Financial Disclosure Affirmation (Short Form) {4-17a}

Form 4-17a - FINANCIAL DISCLOSURE AFFIRMATION (SHORT FORM). You are required to bring this form to Court. Fill it out before you come in on the next court date. In addition to this form, you must bring with you a copy of: • Your two (2) most recent pay stubs • Your most recent Federal and state tax returns, • Your W-2s and/or 1099 statements • All documents which prove the amount of other income and/or debt and loans • Proof of health insurance coverage and cost • Proof of public assistance www.FormsWorkflow.com