Financial Declaration
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Financial Declaration Form. This is a Washington form and can be use in Clark Local County.
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Tags: Financial Declaration, Washington Local County, Clark
IN AND FOR THE STATE OF WASHINGTON
COUNTY OF CLARK
)
)
Petitioner,
)
)
vs.
)
)
)
Respondent.
)
________________________________)
No.
FINANCIAL DECLARATION
(FNDCLR)
1. GENERAL INFORMATION
Name:
Address (omit, if confidential):
Telephone #:
Employer Name:
Employer Address:
Spouse’s Name:
Spouse’s Employer Name:
Spouse’s Employer Address:
1.2 PERSONS (including children) WHOM YOU FINANCIALLY SUPPORT
Name
Age
Relationship
Address
2. INCOME AND ASSETS
Gross Monthly Income (personal):
Other Income:
Cash:
Savings:
FINANCIAL DECLARATION
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Current spouse or partner living in residence:
Home (cash value less amount owing):
Auto (cash value less amount owing):
Furniture (approximate value):
Notes, Mortgages, Trusts, Deeds:
Stocks, Bonds (approximate value):
Other Assets and Property:
Any Indebtedness Owed to You:
3. MONTHLY EXPENSES
Rent or Mortgage:
Food:
Utilities:
Transportation:
Installment payments (per month):
Medical & Dental:
Insurance:
Other:
Total Monthly Expenses:
3.1 DEBTS
Name of Creditor:
Amount Owed:
Under the penalty of perjury I declare that I have examined this document
and the preceding information is true and accurate to the best of my knowledge
and ability.
_____________________________
Signature
__________________________
Date
FINANCIAL DECLARATION
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