FL-150 PDF Details

Here's a concise summary of what you should be aware of regarding Form FL-150:

Accuracy is Critical: Because this form is submitted under penalty of perjury, ensure that all information provided is accurate to the best of your knowledge. Submitting false information can have legal consequences.

Documentation: You might be required to provide documentation to back up your declared income and expenses. This can include pay stubs, bank statements, tax returns, receipts, or other relevant documentation.

Changes in Circumstances: If there are significant changes in your financial situation after submitting this form, you may need to submit an updated form.

Legal Assistance: Given the form's significance and the potential complexity of some sections, consider seeking advice from a family law attorney or legal aid clinic when filling it out.

Question	Answer
Form Name	FL-150 Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	fl 150 california form, income and expense forms, form fl 150 fill out, form fl 150 kern county

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FL-150

PARTY WITHOUT ATTORNEY OR ATTORNEY	STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:	STATE:	ZIP CODE:
TELEPHONE NO.:	FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER:

RESPONDENT:

OTHER PARTY/PARENT/CLAIMANT:

INCOME AND EXPENSE DECLARATION

FOR COURT USE ONLY

CASE NUMBER:

1.Employment (Give information on your current job or, if you're unemployed, your most recent job.)

Attach copies of your pay stubs for last two months (black out Social Security numbers).

a.Employer:

b. Employer's address:

c.Employer's phone number: d. Occupation:

e. Date job started:

f. If unemployed, date job ended:

g.	I work about	hours per week.
h.	I get paid $	gross (before taxes)

per month

per week

per hour.

(If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1—Other Jobs" at the top.)

2.Age and education

a.My age is (specify):


b.	I have completed high school or the equivalent:		Yes
b.	I have completed high school or the equivalent:		Yes
c. Number of years of college completed (specify):
c. Number of years of college completed (specify):
d. Number of years of graduate school completed (specify):
e.	I have:	professional/occupational license(s) (specify):
e.	I have:	professional/occupational license(s) (specify):
		vocational training (specify):
		vocational training (specify):

No If no, highest grade completed (specify): Degree(s) obtained (specify):

Degree(s) obtained (specify):

3.Tax information

I last filed taxes for tax year (specify year):

My tax filing status is

single

head of household

married, filing separately

married, filing jointly with (specify name):

I file state tax returns in

California

other (specify state):

d. I claim the following number of exemptions (including myself) on my taxes (specify):

4.Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain):

(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the question number before your answer.) Number of pages attached:

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)

Page 1 of 4

Form Adopted for Mandatory Use Judicial Council of California FL-150 [Rev. January 1, 2019]

INCOME AND EXPENSE DECLARATION

Family Code, §§ 2030–2032, 2100–2113, 3552, 3620–3634, 4050–4076, 4300–4339 www.courts.ca.gov

FL-150

PETITIONER:

RESPONDENT:

OTHER PARTY/PARENT/CLAIMANT:

CASE NUMBER:

Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax return to the court hearing. (Black out your Social Security number on the pay stub and tax return.)

5. Income (For average monthly, add up all the income you received in each category in the last 12 months

Average

and divide the total by 12.)

Last month monthly

a. Salary or wages (gross, before taxes)

................................................................................................................b. Overtime (gross, before taxes)

.........................................................................................................................Commissions or bonuses

Public assistance (for example: TANF, SSI, GA/GR)

currently receiving

Spousal support

from this marriage

from a different marriage

federally taxable*

Partner support

from this domestic partnership

from a different domestic partnership

Pension/retirement fund payments

.........................................................................................................h. Social Security retirement (not SSI)

Disability:

Social Security (not SSI)

State disability (SDI)

Private insurance

Unemployment compensation

............................................................................................................................Workers' compensation

Other (military allowances, royalty payments) (specify):

6.Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)

a.	Dividends/interest	$
b.	Rental property income	$
c.	Trust income	$
d.	Other (specify):	$

7. Income from self-employment, after business expenses for all businesses				$
I am the	owner/sole proprietor	business partner	other (specify):

Number of years in this business (specify):

Name of business (specify):

Type of business (specify):

Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your Social Security number. If you have more than one business, provide the information above for each of your businesses.

8. Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and amount):

9. Change in income. My financial situation has changed significantly over the last 12 months because (specify):

10.Deductions

a.	Required union dues		$
b. Required retirement payments (not Social Security, FICA, 401(k), or IRA)		..................................................................	$
c. Medical, hospital, dental, and other health insurance premiums (total monthly amount)			$
d. Child support that I pay for children from other relationships			$
e.	Spousal support that I pay by court order from a different marriage	federally tax deductible*	$

f. Partner support that I pay by court order from a different domestic partnership			$
g.	Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g")		$

11.Assets

a.	Cash and checking accounts, savings, credit union, money market, and other deposit accounts			$
b. Stocks, bonds, and other assets I could easily sell				$
c.	All other property,	real and	personal (estimate fair market value minus the debts you owe)	$

Last month

Total

*Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.

