If you are not working, why not? Previous employer name and address: Previous job/occupation/profession/title: Date previous job began: Date previous job ended: Reason you left job: Gross monthly pay at previous job: $ Total gross income for the last two years: Year $ Year $ Your total gross income from January 1 of this year to the date of this Affidavit income): $ YOUR EDUCATION/TRAINING: List name of school, length of time there, a year of last attendance, and degree earned: High School: College: Post-Graduate: Occupational Training: YOUR CURRENT GROSS MONTHLY INCOME: List all income you receive from any source, whether private or governmental, taxable or not. List all income payable to you individually or payable jointly to you and your spouse. Use a monthly average for items that vary from month to month. Multiply weekly income and deductions by 4.33. Multiply biweekly income by 2.165 to arrive at the total amount for the month. A. Gross Salary/wages per month $ Attach copies of your two most recent pay stubs. Rate of Pay $ per hour week month year B. Expenses paid for by your employer: 1. Automobile $ 2. Auto expenses, such as gas, repairs, insurance $ 3. Lodging $ 4. Other $ (explain) C. Commissions/Bonuses $ D. Tips $ E. Self-Employment Income $ (see below) F. Social Security Benefits $ G. Worker’s Compensation and/or disability income $ H. Unemployment compensation $ I. Gifts/Prizes $ J. Payments from prior spouse $ K. Rental income $ (net after expenses)
If you are not working, why not? Previous employer name and address: Previous job/occupation/profession/title: Date previous job began: Date previous job ended: Reason you left job: Gross monthly pay at previous job: $ Total gross income for the last two years: Year $ Year $ Your total gross income from January 1 of this year to the date of this Affidavit income): $ YOUR EDUCATION/TRAINING: List name of school, length of time there, a year of last attendance, and degree earned: High School: College: Post-Graduate: Occupational Training: YOUR CURRENT GROSS MONTHLY INCOME: List all income you receive from any source, whether private or governmental, taxable or not. List all income payable to you individually or payable jointly to you and your spouse. Use a monthly average for items that vary from month to month. Multiply weekly income and deductions by 4.33. Multiply biweekly income by 2.165 to arrive at the total amount for the month. A. Gross Salary/wages per month $ Attach copies of your two most recent pay stubs. Rate of Pay $ per hour week month year B. Expenses paid for by your employer: 1. Automobile $ 2. Auto expenses, such as gas, repairs, insurance $ 3. Lodging $ 4. Other (explain) $ C. Commissions/Bonuses $ D. Tips $ E. Self-Employment Income (see below) $ F. Social Security Benefits $ G. Worker’s Compensation and/or disability income $ H. Unemployment compensation $ I. Gifts/Prizes $ J. Payments from prior spouse $ K. Rental income (net after expenses) $
CAO%20RFLPPi%201-3%20Affidavit%20Re%20Motion%20for%20Temporary%20Orders.docx