Stanislaus — Declaration disclosure

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/declaration-disclosure.pdf

www.stanct.org (209) 530-3100 Street Address: 1100 I Street Modesto, CA 95353 Mailing Address: P.O. Box 1098 Modesto, CA 95353

Self Help Center: 800 11th Street Room #220 Modesto, CA 95353

(PROVIDING ASSISTANCE TO PARTIES REPRESENTING THEMSELVES)

Declara tions of Di sclosur e Packet

All documents must be typed or printed legibly per Rules of Court 2.104, in blue or black ink.

This packet includes the necessary forms to Request a Default and to file Declarationsof Disclosure.

Judicial Council forms, local forms, and information are available in the Clerk’s Office, the Stanislaus County Law Library located at 1101 13th Street, Modesto, CA and on the following websites:

Stani slaus Coun ty Superi or Court: www. stan ct.org Stani slaus Coun ty – Local Forms: www.stanct. org/ Forms.aspx?id = 3 Judicial Council ’s Self He lp: www.courts.ca.gov/selfhe lp .htm Judicial Counc il Form s: www.courts.ca. gov /formsrules .h tm Stani slaus Coun ty Law Li brary: www.stan islau sla wlibr ary.o rg Free Interactive Electronic Forms Program: www.icandocs.org/c a/ california .html Califo rnia ’s Free Website for Legal Hel p: www.law helpca lif ornia.o rg Law Lib raries, We bsites, or Self-He lp Legal Books: www. courts.ca.go v/1091 .h tm REQUIR ED FORMS:

• FL- 140 - Declara tion of Disclosure MUST BE SERVED ON OTH ER PARTY; DO NO T FI LE WIT H THE COU RT • FL- 142 - Schedu le of Assets and De bts MUST BE SERVED ON OTH ER PAR TY; DO NOT FI LE WIT H TH E COURT • FL- 150 - Inc ome and Ex pense De cla ration • FL- 141 - Declara tion Rega rding Service of Decla ration of Disc losure and Income and Ex pense De clara tion

Partiesare encouragedto reviewand comply withLocal Rules regarding Family Law proceedings. Local Rules can be located on the followingSuperior Court website: www.stanct.org.

Material distributed by the Superior Court Clerk’s Office or Self Help Center IS IN TENDED FO R IN FOR MATI ONAL AND ED UCAT IONAL PURPOSES ON LY . Such material is NOT LEGAL AD VIC E and is not intended to be legal advice as to your specificcase. IT IS NOT I NTE N DED TO TA KE TH E PLACE OF LEGAL AD VICE FR OM AN AT TORNEY. You are strongly urged to seek the advice of a licensedattorney before starting or completing your case in order to protectvaluable legal rightsthatyou may have, of whichyou may be unaware of. Please contact an attorney of your choice or contact the LAWYERS REFERR AL SERVICE of the Stani sla us County Bar Association at: (209)571-5727for a referral. The Clerk’s Office cannot give you legal advice.

Revised 07/01/2013

This is the Form Number

YOUR NAME HERE

YOUR STREET ADDRESS HERE YOUR CITY, STATE, and ZIP CODE HERE

IN PRO PER COUNTY NAME HERE SAMPLE

COURT’S PHYSICAL ADDRESS HERE
COURT’S MAILING ADDRESS HERE
COURT’S CITY, STATE, and ZIP CODE HERE

FILL THIS OUT EXACTLY AS THE INFORMATION
APPEARS ON YOUR OTHER DOCUMENTS

CHECK THIS BOX CHECK BOTH BOXES COURT CASE NUMBER HERE

IF THERE ARE ASSETS AND DEBTS
INVOLVED IN THE CASE, CHECK
BOX 1 AND FILL OUT A SCHEDULE
OF ASSETS AND DEBTS, FL-142

IF YOU WANT A CHILD SUPPORT OR
SPOUSAL SUPPORT AMOUNT TO BE
DETERMINED BY THE COURT, FILL
OUT THE FL-150 AND CHECK THIS
BOX.

DATE HERE

PRINT YOUR NAME HERE. SIGN YOUR NAME HERE

THIS FORM SHOULD NOT BE FILED WITH THE COURT FL-142 ATTORNEY OR PARTY W ITHOUT ATTORNEY (Name and Address): TELEPHONE NO.: YOUR PHONE #

YOUR NAME YOUR ADDRESS CITY, STATE, ZIP CODE

ATTORNEY FOR (Name): in pro per SUPERIOR COURT OF CALIFORNIA, COUNTY OF Stanislaus

PETITIONER: PETITIONER'S NAME AS IT IS ON THE PETITION

RESPONDENT: RESPONDENT'S NAME AS IT IS ON THE PETITION

SCHEDULE OF ASSETS AND DEBTS CASE NUMBER:
x Petitioner's Respondent's YOUR CASE #
— INSTRUCTIONS —

List all your known community and separate assets or debts. Include assets even if they are in the possession of another person, Select the box toincluding your spouse. If you contend an asset or debt is separate, put P (for Petitioner) or R (for Respondent) in the first column (separate property) to indicate to whom you contenddescribeit belongs."you"

All values should be as of the date of signing the declaration unless you specify a different valuation date with the description. For additional space, use a continuation sheet numbered to show which item is being continued.

