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
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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
Drag and Drop (or) Choose Files
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)
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.)
Financial Assets (Attach evidence of items listed, including last 3 months of bank statements, contracts, etc.)
Real Property. (Attach evidence of items listed, such as mortgage statements, loan documents, most recent appraisal, basis of valuation, etc.)
Personal Property (Attach evidence of items listed, such as receipts, loan documents, basis of current value, etc.)
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.)