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Unavailable Documents (I have not attached all or some of the documents required by Utah Rule of Civil Procedure 26.1 to support this Financial Declaration. They are not available to me.)

Gross Monthly Income. (Print your pre-tax income in the appropriate boxes below. Attach evidence of items listed, such as most recent pay stubs, federal and state tax returns for past 2 years, W-2 forms, or a work history report from the Department of Workforce Services.)

Work (including self employment, wages, salaries, commissions, bonuses, tips, and overtime)

Rental Income

Business Income

Interest Income

Dividends

Retirement Income (Including pensions, 401(k), IRA, etc.)

Worker’s Compensation

Private Disability Insurance

Social Security Disability Income (SSDI)

Supplemental Security Income (SSI)

Social Security (other than SSDI or SSI)

Unemployment Benefits

Education Benefits

Veteran’s Benefits (reserve pay)

Alimony (from a prior marriage)

Child Support (from a prior order)

Payments from Civil Litigation

Victim Restitution

Public Assistance

Support from household members

Support from Non-household members

Trust Income

Annuity Income

Other

 

Monthly Tax Deductions (These are deductions required by law and which you do not make voluntarily. There funds withheld from your paycheck that you will report in Paragraph (7), Monthly Expenses Attach evidence of claims, such as most recent pay stubs, federal and state tax for past 2 years, W-2 forms, or a work history report from the Department of Workforce Services.)

Federal Income Tax

State Income Tax

FICA

Medicare

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    Monthly Expenses (Include amounts other than taxes withheld from your paycheck. Attach evidence of items listed, such as pay stubs, leases, bills, receipts, etc. For expenses that change from month to month, calculate the annual total and divide by 12 months to list a monthly amount. Include amounts you pay for yourself and any children or other dependents in your household.)

    Rent or mortgage

    Real property taxes (if not included in mortgage)

    Real property insurance (if not included in mortgage)

    Real property maintenance

    Food and household supplies

    Clothing

    Automobile loan

    Automobile insurance

    Automobile gasoline

    Automobile maintenance

    Other Transportation costs (parking, public etc)

    Utilities (electricity, gas, water, sewer, garbage)

    Telephone

    Paid television (Cable, Satellite, etc.)

    Internet

    Credit Card payments

    Loans and other debt payments (not including auto)

    Alimony (from prior marriage)

    Child support (from prior order)

    Childcare

    Extra-curricular activities (children)

    Education (children)

    Education (self)

    Health care insurance premiums

    Health care expenses

    Other insurance (Describe) Renters

    Other insurance (Describe) Life

    Entertainment

    Laundry and dry cleaning

    Donations

    Gifts

    Union and other dues

    Garnishments or income withholding order

    Retirement Deposits (401K, IRS, pensions)

    Other

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      Business Interests (You must attach proof of amounts listed. If the proof is not available, estimate the amount and explain how you reached that amount.)

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        Financial Assets (Attach evidence of items listed, including last 3 months of bank statements, contracts, etc.)

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          Real Property. (Attach evidence of items listed, such as mortgage statements, loan documents, most recent appraisal, basis of valuation, etc.)

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            Personal Property (Attach evidence of items listed, such as receipts, loan documents, basis of current value, etc.)

            Personal Property (such as vehicles, boats, trailers, major equipment, etc.)

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              Debts (Do not include amount owed on property reported in Paragraphs (10) and (11). (Attach evidence of items listed, such as credit card statements, loan documents, leases, bills, etc.)

              (Name & Address of Creditor)
              Such as credit card, cash loan, installment payment, etc.

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                Brown Family Law
                8915 South 700 East Suite #203, Sandy, UT 84070

                Phone: 801-685-9999

                Fax: 800-299-1016

                Email: [email protected]

                American Fork Office
                121 W Main St, American Fork, UT 84003

                Phone: 385-281-7828

                Fax: 800-299-1016

                Email: [email protected]

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                4020 W Daybreak Parkway Ste 210
                South Jordan, UT 84009

                Phone: 385-281-7670

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