Income Statement Form. This is a Tennessee form and can be use in Hamilton Local County.
Tags: Income Statement, 034, Tennessee Local County, Hamilton
COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : : IN THE CHANCERY COURT OF HAMILTON COUNTY, TENNESSEE : * ________________________________________ * Defendant(s) : . .PLAINTIFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *. . . . . . ......... . * vs. * * THE PEOPLE OF THE STATE OF NEW YORK ________________________________________ * * D TO EFENDANT N0.______________ PART___________ INCOME STATEMENT GREETINGS: STATEMENT is submitted pursuant to LRCP 10.02. By signing this statement below, I This INCOME hereby certify that the information contained herein is current and correct. full COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 1. MyWE name is: ____________________________________________________________________ , the Honorable at the Court 2. My Social Security Number is : _________-______-_________ (I certify I do not have or use a different number.) located at County of 3. My Taxpayer Identification Number is: _______________________________ qI do not have a number. in room , on the day of , 20 , at o'clock in the noon, and at any recessed 4. High school to testify q evidence as Date of graduation: ____________________, or adjourned date,graduate? and giveNO qYES, a witness in this action on the part of the 20___ College graduate? qNO qYES, Degree:______ ON ____________________, 20___ If no college degree, years attended:_____. Date last attended:______________20___. 5. I last worked outside the home on or about _____________, 20___. Your schooling as stated in N0. 4 subpoena is punishable as the home approximately ______ years. 6. Since lastfailure to comply with this above, I have worked outside a contempt of court and will make you liable to the7. Foron whose behalfyear, the income attributable to me was $__________ (gross$50 and all damages sustained as a party the last calendar this subpoena was issued for a maximum penalty of income) and $__________(adjusted result of your failure to comply. gross income). 8. For the year before last calendar year, the income attributable to me was $________ (gross income) and $__________ (adjusted gross income). Witness, Honorable , one of the Justices of the 9. I qWeekly qEvery two weeks qTwice each month qMonthly qOther____________________ Court inam paid: County, day of , 20 10. My pay check, without overtime, is $__________. 11. The following are deducted from my pay check: $_________ for federal income taxes; $_________ for social security; $__________ for Medicare; and $__________for state taxes. (Attorney must sign above and type name below) 12. My net pay check, without overtime, is $__________. [Subtract total listed in N0. 11 from amount listed in N0. 10. 13. My net pay per month — without overtime — is $_________. [If you are paid weekly, multiply N0. 12 by 4.33; if paid every two weeks, multiply by 2.17; if twice a month, multiply by 2.] Attorney(s) 14. I have averaged $__________ per month overtime in the last 12 months. for 15. If your spouse has not filed an income statement or you challenge the amount he or she allegedly makes, your best estimate as to your spouse’s income per month is $__________. Office and P.O. Address __________________________________________________ AFFIANT SWORN TO AND SUBSCRIBED BEFORE ME THIS ____ DAY OF ______________, 20___. Telephone No.: My Commission expires: ___________, 20___. Facsimile No.: E-Mail Address: __________________________________________________ Mobile Tel. No.: NOTARY PUBLIC [Form 034, Rev. 2002.01.11] American LegalNet, Inc. www.USCourtForms.com