FL-150 [Rev. January 1, 2019]

INCOME AND EXPENSE DECLARATION

Page 2 of 4

FL-150

PETITIONER:

RESPONDENT: OTHER PARTY/PARENT/CLAIMANT:

CASE NUMBER:

12.The following people live with me:

Name	Age	How the person is	That person's gross	Pays some of the
Name	Age	related to me (ex: son)	monthly income	household expenses?
a.					Yes	No
a.					Yes	No
b.					Yes	No
b.					Yes	No
c.					Yes	No
c.					Yes	No
d.					Yes	No
d.					Yes	No
e.					Yes	No
e.					Yes	No

13.Average monthly expenses

a. Home:

(1) Rent or

If mortgage:

(a)average principal:

(b)average interest:

Estimated expenses

mortgage.......... $


Actual expenses		Proposed needs
Actual expenses		Proposed needs
h.	Laundry and cleaning		$
i.	Clothes		$
j.	Education		$
k.	Entertainment, gifts, and vacation		$
l.	Auto expenses and transportation

	(2)	Real property taxes	$
	(3)	Homeowner's or renter's insurance	$
		(if not included above)	$
	(4)	Maintenance and repair	$
b. Health-care costs not paid by insurance			$
c.	Child care		$
d. Groceries and household supplies			$
e.	Eating out		$
f. Utilities (gas, electric, water, trash)			$
g.	Telephone, cell phone, and e-mail		$

14.Installment payments and debts not listed above

	(insurance, gas, repairs, bus, etc.)	$
m. Insurance (life, accident, etc.; do not include		$
	auto, home, or health insurance)	$
n.	Savings and investments	$
o.	Charitable contributions	$
p. Monthly payments listed in item 14		$
	(itemize below in 14 and insert total here)	$
q.	Other (specify):	$

r.TOTAL EXPENSES (a–q) (do not add in

the amounts in a(1)(a) and (b))	$

s. Amount of expenses paid by others	$

Paid to	For	Amount	Balance	Date of last payment
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$

15.Attorney fees (This information is required if either party is requesting attorney fees):

a.To date, I have paid my attorney this amount for fees and costs (specify): $

b.The source of this money was (specify):

c.I still owe the following fees and costs to my attorney (specify total owed): $

d.My attorney's hourly rate is (specify):

I confirm this fee arrangement.

Date:

	(TYPE OR PRINT NAME)	(SIGNATURE OF DECLARANT)

FL-150 [Rev. January 1, 2019]	INCOME AND EXPENSE DECLARATION	Page 3 of 4

FL-150

PETITIONER:

RESPONDENT:

OTHER PARTY/PARENT/CLAIMANT:

CASE NUMBER:

CHILD SUPPORT INFORMATION

(NOTE: Fill out this page only if your case involves child support.)

16.Number of children

a.	I have (specify number):	children under the age of 18 with the other parent in this case.
b.	The children spend	percent of their time with me and	percent of their time with the other parent.
	(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)

17.Children's health-care expenses

a.		I do		I do not	have health insurance available to me for the children through my job.

b.Name of insurance company:

c.Address of insurance company:

d.The monthly cost for the children's health insurance is or would be (specify): $ (Do not include the amount your employer pays.)

18. Additional expense for the children in this....................................................................case		Amount per month
a. Childcare so I can work or get job training	$
b. Children's health care not covered by insurance	$
c. Travel expenses for visitation	$
d. Children's educational or other special needs (specify below):	$
19. Special hardships. I ask the court to consider the following special financial circumstances
(attach documentation of any item listed here, including court orders):	$	Amount per month For how many months?
a. Extraordinary health expenses not included in 18b	$

	b. Major losses not covered by insurance (examples: fire, theft, other	$
	insured loss)	$
	insured loss)
	c. (1) Expenses for my minor children who are from other relationships and	$
	are living with me	$
	are living with me
	(2) Names and ages of those children (specify):

(3) Child support I receive for those children............................................... $

The expenses listed in a, b, and c create an extreme financial hardship because (explain):

20.Other information I want the court to know concerning support in my case (specify):

FL-150 [Rev. January 1, 2019]	INCOME AND EXPENSE DECLARATION

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The next sections will compose the PDF template that you will be creating:

Jot down the details in the Attach copies of your pay stubs, a b c d e f g h, Employer Employers address, hours per week gross before taxes, per month, per week, per hour, If you have more than one job, Age and education, My age is specify I have completed, Yes, If no highest grade completed, Number of years of college, Degrees obtained specify, and Number of years of graduate school field.

form fl 150 ca Attach copies of your pay stubs, a b c d e f g h, Employer Employers address, hours per week gross before taxes, per month, per week, per hour, If you have more than one job, Age and education, My age is specify I have completed, Yes, If no highest grade completed, Number of years of college, Degrees obtained specify, and Number of years of graduate school fields to insert

Note down all information you may need inside the box If you need more space to answer, Number of pages attached, I declare under penalty of perjury, Date, TYPE OR PRINT NAME, SIGNATURE OF DECLARANT, Form Adopted for Mandatory Use, INCOME AND EXPENSE DECLARATION, Page of, and Family Code wwwcourtscagov.

The area PETITIONER, RESPONDENT, OTHER PARTYPARENTCLAIMANT, CASE NUMBER, Attach copies of your pay stubs, Income For average monthly add up, Salary or wages gross before taxes, a b c d e f g h i j k l Other, from this marriage from this, Social Security not SSI, from a different marriage, State disability SDI, currently receiving, federally taxable, and Average monthly will be where you include both parties' rights and obligations.

Terminate by reviewing the next fields and completing them accordingly: ownersole proprietor, Income from selfemployment after, business partner, other specify, Attach a profit and loss statement, Additional income I received, Change in income My financial, Deductions, a b c d e f g, Required union dues Required, federally tax deductible, Assets a b c, Cash and checking accounts savings, real and, and personal.

form fl 150 ca ownersole proprietor, Income from selfemployment after, business partner, other specify, Attach a profit and loss statement, Additional income I received, Change in income My financial, Deductions, a b c d e f g, Required union dues Required, federally tax deductible, Assets a b c, Cash and checking accounts savings, real and, and personal blanks to fill out

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