FL-155 PDF Details

Here's a short summary of what you should be aware of regarding Form FL-155:

Eligibility: Not everyone is eligible to use this form. Certain conditions such as being self-employed or seeking spousal support may preclude you from using it. Before completing the form, ensure you are eligible by checking the criteria listed.

Income Sources: Clearly specify your sources of income, whether from salary, social security, unemployment, etc. If you only have income from TANF, SSI, or GA/GR, this form can be especially appropriate.

Monthly Expenses: Detail your average monthly expenses. This includes job-related costs not covered by your employer, union dues, retirement payments, and more.

Child-Related Expenses: If you have children from the relationship, specify custody arrangements, time spent with each parent, and related monthly expenses.

Service and Filing: After completing the form, make copies. One copy is for you, another must be served on the other party (or their attorney), and the original is filed with the court. Proof of service will also typically need to be filed.

Hearing: If a court hearing is scheduled, attendance is crucial. The court may make determinations without your input if you are absent.

QuestionAnswer
Form Name FL-155 Form
Form Length 2 pages
Fillable? Yes
Fillable fields 11
Avg. time to fill out 2 min 46 sec
Other names fl 155 fillable, fl 155 form california, court form statement, fl 155 california pdf

Form Preview Example

FL-155

Your name and address or attorney's name and address:

TELEPHONE NO.:

FOR COURT USE ONLY

 

 

 

To keep other people from

 

 

 

 

 

 

seeing what you entered on

 

 

 

 

your form, please press the

 

ATTORNEY FOR (Name):

 

Clear This Form button at the

 

 

end of the form when finished.

 

 

 

 

 

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

 

 

 

 

STREET ADDRESS:

 

 

 

 

 

 

 

 

MAILING ADDRESS:

 

 

 

 

CITY AND ZIP CODE:

 

 

 

 

BRANCH NAME:

 

 

 

 

PETITIONER/PLAINTIFF:

 

 

 

 

RESPONDENT/DEFENDANT:

 

 

 

 

OTHER PARENT:

 

 

 

 

 

 

 

 

 

 

CASE NUMBER:

 

FINANCIAL STATEMENT (SIMPLIFIED)

 

 

 

NOTICE: Read page 2 to find out if you qualify to use this form and how to use it.

1.

a.

 

 

My only source of income is TANF, SSI, or GA/GR.

 

 

 

 

 

 

 

 

 

 

 

 

 

I have applied for TANF, SSI, or GA/GR.

 

 

 

 

 

 

 

 

 

 

 

 

b.

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

I am the parent of the following number of natural or adopted children from this relationship

 

3. a. The children from this relationship are with me this amount of time

. .

. . . . . . . . . . . . . . . . . .

 

. . .

 

. . . . . . . . . . . . . .

 

 

b. The children from this relationship are with the other parent this amount of time

 

 

c. Our arrangement for custody and visitation is (specify, using extra sheet if necessary):

 

 

4. My tax filing status is:

 

 

 

 

single

 

 

married filing jointly

 

 

head of household

 

 

 

married filing separately.

 

 

 

 

 

 

 

 

 

 

 

5.

My current gross income (before taxes) per month is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

 

Attach 1

 

This income comes from the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salary/wages: Amount before taxes per month

 

 

 

 

 

 

$

 

copy of pay

 

 

. . . . . . . . . . . . . . . . .

.

. . .

 

. . . . . . . . . . . . . .

 

 

 

Retirement: Amount before taxes per month

 

 

 

 

 

 

$

 

stubs for

 

 

 

 

 

 

 

 

 

 

 

. . . . . . . . . . . . . . . . .

.

. . .

 

. . . . . . . . . . . . . .

$

 

 

 

 

 

 

 

 

 

 

last 2

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Unemployment compensation: Amount per month

 

months here

 

 

Workers' compensation: Amount per month

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

 

 

 

 

(cross out

 

 

Social security:

 

 

 

SSI

 

 

 

Other Amount per month

 

$

 

 

 

 

 

 

 

 

 

 

social

 

 

 

Disability: Amount per month . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

 

 

 

 

 

security

 

 

 

Interest income ( from bank accounts or other): Amount per month

 

$

 

 

 

 

 

 

numbers)

 

 

 

I have no income other than as stated in this paragraph.

 

 

 

 

 

 

 

 

 

 

 

6. I pay the following monthly expenses for the children in this case:

 

 

 

 

 

 

 

 

a.

 

 

 

Day care or preschool to allow me to work or go to school

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

 

 

 

 

 

 

 

 

 

Health care not paid for by insurance

 

 

 

 

 

 

 

 

 

 

$

 

b.

 

 

 

. . . .

. .. .

. . .

. . . . . . . . . . . . . . . . . .

 

. . .

 

. . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

c.

 

 

 

. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .School, education, tuition, or other special needs of the child

 

 

 

 

 

Travel expenses for visitation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

d.

 

 

 

 

. . .

. . .

. . .

 

. . .

.

. .

. . .

. . . .

. . .

. . . . . . . . . . . . . . . . . .

 

. . .

