Judicial Council of California Form FL-150, Income and Expense Declaration Instructions

Check this box if you received one-time money in the last 12 months (for example, lottery winnings, inheritance, etc.); also specify the source and amount.

Specify the source and total amount of any one-time money (for example, lottery winnings, inheritance) you received in the last 12 months. Fill only if 'Additional income (one-time money)' is 'Yes'.

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

Check this box if you have not completed high school (then specify highest grade completed).

Check this box if you have obtained one or more college degrees and list the degree(s) in the adjacent space.

Enter the college degree(s) you have earned (for example: BA in English; Associate of Science), including any major or concentration and year if known. Fill only if 'College — Degree(s) obtained' is greater than 0.

List any professional or occupational licenses you hold, including the license type, issuing authority (state or board), and license number or year issued if available.

Check this box if you have completed vocational training and specify the training in the space provided.

Check this box if you have other real property (not listed elsewhere) and are reporting its value on this line.

Check this box if you have other personal property (not listed elsewhere) and are reporting its value (estimate fair market value minus debts) on this line.

Enter the date when you (or the attorney) confirm and sign the attorney fee arrangement.

Enter the attorney's State Bar number, if applicable; leave blank if none.

Enter the full name of the attorney or the party representing themselves (first and last name).

Enter the name of the law firm or business association for the attorney or party, if any.

Enter the street mailing address including number, street name, and apartment or suite number if applicable.

Enter the city for the street mailing address.

Enter the state for the mailing address (use the two-letter state abbreviation if applicable).

Enter the ZIP code for the mailing address, using 5 digits or 9-digit ZIP+4 if available.

Enter the daytime telephone number including area code and any extension.

Enter the fax number including area code, or leave blank if none.

Enter a current email address for service and official communications.

Enter the name of the party the attorney represents, or enter 'self' or leave blank if not representing another party.

Check this box when the amounts you are listing for monthly expenses are estimates rather than actual past payments or proposed future needs.

Check this box when the amounts you are listing reflect the actual current or historical monthly expenses you or your household pay.

Check this box when the amounts you are listing represent proposed or requested future monthly needs rather than current or estimated expenses.

Enter the court-assigned case number for this matter exactly as shown on court documents, including any letters, dashes, or leading zeros.

Enter the full name of the petitioner (the person who filed the case) as it should appear on court documents.

Enter the full name of the respondent (the person responding to the petition) as it should appear on court documents.

Enter the full name of any other involved party, parent, or claimant relevant to this case as it should appear on court documents.

Check this box if your financial situation has changed significantly in the last 12 months and you will specify the reason(s) for the change on the form.

Enter the name of the county where the Superior Court for this case is located (the 'County of' shown on the court heading).

Enter the courthouse street address or physical location of the court where filings or appearances are made.

Enter the court's mailing address or P.O. Box to which correspondence and court documents should be sent.

Enter the city and postal ZIP code for the court's address, including both the city name and the ZIP code.

Enter the specific branch, division, or location name of the court (for example, 'Downtown Branch' or 'Family Court') if applicable.

Enter the date on which the declarant signs and submits this declaration.

Type or print the full legal name of the person making this declaration as it should appear next to the signature.

Enter the name of your current employer or, if unemployed, the name of your most recent employer.

Enter the employer’s street address (include city, state, and ZIP code as appropriate).

Enter the employer’s main telephone number, including the area code.

Enter your job title or occupation for this employment.

Enter the date when you began this job.

If you are unemployed, enter the date this job ended.

Enter the approximate number of hours you work per week at this job.

Enter the gross pay amount you receive for this job before taxes.

Check this box if your gross (before taxes) pay amount is received monthly (you are paid once per month).

Check this box if your gross (before taxes) pay amount is received weekly (you are paid once every week).

Check this box if you are paid by the hour and the amount entered is your gross hourly rate.

Enter the monetary amount for the fifth installment payment or balance being recorded in this row.

Enter the date of the last payment associated with the fifth installment entry.

Enter the date when the most recent payment was made for this first installment/debt entry.

Enter the dollar amount of the fourth installment payment owed for this listed payee.

Enter the current outstanding balance remaining on the obligation for the fourth installment.

Enter the date when the last payment was made on this installment.

Check this box if you have health insurance available to you through your job that can cover the children.

Check this box if you do not have health insurance available to you through your job that can cover the children.

Enter the average monthly amount you pay for rent or your mortgage.

Enter the average monthly principal portion of your mortgage payment.

Enter the average monthly interest portion of your mortgage payment.

Enter the household member A's age in years as a numeric string (e.g., 34).

Enter how Household Member A is related to you (for example, son, spouse, roommate).

