Form FL-150, Income and Expense Declaration Instructions

Enter the monthly amount for childcare expenses incurred while you work or get job training.

Enter the monthly amount for children's health care expenses not covered by insurance.

Enter the monthly amount for travel expenses related to child visitation.

Provide details about the children's educational or other special needs. Fill only if 'Educational/Special Needs Expense Amount' has a value.

Enter the monthly amount for children's educational or other special needs.

Check this box if you received one-time money such as lottery winnings or inheritance in the last 12 months.

Enter the source and the amount of any one-time money received in the last 12 months, such as lottery winnings or inheritance. Fill only if 'Additional income' is 'Yes'.

Enter your current age in years.

Enter the total amount paid to your attorney for fees and costs to date. Fill only if 'ATTORNEY FOR (name):' is filled

Specify the source from which the money paid to your attorney originated. Fill only if 'ATTORNEY FOR (name):' is filled

Enter the total amount of fees and costs still owed to your attorney. Fill only if 'ATTORNEY FOR (name):' is filled

Enter your attorney's hourly billing rate. Fill only if 'ATTORNEY FOR (name):' is filled

Enter the full name of the petitioner.

Enter the full name of the respondent.

Enter the full name of any other party, parent, or claimant involved in the case.

Enter the official case number assigned to this legal matter.

Enter the case number associated with this legal matter.

Provide the full legal name of the petitioner in this case.

Provide the full legal name of the respondent in this case.

Provide the full legal name of any other party, parent, or claimant involved in this case.

Enter the case number assigned to this legal filing.

Enter the unique identification number assigned to this case.

Enter the full name of the petitioner in this case.

Enter the full name of the respondent in this case.

Enter the full name of any other party, parent, or claimant involved in this case.

Enter the full name of the petitioner in this case.

Enter the full name of the respondent in this case.

Enter the full name of any other party, parent, or claimant involved in this case.

Enter the total current value of all cash and checking accounts, savings accounts, credit union accounts, money market accounts, and other deposit accounts.

Check this box if your financial situation has changed significantly over the last 12 months.

Provide a detailed explanation for the significant change in your financial situation over the last 12 months. Fill only if 'Change in income' is 'Yes'.

Enter the amount of child support paid for children from other relationships.

Check this box if you have health insurance available for the children through your job.

Check this box if you do not have health insurance available for the children through your job.

Provide the name of the insurance company that provides health insurance for the children. Fill only if 'I do' is 'Yes'.

Provide the complete address of the insurance company. Fill only if 'I do' is 'Yes'.

Enter the monthly cost for the children's health insurance, excluding any amount your employer pays. Fill only if 'I do' is 'Yes'.

Enter the total number of years of college education completed.

Check this box if you have obtained a degree from college.

Provide the name of the degree(s) obtained during college education.

Provide the total amount of commissions or bonuses received last month. Fill only if 'Employed' is 'Yes'.

Provide the average monthly amount of commissions or bonuses received over the last 12 months. Fill only if 'Employed' is 'Yes'.

Enter the date on which this fee arrangement is confirmed. Fill only if 'ATTORNEY FOR (name):' is filled

Provide the full typed or printed name of the attorney. Fill only if 'ATTORNEY FOR (name):' is filled

Enter the name of the county for the Superior Court of California.

Provide the street address of the court.

Provide the mailing address of the court.

Enter the city and zip code for the court location.

Enter the name of the specific court branch.

Enter the date of the declaration.

Enter the full printed name of the person making this declaration.

Check this box if you receive disability income from Social Security (excluding Supplemental Security Income).

Check this box if you receive disability income from State Disability Insurance (SDI).

Check this box if you receive disability income from a private insurance policy.

Enter the total amount of private insurance disability income received last month.

Enter the average monthly amount of private insurance disability income received over the last 12 months.

Please enter the total dividends and interest income received in the last month.

Please enter the average monthly dividends and interest income received over the last 12 months.

Enter the full name of your current or most recent employer.

Provide the complete street address of your current or most recent employer.

Enter the telephone number of your current or most recent employer.

State your primary job title or occupation at your current or most recent employment.

Provide the date when you began your current or most recent employment.

If you are currently unemployed, enter the date when your most recent job ended.

Check this box if the expense figures provided in Section 13 are estimates.

Check this box if the expense figures provided in Section 13 are actual incurred expenses.

Check this box if the expense figures provided in Section 13 represent proposed needs.