 

. . . . . . . . . . . . . .

7.

 

 

 

There are (specify number)

 

 

 

 

other minor children of mine living with me. Their monthly expenses

 

 

 

 

 

 

 

 

 

 

 

 

that I pay are

$

 

 

 

 

8. I spend the following average monthly amounts (please attach proof):

 

 

 

 

 

 

 

 

a.

 

 

Job-related expenses that are not paid by my employer (specify reasons for expenses on separate sheet)

$

 

 

 

 

 

 

 

Required union dues

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

 

 

 

 

. .

.

. . . .

 

 

. . .

. . .

. . .

 

. . .

.

. .

. . .

. . . .

. . .

. . . . . . . . . . . . . . . . . .

 

. . .

 

. . . . . . . . . . . . . .

$

 

 

Required retirement payments (not social security, FICA, 401k or IRA)

 

$

 

c.

 

 

 

 

 

d.

 

 

 

 

. . . . .Health insurance costs

 

. . .

. . .

. . .

 

. . .

.

. .

. . .

. . . .

.

. .

. . . . . . . . . . . . . . . . . .

 

. . .

.

. . . . . . . . . . . . .

$

 

 

Child support I am paying for other minor children of mine who are not living with me

 

$

 

e.

 

 

 

 

. . . . . . . . . . . . . .

 

f.

 

 

 

 

Spousal support I am paying because of a court order for another relationship. . . . . . . . . . . . . . . . . . . . . . . $

 

 

Monthly housing costs:

 

 

rent or

 

mortgage

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

 

g.

 

 

 

 

 

 

 

 

 

 

 

 

If mortgage: interest payments $____________ real property taxes $____________

 

 

9.

Information concerning

 

my current employment

 

 

my most recent employment:

 

 

 

 

 

 

 

 

Employer:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My occupation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date work started:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date work stopped (if applicable):

 

 

What was your gross income (before taxes) before work stopped?:

 

%

%

Page 1 of 2

Form Approved for Optional Use

Judicial Council of California FL-155 [Rev. January 1, 2004]

FINANCIAL STATEMENT (SIMPLIFIED)

Family Code, § 4068(b)

www.courtinfo.ca.gov

• Interest
• Workers' compensation
• Social security
• Retirement

PETITIONER/PLAINTIFF:

CASE NUMBER:

RESPONDENT/DEFENDANT:

OTHER PARENT:

10. My estimate of the other party's gross monthly income(before taxes) is . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . $ 11. My current spouse's monthly income(before taxes) is . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . $ 12. Other information I want the court to know concerning child support in my case (attach extra sheet with the information).

13.

I am attaching a copy of page 3 of form FL-150, Income and Expense Declaration showing my expenses.

I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

PETITIONER/PLAINTIFF

RESPONDENT/DEFENDANT

INSTRUCTIONS

Step 1: Are you eligible to use this form? If your answer is YES to any of the following questions, you may NOT use this form:

•Are you asking for spousal support (alimony) or a change in spousal support?

•Is your spouse or former spouse asking for spousal support (alimony) or a change in spousal support?

•Are you asking the other party to pay your attorney fees?

•Is the other party asking you to pay his or her attorney fees?

•Do you receive money (income) from any source other than the following?

• Welfare (such as TANF, GR, or GA)

• Salary or wages

• Disability

• Unemployment

• Are you self-employed?

If you are eligible to use this form and choose to do so, you do not need to complete the Income and Expense Declaration (form FL-150). Even if you are eligible to use this form, you may choose instead to use the Income and Expense Declaration (form FL-150).

Step 2: Make 2 copies of each of your pay stubs for the last two months. If you received money from other than wages or salary, include copies of the pay stub received with that money.

Privacy notice: If you wish, you may cross out your social security number if it appears on the pay stub, other payment notice or your tax return

Step 3: Make 2 copies of your most recent federal income tax form.

Step 4: Complete this form with the required information. Type the form if possible or complete it neatly and clearly in black ink. If you need additional room, please use plain or lined paper, 8½-by-11", and staple to this form.

Step 5: Make 2 copies of each side of this completed form and any attached pages.

Step 6: Serve a copy on the other party. Have someone other than yourself mail to the attorney for the other party, the other party, and the local child support agency, if they are handling the case, 1 copy of this form, 1 copy of each of your stubs for the last two months, and 1 copy of your most recent federal income tax return.

Step 7: File the original with the court. Staple this form with 1 copy of each of your pay stubs for the last two months. Take this document and give it to the clerk of the court. Check with your local court about how to submit your return.

Step 8: Keep the remaining copies of the documents for your file.

Step 9: Take the copy of your latest federal income tax return to the court hearing.

It is very important that you attend the hearings scheduled for this case. If you do not attend a hearing, the court may make an order without considering the information you want the court to consider.

FL-155 [Rev. January 1, 2004]

FINANCIAL STATEMENT (SIMPLIFIED)

 

 

 

 

For your protection and privacy, please press the Clear This Form

 

 

 

Save This Form

button after you have printed the form.

 

 

 

 

 

Print This Form

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