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Affidavit Verifying Income Form. This is a Idaho form and can be use in 6th Judicial District Local District Court.
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Tags: Affidavit Verifying Income, Idaho Local District Court, 6th Judicial District
COURT
COUNTY .OF. .THE .DISTRICT . . . . . . . . .OF . . . . . . . . . . . . .
IN . . . . . . . . . . . . . . COURT . . . THE SIXTH JUDICIAL DISTRICT
......... ..
OF THE STATE OF IDAHO, COUNTY OF _____________________
:
Index No.
)
:
Calendar No.
___________________________________________________________________ (Soc. Sec. No.) )
Case No. __________________________
:
)
JUDICIAL SUBPOENA
Plaintiff(s)
vs.
)
Affidavit Verifying Income
-against:
)
)
_____________________________________________________________________ (Name)
:
_____________________________________________________________________ (5- Sec. N..) )
__________________________________ )
:
____________________________________________________________________ (Name)
Defendant(s)
:
I hereby state .under.oath.that . . . . . . . . . . . information .is .true: . . . . . . . . .
. . . . . . . . . . . . . . . . the following . . . . . . . . . . . . .
A.
ANNUAL GROSS INCOME (ICSG Sec 6)
FATHER
1. wages, salary, commissions, & bonuses ............................................... $ __________________
THE PEOPLE OF THE STATE OF NEW YORK
2. Unemployment benefits ......................................................................... $ __________________
3. Workers compensation, disability, Social Security ................................ $ __________________
TO 4. Interest, Dividends, Pensions, & Annuities
............................................ $ __________________
MOTHER
$ __________________
$ __________________
$ __________________
$ __________________
5. Alimony .................................................................................................. $ __________________
$ __________________
6. Veterans' benefits .................................................................................. $ __________________
$ __________________
7. Education grants and student loans ...................................................... $ __________________
$ __________________
GREETINGS:
8. Public assistance for self (not children)
................................................ $ __________________
9. Self-employment, business, trade and rent income:
$ __________________
$ __________________
Less straight line depreciation
(_________________)
WE COMMAND YOU, that all business$and excuses being laid aside, you and each of you attend before
Less one-half self-employment S.S. tax
$at the
(_________________) Court
,
the Honorable
Less necessary & ordinary expenses
$ (_________________)
located at
County of
Equals
in room NET self-employment/business income.........................................$ at
, on the
day of
, 20
, __________________in the $ __________________ recessed
o'clock
noon, and at any
10. Value of company paid car, housing, other expenses: .........................$ __________________
$
or adjourned date, to testify and give evidence as a witness in this action on the part of __________________
the
11, Potential Income (if unemployed or underemployed) ............................$ __________________
B.
C.
D.
$ __________________
12. Other ..................................................................................................$ __________________
$ __________________
SUBTOTAL OF ANNUAL GROSS INCOME .......................... $ __________________
MONTHLY GROSS INCOME (Line B divided by 12) .........................$ __________________
Your failure to comply with this subpoena is punishable as a contempt
theADJUSTMENTS TO MONTHLYsubpoena was issued for a7)maximum penalty of
party on whose behalf this GROSS INCOME (ICSG sec
$ __________________
$ __________________
of court and will make you liable to
$50 and all damages sustained as a
result of your failure to comply.
1. Monthly child support paid for other children .......................................... $ __________________
$ __________________
2. Monthly alimony paid for another relationship ......................................... $ __________________
$ __________________
Witness, Honorable
, one of the Justices of the
Court in living in the home ........................................................................ $ __________________
County,
day of
, 20
$ __________________
3. Adjustment for natural or adopted child of another relationship
E.
ADJUSTMENTS TO MONTHLY GROSS INCOME (TOTAL)
F.
(Attorney must sign above and type name below)
$ __________________
MONTHLY ICSG INCOME (C minus E) ................................. .$ __________________
_________________________________________________________
.......... $ __________________
$ __________________
Attorney(s) for
Signature of Party Submitting
Subscribed and sworn to before me on________________________________________ , ____________
Office and P.O. Address
___________________________________________________ (Notary Public for Idaho)
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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