Enter the name of the person or entity to whom the payment was made for this fifth debt.

Enter a brief description of what this fifth debt is for.

Enter the original amount of the fifth debt.

Enter the current outstanding balance of the fifth debt.

Enter the date when the last payment was made for this fifth debt.

Enter the full name of the fifth person living with you.

Enter the current age of the fifth person living with you.

Enter how the fifth person living with you is related to you (e.g., son, daughter, spouse, parent).

Enter the total gross monthly income of the fifth person living with you.

Check this box if the fifth household member listed on line 12.e pays some of the household expenses.

Check this box if the fifth household member listed on line 12.e does not pay any household expenses.

Provide the state bar number of the attorney or party filling out the form.

Enter the full name of the party or attorney.

Enter the name of the law firm, if applicable.

Provide the street address of the party or attorney.

Enter the city of residence or business for the party or attorney.

Enter the two-letter state abbreviation.

Enter the five or nine-digit zip code.

Provide the telephone number, including the area code.

Provide the fax number, including the area code.

Enter the email address.

Enter the name of the party for whom the attorney is representing.

Provide a detailed explanation of why the listed expenses create an extreme financial hardship. Fill only if 'Extraordinary Health Expenses Monthly Amount', 'Extraordinary Health Expenses Number of Months', 'Major Losses Monthly Amount', 'Major Losses Duration in Months', 'Monthly Expenses for Other Children', 'Months for Expenses for Other Children', 'Names and Ages of Other Children', 'Child Support Received for Other Children' has a value in any.

Enter the name of the person or entity to whom the installment payment or debt was made.

Describe what the installment payment or debt was for, such as an item purchased or service rendered.

Enter the total amount of the installment payment or debt.

Enter the current outstanding balance of the installment payment or debt.

Enter the date when the last payment was made for this installment or debt.

Enter the full name of the first person who lives with you.

Enter the age of the first person who lives with you.

Specify how the first person is related to you (e.g., son, daughter, spouse).

Enter the first person's total gross income for one month.

Check this box if the first household member listed pays some of the household expenses.

Check this box if the first household member listed does not pay any of the household expenses.

Press this button to clear the form after printing for privacy protection.

Press this button to print the form.

Press this button to save the form.

Press this button to clear all fields in the form.

Enter the name of the entity or person to whom the fourth debt or installment payment is made.

Specify the purpose or item for which the fourth debt or installment payment was incurred.

Enter the total original amount of the fourth debt or installment payment.

Enter the current outstanding balance for the fourth debt or installment payment.

Provide the date when the last payment was made for the fourth debt or installment payment.

Enter the full name of the fourth household member.

Enter the age of the fourth household member.

Enter how the fourth household member is related to you (e.g., son, daughter, spouse).

Enter the fourth household member's gross monthly income.

Check this box if the fourth household member pays some of the household expenses.

Check this box if the fourth household member does not pay some of the household expenses.

Enter the total amount of monthly health-care costs not covered by insurance.

Enter the total monthly cost for child care.

Enter the total monthly cost for groceries and household supplies.

Enter the total monthly cost for eating out.

Enter the total monthly cost for utilities such as gas, electricity, water, and trash.

Enter the total monthly cost for telephone, cell phone, and e-mail services.

Enter the total monthly cost for laundry and cleaning expenses.

Enter the total monthly cost for clothes.

Enter the total monthly cost for education expenses.

Enter the total monthly cost for entertainment, gifts, and vacation expenses.

Enter the total monthly cost for auto expenses and transportation, including insurance, gas, repairs, and bus fares.

Enter the total monthly cost for other insurance (life, accident, etc.), excluding auto, home, or health insurance.

Enter the total monthly amount contributed to savings and investments.

Enter the total monthly amount for charitable contributions.

Enter the number of years of graduate school you have completed.

The user should check this box if they have obtained a degree from graduate school.

Enter the graduate degree(s) you have obtained.

Enter the total monthly amount paid for medical, hospital, dental, and other health insurance premiums.

Check this box if you have completed high school or its equivalent.

Check this box if you have not completed high school or its equivalent.

Enter the highest grade level completed if high school or its equivalent was not completed. Fill only if 'No' is 'Yes'.

Check this box if your average monthly home expense is rent.

Check this box if your average monthly home expense is a mortgage.

Enter the average monthly cost for rent or mortgage.

Enter the average monthly principal payment for the mortgage. Fill only if 'Mortgage' is 'Yes'.

