for children Total Children's Expenses E. Health Care Expenses Insurance premium (health, vision, dental) Health, vision, dental, orthodontia, mental health expenses not covered by insurance Other health expenses not covered by insurance Total Health Care Expenses F. Transportation Expenses Automobile payment (loan or lease) Auto insurance, license, registration Gas and auto maintenance Parking, tolls, public transportation Other transportation expenses Total Transportation Expenses G. Personal Expenses (not children's) Clothes Hair care, personal care Recreation, clubs, gifts Education, books, magazines Other Personal Expenses Total Personal Expenses H. Other Expenses Life insurance (not deducted from pay) Other (specify): Other (specify): Other (specify): Total Other Expenses List all Total Expenses from above: A. Total Housing Expenses B. Total Utilities Expenses C. Total Food and Household Expenses D. Total Children's Expenses E. Total Health Care Expenses F. Total Transportation Expenses G. Total Personal Expenses H. Total Other Expenses I. All Total Expenses (add A - H above) Use section 10 below to explain any unusual expenses, or attach additional pages. RCW 26.18.220(1) Mandatory Form (09/2016) FL All Family 131 Financial Declaration p. 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 8. Debts included in Monthly Expenses listed in section 7 above Debt for what expense (mortgage, car loan, etc.) Who do you owe (Name of creditor) Amount you owe this creditor now $ $ $ $ Last Monthly Payment made Date: Date: Date: Date: 9. Monthly payments for other debts (not included in expenses listed in section 7) Descri