Financial Information Statement
Financial Information Statement Form. This is a Texas form and can be use in Fort Bend Local County.
Tags: Financial Information Statement, 126, Texas Local County, Fort Bend
This form is to be completed and a copy furnished to opposing Counsel and Court prior to the show cause hearing and/or hearing on the merits. All columns must be totaled. FINANCIAL INFORMATION STATEMENT NOTICE: Cause No: District Court Petitioner Respondent Attorney for Petitioner Attorney for Respondent 1. Date of (marriage) (separation) 2. Ages of children of this marriage: 3. A. Necessary monthly Expenses: House payment/rent Utilities including telephone Food Doctor/Dentist/Drugs Insurance Premiums Car payments Gasoline/oil/parking/bus fares Car repairs/maintenance Child care/school tuition Lunches/school supplies Haircuts ; $ $ $ $ $ $ $ $ $ $ (+) $ SUBTOTAL B. Debts(other than house and car) ; ; ; ; SUBTOTAL FORWARD Clothing Cleaning and laundry Legal Fees Gifts Church Support Entertainment Activities/lessons for children Miscellaneous $ $ $ $ $ $ $ $ $ (+) $ “A” Subtotal Total $ $ AMOUNT MONTHLY PAYMENT $ $ $ $ $ $ (+) $ (+) $ “B” Subtotal Total (+) $ $ GRAND TOTAL (monthly expenses and debts) (3A & 3B) 4. No Yes Are you working? $ $ Kind of work: Name of employer: 5. I am paid: weekly once a month. I will get my next check twice a month every two weeks . 6. Gross Income(If available, attach last three pay stubs): EACH PAY PERIOD $ Deductions: Withholding tax FICA Retirement $ $ (-) 7. Other income: 8. Have you received any overtime pay in the last 12 months? Yes No $ $ (-)$ $ Explain: Quick assets: cash $ banks savings and loan associations stocks and bonds Yes No I have or subject to my control: $ $ $ I can borrow $ 10. $ $ $ $ $ $ TOTAL DEDUCTIONS NET INCOME 9. MONTHLY Is your spouse working? Name of employer: Financial Information Statement Form126 Revised: 2009/03 $ $ $ undeposited checks credit unions other on my signature. Yes No Kind of work: - 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 11. My spouse is paid: weekly every two weeks twice a month spouse’s paycheck is received 12. once a month. My . Gross Income(If available, attach last three pay stubs): EACH PAY PERIOD $ Deductions: Withholding tax $ $ (-)$ $ $ $ FICA MONTHLY $ Retirement $ $ $ TOTAL DEDUCTIONS $ (-) NET INCOME $ 13. Other income - - Spouse: 14. Have you received any overtime pay in the last 12 months? 15. Quick assets: My spouse has control of: $ cash $ Yes No Explain: banks Yes No $ undeposited checks $ savings and loan associations $ credit unions $ stocks and bonds $ other My spouse can borrow $ 16. by signature. Custody of the children is at present as follows: 17. (ANSWER ONLY IF ANTICIPATE RECEIVING SUPPORT) The following sums are reasonably necessary or within the ability of my Spouse to pay, and that it will be fair and equitable to require the following: EACH PAY PERIOD MONTHLY a. For temporary alimony b. $ For child support (+) $ $ (+)$ 18. Total lines 17a and 17b 19. Wife’s Net Income (+) 20. Total lines 18 and 19 $ 21. Husband’s Net Income 22. Less alimony and support (line 18) 23. Net husband after deduction of child support and alimony 24. (ANSWER ONLY IF ANTICIPATE PAYING SUPPORT) I feel that a reasonable sum for me to pay weekly or monthly would be: a. 25. $ $ (+)$ $ $ For child support $ $ (-)$ $ (-) For temporary alimony b. $ $ $ Total lines 24a and 24b $ $ (+)$ $ (+) $ DATE: Signature of Printed Name of Husband Wife Husband Wife FILED: Financial Information Statement Form126 Revised: 2009/03 - 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com