Enter the average monthly interest payment for the mortgage. Fill only if 'Mortgage' is 'Yes'.

Enter the average monthly cost for real property taxes.

Enter the average monthly cost for homeowner's or renter's insurance, if not included in other expenses.

Enter the average monthly cost for home maintenance and repair.

Please provide the total income from self-employment for the last month.

Please provide the average monthly income from self-employment after business expenses for all businesses.

Provide the total amount of necessary job-related expenses that were not reimbursed by your employer. Fill only if 'Employed' is 'Yes'.

Check this box if you have filed taxes for a previous tax year and will specify the last tax year filed.

Enter the year for which you last filed taxes. Fill only if 'Last Filed Taxes' is 'Yes'.

Enter the total number of children under the age of 18 you have with the other parent in this case.

Enter the percentage of time the children spend with you.

Enter the percentage of time the children spend with the other parent.

Provide a detailed description of your parenting schedule, especially if you are unsure about the percentages or if it has not been formally agreed upon.

Provide the total number of pages attached to this form.

Please provide the total monthly amount of payments listed in item 14.

Please specify the type of other monthly expense.

Please provide the monthly amount for the specified other expense.

Please provide the total amount of average monthly expenses from categories a through q, excluding amounts from a(1)(a) and (b).

Please provide the total amount of expenses paid by other individuals.

Specify and enter any other income received, such as military allowances or royalty payments.

Enter the amount of other income received last month, such as military allowances or royalty payments.

Enter the average monthly amount of other income, such as military allowances or royalty payments.

Provide any other information you want the court to know concerning support in your case.

Enter the type of other investment income.

Provide the amount of other investment income received last month.

Provide the average monthly amount of other investment income received.

Enter the estimated gross monthly income (before taxes) of the other party.

Explain the basis for the estimated gross monthly income of the other party.

Check this box if the asset is real property.

Check this box if the 'all other property' being described is personal property.

Enter the estimated fair market value of all other real and personal property, minus any debts owed.

Provide the gross overtime income received last month, before taxes. Fill only if 'Employed' is 'Yes'.

Provide the average gross monthly overtime income received over the last 12 months, before taxes. Fill only if 'Employed' is 'Yes'.

Check this box if the partner support income is received from the current domestic partnership.

Check this box if the partner support income is received from a domestic partnership other than the current one.

Provide the total amount of partner support income received in the last month.

Provide the average monthly partner support income received over the last 12 months.

Please enter the total amount of partner support paid last month by court order from a different domestic partnership.

Enter the approximate number of hours worked per week for your current job.

Enter the gross amount of pay received before taxes.

Check this box if you get paid monthly.

Check this box if you get paid weekly.

Check this box if you get paid hourly.

Enter the total amount of pension or retirement fund payments received last month.

Enter the average monthly amount of pension or retirement fund payments received over the last 12 months.

Check this box if you have one or more professional or occupational licenses.

Please provide a description of your professional or occupational license(s). Fill only if 'Professional/Occupational License(s)' is 'Yes'.

Check this box if you have completed vocational training.

Please provide a description of your vocational training. Fill only if 'Vocational Training' is 'Yes'.

Check this box if you are currently receiving public assistance, such as TANF, SSI, GA/GR.

Enter the total public assistance income received in the last month.

Enter the average monthly public assistance income received over the last 12 months.

Provide the total gross rental property income received last month.

Provide the average monthly gross rental property income received over the last 12 months.

Enter the total amount of required retirement payments, excluding Social Security, FICA, 401(k), or IRA contributions.

Provide the total amount of required union dues deducted during the last month.

Enter the gross amount of salary or wages received during the last month, before taxes. Fill only if 'Employed' is 'Yes'.

Enter the average monthly gross salary or wages, calculated by adding all salary or wages received in the last 12 months and dividing by 12, before taxes. Fill only if 'Employed' is 'Yes'.

Enter the name of the person or entity to whom the second installment payment or debt is paid.

Enter a description of what the second installment payment or debt is for.

Enter the monthly payment amount for the second installment payment or debt.

Enter the outstanding balance of the second installment payment or debt.

Enter the date when the last payment was made for the second installment payment or debt.

Enter the full name of the second person living in your household.

Enter the current age of the second person living in your household.

Enter how the second person living in your household is related to you (e.g., son, daughter, spouse).

Enter the second person's gross monthly income.

Check this box if the second household member listed pays some of the household expenses.

Check this box if the second household member listed does not pay any of the household expenses.

