Free STATE OF HAWAII - Hawaii


File Size: 79.4 kB
Pages: 1
Date: June 26, 2006
File Format: PDF
State: Hawaii
Category: Court Forms - State
Author: CSEA, AG
Word Count: 253 Words, 2,137 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.hi.us/attachment/1821D28973BA2EBBFDC45796D4/1F-P-581.pdf

Download STATE OF HAWAII ( 79.4 kB)


Preview STATE OF HAWAII
FAMILY COURT FIRST JUDICIAL CIRCUIT STATE OF HAWAI`I

CASE NUMBER: FINANCIAL INFORMATION SHEET FCNO.

[ ] CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI`I, _____________________________________________
[ ] MOTHER [ ] FATHER

This document was prepared by: [ ] Petitioner [ ] Defendant, _______________________________ [ ] Attorney for [ ] Petitioner [ ] Defendant

PETITIONER, vs. _____________________________________________
[ ] M OTHER [ ] FATHER [ ] CARETAKER

Name

Address

_____________________________________________
[ ] M OTHER [ ] FATHER [ ] CARETAKER

City

State

Zip Code

[ ] and CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI`I,

Telephone Number

DEFENDANT(S). INCOME: YOU MUST LIST ALL INCOME AMOUNTS AND SOURCES (Note: The Court may require you to file more detailed financial information.) 1. NAME OF PRIMARY EMPLOYER: Paid: [ ]monthly [ ]2 times per month [ ]every 2 weeks [ ]weekly [ ]other OTHER INCOME: NAME OF SECOND EMPLOYER INTEREST INCOME, name of financial institution(s) NET RENTAL INCOME, location OTHER (i.e. social security, workers comp, etc.) TOTAL. . . . . . . . . . . . 3. MONEY RECEIVED FROM WELFARE BENEFITS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EXPENSES 1. Child care expenses paid by you, on behalf of child(ren) involved in case . . . . . . . . . . . . . . 2. Medical and Dental Insurance paid for yourself $ 3. Medical and Dental Insurance paid by you for your child(ren) involved in this case. . . . . . . TOTAL ASSETS (List the total amounts of the following): 1. Credit Union/Bank/Savings Account Balances .. . . . . . . . $ 2. Securities Values, Stocks, Bonds, etc. . . . . . . . . . . . . . . . $ 3. Real Property Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4. Personal Property (car, jewelry, etc.) . . . . . . . . . . . . . . . . $ CERTIFICATION: I declare under the penalty of law that the foregoing is true and correct. Date Signature of [ ]Petitioner/Movant [ ]Defendant/Movant
FOR COURT USE ONLY
01/2005 Reprographics(6/06)1F FIN AN CIAL IN FO RM AT IO N SH EET
1F-P-581

GROSS MONTHLY INCOME

$

2.

$ $ $ $ $ 0.00 $ $ $ $

Reset Form