Judicial Council of California Form FL-150, Income and Expense Declaration Completed Form Examples and Samples

Find clear, completed examples of the Judicial Council of California Form FL-150, Income and Expense Declaration. Our detailed samples guide you through filling out the form correctly for your divorce or family law case, covering income, expenses, assets, and debts.
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Completed sample of California Form FL-150, Income and Expense Declaration for a salaried employee.

FL-150 Income and Expense Declaration Example - Employed Parent

How this form was filled:

This is an example of a completed Judicial Council of California Form FL-150 for a petitioner, Maria Garcia, who is a salaried W-2 employee (a teacher). The form details her monthly income, payroll deductions, estimated living expenses, and information about her child. It's a common scenario in a divorce or legal separation case where child and spousal support are at issue.

Information used to fill out the document:

  • Petitioner's Name: Maria Garcia
  • Occupation: High School Teacher
  • Employer: San Diego Unified School District
  • Case Type: Divorce with one child
  • Filing Date: February 10, 2026
  • Last Month's Gross Income (Salary): $6,500
  • Total Gross Monthly Income: $6,500
  • Payroll Deductions (Monthly): $1,988
  • - Federal Income Tax: $750
  • - State Income Tax: $350
  • - Social Security/FICA: $403
  • - Health Insurance Premium: $150
  • - Mandatory Union Dues: $85
  • - Mandatory Retirement (CalSTRS): $300
  • Net Monthly Disposable Income: $4,512
  • Liquid Assets (Cash & Checking): $5,000
  • Monthly Expenses (Total): $4,280
  • - Rent: $2,200
  • - Utilities, Phone, Internet: $300
  • - Food & Household Supplies: $600
  • - Clothing: $150
  • - Transportation (Payment, Insurance, Fuel): $730
  • - Child's Extracurriculars: $200
  • - Credit Card Payment: $150
  • Attorney's Fees Paid: $2,500

What this filled form sample shows:

  • Demonstrates how to report W-2 salary income based on recent pay stubs.
  • Provides a clear breakdown of both mandatory and voluntary payroll deductions.
  • Includes a realistic itemization of estimated monthly living expenses for one adult and one child.
  • Accurately reports child-related costs, such as health insurance premiums and extracurricular activities.
  • Shows how to declare assets and disclose information about attorney's fees.

Form specifications and details:

Form Name: Judicial Council of California Form FL-150, Income and Expense Declaration
Use Case: Divorce/Separation with one child, filed by a W-2 salaried employee.
Filing Party: Petitioner
Key Financials: Based on 2025 year-end information for a 2026 court filing.
Created: January 27, 2026 02:40 AM
Completed sample of California Form FL-150, Income and Expense Declaration for a salaried employee.