Check this box if you are an owner or sole proprietor of the self-employment business.

Check this box if you are a business partner in the self-employment business.

Check this box if your self-employment status is not 'owner/sole proprietor' or 'business partner' and specify your role.

Specify your self-employment role if you are neither an owner/sole proprietor nor a business partner. Fill only if 'Other (specify)' is 'Yes'.

Enter the number of years you have been operating this business. Fill only if 'Owner/sole proprietor', 'Business partner', 'Other (specify)' is 'Yes', any.

Provide the full legal name of your self-employment business. Fill only if 'Owner/sole proprietor', 'Business partner', 'Other (specify)' is 'Yes', any.

Describe the type or nature of your self-employment business. Fill only if 'Owner/sole proprietor', 'Business partner', 'Other (specify)' is 'Yes', any.

Enter the name of the person or entity to whom the sixth installment payment or debt is paid.

Describe the purpose or nature of the sixth installment payment or debt.

Enter the total amount of the sixth installment payment or debt.

Enter the current outstanding balance of the sixth installment payment or debt.

Enter the date when the last payment was made for the sixth installment payment or debt.

Enter the total Social Security retirement income (excluding SSI) received in the last month.

Enter the average monthly Social Security retirement income (excluding SSI) received over the last 12 months.

Enter the monthly amount of expenses incurred for your minor children who are from other relationships and are living with you.

Enter the number of months these expenses for your minor children from other relationships are expected to continue.

Provide the names and ages of the minor children from other relationships for whom expenses are being claimed. Fill only if 'Monthly Expenses for Other Children', 'Months for Expenses for Other Children' has a value in any.

Enter the monthly amount of child support you receive for the minor children from other relationships. Fill only if 'Monthly Expenses for Other Children', 'Months for Expenses for Other Children', 'Names and Ages of Other Children' has a value in any.

Enter the monthly amount for extraordinary health expenses that were not included in section 18b.

Enter the number of months for which these extraordinary health expenses apply.

Please provide the monthly amount of major losses not covered by insurance.

Please provide the number of months these major losses not covered by insurance will last.

Check this box if the spousal support income is received from this marriage.

Check this box if the spousal support income is received from a different marriage.

Check this box if the spousal support income is federally taxable. Fill only if 'From a different marriage' is 'Yes'.

Please enter the total amount of spousal support received in the last month.

Please enter the average monthly spousal support received, calculated over the last 12 months.

Check this box if the spousal support you pay by court order from a different marriage is federally tax deductible.

Enter the monthly amount of spousal support you pay by court order from a different marriage.

Check this box if you file your state tax returns in California.

Check this box if you file your state tax returns in a state other than California.

Please provide the name of the state where you file your tax returns, if not California. Fill only if 'Other (specify state)' is 'Yes'.

Enter the total current value of all stocks, bonds, and other assets that can be easily sold.

Enter the total number of exemptions you claim on your taxes, including yourself.

Check this box if your tax filing status is Single.

Check this box if your tax filing status is Head of Household.

Check this box if your tax filing status is Married, Filing Separately.

Check this box if your tax filing status is Married, Filing Jointly.

Please provide the full name of the person with whom you are filing taxes jointly. Fill only if 'Married, Filing Jointly' is 'Yes'.

Enter the name of the individual or entity to whom the third installment payment or debt is paid.

Provide a brief description of what the third installment payment or debt is for.

Enter the total amount of the third installment payment or debt.

Enter the outstanding balance remaining for the third installment payment or debt.

Provide the date when the last payment was made for the third installment payment or debt.

Enter the full name of the third person who lives with you.

Enter the age of the third person who lives with you.

Describe your relationship to the third person who lives with you (e.g., son, daughter, parent, roommate).

Enter the third person's total gross income before taxes and deductions, earned in a month.

Check this box if the third person living with you (listed as 'c.') pays some of the household expenses.

Check this box if the third person living with you (listed as 'c.') does not pay any of the household expenses.

Enter the amount of trust income received in the last month.

Enter the average monthly amount of trust income received.

Enter the income received last month for the specified category. This may include wages, salary, or other income sources. Fill only if 'Unemployed' is 'Yes'.

Enter the average monthly income for the specified category. This may include wages, salary, or other regular income sources. Fill only if 'Unemployed' is 'Yes'.

Enter the total amount of workers' compensation received in the last month.

Enter the average monthly amount of workers' compensation received over the last 12 months.