Enter Household Member A's total gross monthly income before taxes and deductions (numbers only).

Check this box if the first person listed (household member A, line a) does pay some of the household expenses.

Check this box if the first person listed (household member A, line a) does not pay any of the household expenses.

Check this box if Household Member B contributes to or pays some portion of the household expenses.

Check this box if Household Member B does not contribute to or pay any of the household expenses.

Check this box if household member C (line c) pays some of the household expenses (answer = Yes).

Check this box if household member C (line c) does not pay any of the household expenses (answer = No).

Check this box if the person listed as household member D contributes to or pays some of the household expenses.

Check this box if the person listed as household member D does not contribute to or pay any of the household expenses.

Check this box if the fifth person listed (household member E) contributes toward some of the household expenses.

Check this box if the fifth person listed (household member E) does not contribute toward any of the household expenses.

Check this box if you are currently receiving state disability insurance (SDI) benefits and want to report that income on this form.

Enter the average monthly amount of disability income you receive (including SDI, Social Security disability, or private disability insurance) for the last 12 months.

Enter the average monthly gross salary or wages (before taxes) you received over the last 12 months for this job.

Enter the average monthly gross overtime pay (before taxes) you received over the last 12 months.

Enter the average monthly commissions or bonuses you received over the last 12 months.

Enter the amount you received last month for Other income (for example military allowances, royalty payments, or other specified sources).

Enter the average monthly amount you receive from Other income (for example military allowances, royalty payments, or other specified sources) calculated over the last 12 months.

Enter the average monthly amount of partner support you receive (total from this domestic partnership or from a different domestic partnership).

Enter the average monthly amount you received from pension or retirement fund payments over the past 12 months.

Check this box if you are currently receiving public assistance (for example: TANF, SSI, GA/GR).

Enter the average monthly amount you receive from public assistance (for example: TANF, SSI, GA/GR) for the past 12 months. Fill only if 'Public assistance — currently receiving' is 'Yes'.

Enter the average monthly amount you receive from Social Security retirement (not SSI).

Check this box if the spousal support you receive is from a different marriage (not from this marriage).

Check this box if the spousal support you receive is federally taxable.

Enter the average monthly dollar amount of spousal support you receive that is federally taxable.

Enter the average monthly amount of unemployment compensation you received (total unemployment benefits for the past 12 months divided by 12).

Enter the average monthly amount of workers' compensation you received (the dollar amount averaged over the last 12 months).

Enter the average monthly amount of dividends and interest you received from investments during the last 12 months.

Enter the average monthly gross rental property income you received (attach a schedule showing gross receipts less cash expenses if required).

Enter the average monthly amount of income you received from any trusts during the last 12 months.

Enter the average monthly amount of any other investment income not listed and specify the type of income on the form.

Enter the total number of additional pages (8 1/2-by-11-inch sheets) you are attaching to this form.

Enter your estimate of the other party's gross monthly income (before taxes) for this case.

Enter the person, creditor, or purpose this installment payment is for (e.g., creditor name or what the payment covers).

Enter the monetary amount of this installment payment.

Enter the date when the most recent payment was made on this installment.

Enter the specific type or nature of the self-employment business (for example, "plumbing contractor", "consulting", "retail store", or "freelance graphic design").

Enter the total net income from all self-employment activities after business expenses for the last month.

Enter the average monthly net income from all self-employment activities after business expenses (average of the past 12 months).

Enter the dollar amount of the sixth installment payment owed or paid (enter the numeric value for the payment).

Enter the remaining dollar balance for the sixth installment (the outstanding amount still owed).

Enter the date when the most recent payment toward the sixth installment was made.

Enter the number of months for which the extraordinary health expenses (item 19a) apply.

Enter the number of months you are requesting the court to consider for major losses not covered by insurance (for example, fire or theft).

Enter the number of months you are requesting the court to consider for the expenses for your minor children from other relationships.

Check this box if your tax filing status for the year specified in 3a is single.

Check this box if your tax filing status for the year specified in 3a is head of household.

Check this box if your tax filing status for the year specified in 3a is married and you file separately.

Check this box if you file state income tax returns in California for the tax year specified.

Check this box if you file state income tax returns in a state other than California, and specify the state named on the form.

Enter the name of the person or organization to whom this third installment payment is paid.

Enter the amount of this installment payment paid to the payee.

Enter the current remaining balance owed for this installment or debt.

Enter the date when the most recent payment on this installment was made.

Enter the total monthly expenses from lines a through q (do not include the amounts entered for mortgage principal and interest in a(1)(a) and a(1)(b)).

Enter the portion of the total monthly household expenses that is paid by other people or parties.