Family and Financial Information: Monthly Income Summary
June 12, 2023
Salary or Wages (monthly)
Bonuses, Commissions, Allowances, Fees, Overtime, Tips and similar payments (based on past 12-month average or time of employment if less than 1 year)
Income from sources such as self-employment, partnership, close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income)
Severance Pay
Disability/Unemployment/Worker's Compensation
Recurring Income from Pension and Retirement Plans or Annuity Payments
Social Security Benefits
Other Public Benefits (do not include TANF or food stamps)
Spousal or Child Support from people not in this case
Interest and Dividends
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income)
Reimbursed Expenses and In Kind payments to the extent they reduce personal living expenses
Fringe Benefits (if significantly reduce living expenses)
Income from Royalties, Trusts or Estates
Capital Gains or Gains derived from dealing in property (not including non-recurring gains)
Prizes/Lottery Winnings
Gifts (cash or liquid assets of which can be converted to cash)
Judgments from Personal Injury or other civil cases where cash is received on a recurring basis
Assets used for support of family
Other income of a recurring nature (specify source)
Gross Income (monthly)
Employer Paid Automobile Expenses
Employer Paid Insurance Expenses
Employer Paid Miscellaneous
Gross Income including Employer Benefits
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Salary or Wages (monthly)
Bonuses, Commissions, Allowances, Fees, Overtime, Tips and similar payments (based on past 12-month average or time of employment if less than 1 year)
Income from sources such as self-employment, partnership, close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income)
Severance Pay
Disability/Unemployment/Worker's Compensation
Recurring Income from Pension and Retirement Plans or Annuity Payments
Social Security Benefits
Other Public Benefits (do not include TANF or food stamps)
Spousal or Child Support from people not in this case
Interest and Dividends
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income)
Reimbursed Expenses and In Kind payments to the extent they reduce personal living expenses
Fringe Benefits (if significantly reduce living expenses)
Income from Royalties, Trusts or Estates
Capital Gains or Gains derived from dealing in property (not including non-recurring gains)
Prizes/Lottery Winnings
Gifts (cash or liquid assets of which can be converted to cash)
Judgments from Personal Injury or other civil cases where cash is received on a recurring basis
Assets used for support of family
Other income of a recurring nature (specify source)