FL-150 · Step 2 of 3

Employment, income sources, and household size

This is your Income and Expense Declaration. The court uses it to understand your financial picture. Fill in what applies to you — leave blank what doesn't.

Your current job

Employer name Employer address Occupation / job title Date started this job Hours worked per week Gross monthly income from this job ($) Before taxes and deductions.

My gross pay is paid monthly (not hourly or bi-weekly)

Background

I completed high school or received a GED I filed a tax return for the most recent tax year

Other income sources (check all that apply)

These are income types beyond your regular job pay.

Rental income / real property Social Security / SSI / SSDI Disability payments / workers' compensation Reimbursed business expenses included in income Dividends and interest Pension or retirement income Public assistance / CalWORKs / TANF Other income not listed above

Household size

How many people live in your home and depend on you financially?

2 people 3 people 4 people 5 or more people I have monthly expenses to list (see the court form for the full expense list) My monthly expenses are listed in an attachment

Child health care

I pay for child health care insurance (not through an employer)

Monthly expenses (for your records)

Monthly housing cost ($) Monthly childcare cost ($)

Income or expense notes (optional)

Not legal advice. SharpeSystem helps you organize your information and fill out the form. Filing decisions are yours.

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