SEP. DATE CURRENT GROSS AMOUNT OF MONEY

ITEM ASSETS DESCRIPTION PROP. ACQUIRED FAIR MARKET OW ED OR NO. VALUE ENCUMBRANCE

$ $

1. REAL ESTATE (Give street addresses and attach copies of deeds with legal descriptions and latest lender's statement.) WRITE "NONE" You must attach

OR copies of Date Acquired deed(s) with THE ADDRESS, CITY AND S TATE legal Fair Market Value descriptions

Amount of Money

Owed

2. HOUSEHOLD FURNITURE, FURNISHINGS, APPLIANCES (Identify.) MISCELLANEOUS FURNISHINGS

OR DO AN ITEMIZED LIST LIKE THIS: 1 KING BED, 1 COUCH, DINING ROOM TABLE TV, DVD PLAYER IN WIFE POSSESSION

TOOLS, 1 QUEEN BED, TV, LINENS IN HUSBAND'S POSSESSION 3. JEWELRY, ANTIQUES, ART, COIN COLLECTIONS, etc. (Identify.) LIST THE VALUABLE COLLECTIBLES OR WRITE "NONE"

Form Approved for Optional Use SCHEDULE OF ASSETS AND DEBTS Code of Civil Procedure, §§ 2030(c), 2033.5 Judicial Council of California FL-142 [Rev. January 1, 2005] (Family Law)

SEP. DATE CURRENT GROSS AMOUNT OF MONEY ASSETS DESCRIPTION ITEM PROP. ACQUIRED FAIR MARKET OW ED OR NO. VALUE ENCUMBRANCE $ $ 4. VEHICLES, BOATS, TRAILERS (Describe and attach copy of title document.) LIST YEAR, MAKE AND MODEL

OR WRITE "NONE" Date Acquired

Current gross fair

market value

5. SAVINGS ACCOUNTS (Account name, account number, bank, and branch. Attach copy of latest statement.) LIST YOUR JOINT ACCOUNTS Amount of money LIST YOUR SEPARATE ACCOUNTS owed or encumbrance OR WRITE "NONE"

6. CHECKING ACCOUNTS (Account name and number, bank, and branch. Attach copy of latest statement.) LIST YOUR JOINT ACCOUNTS

LIST YOUR SEPARATE ACCOUNTS

OR WRITE "NONE"

7. CREDIT UNION, OTHER DEPOSIT ACCOUNTS (Account name and number, bank, and branch. Attach copy of latest statement.) LIST ALL CREDIT UNION SHARE ACCOUNTS

OR WRITE "NONE"

8. CASH (Give location.) EXAMPLES ARE: SAFE DEPOSIT BOX SOCK DRAWER OR WRITE "NONE"
9. TAX REFUND WRITE "NONE" OR LIST AS "TO BE DETERMINED" IF NEEDED
10. LIFE INSURANCE W ITH CASH SURRENDER OR LOAN VALUE (Attach copy of declaration page for each policy.) MUST HAVE A CASH VALUE! NON-CASH VALUE ACCOUNTS DO NOT GET LISTED HERE

OR WRITE "NONE"

FL-142 [Rev. January 1, 2005] SCHEDULE OF ASSETS AND DEBTS Page 2 of 4 (Family Law)

SEP. DATE CURRENT GROSS AMOUNT OF MONEY ITEM ASSETS DESCRIPTION PROP. ACQUIRED FAIR MARKET OWED OR NO. VALUE ENCUMBRANCE $ $ 11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS (Give certificate number and attach copy of the certificate or copy of latest statement.) LIST ACCOUNTS

OR WRITE "NONE" Date Acquired

Current gross fair

12. RETIREMENT AND PENSIONS (Attach copy of latest summary market value plan documents and latest benefit statement.)

AT LEAST LIST THE EMPLOYER'S NAME

OR WRITE "NONE" Amount of money owed or encumbrance 13. PROFIT - SHARING, ANNUITIES, IRAS, DEFERRED COMPENSATION (Attach copy of latest statement.) AT LEAST LIST THE EMPLOYER'S NAME

OR WRITE "NONE"

14. ACCOUNTS RECEIVABLE AND UNSECURED NOTES (Attach copy of each.) LIST ALL

OR WRITE "NONE"

15. PARTNERSHIPS AND OTHER BUSINESS INTERESTS (Attach copy of most current K-1 form and Schedule C.) LIST ALL

OR WRITE "NONE"

16. OTHER ASSETS EXAMPLES ARE TRACTORS, LIVESTOCK, ETC.

OR WRITE "NONE"

total from # 4 - #1017. TOTAL ASSETS FROM CONTINUATION SHEET

18. TOTAL ASSETS Total BOTH $ $

FL-142 [Rev. January 1, 2005] SCHEDULE OF ASSETS AND DEBTS Page 3 of 4 (Family Law)

ITEM DEBTS—SHOW TO WHOM OWED SEP. TOTAL DATE NO. PROP. OW ING INCURRED

$

19. STUDENT LOANS (Give details.) LIST ALL FOR EACH PERSON'S EDUCTION LIKE: SALLIE MAE FOR HUSBAND'S COLLEGE OR WRITE "NONE"
20. TAXES (Give details.) LIST OUTSTANDING TAX BILLS OR BILLS THAT NEED TO BE DIVIDED Total owing EXAMPLE:

2007 IRS TAXES OR WRITE "NONE" 21. SUPPORT ARREARAGES (Attach copies of orders and statements.) PAST DUE SUPPORT FROM THIS RELATIONSHIP OR FROM ANOTHER RELATIONSHIP OR WRITE "NONE" 22. LOANS—UNSECURED (Give bank name and loan number and attach copy of latest Date incurred statement.) LIKE CONSOLIDATION LOANS

OR WRITE "NONE" 23. CREDIT CARDS (Give creditor's name and address and the account number. Attach copy of latest statement.) LIST ALL CARDS ( MISHT WANT TO SAY WHICH ARE JOINT AND WHICH ARE SEPARATE), LIKE WAMU MASTERCARD IN HUSBAND'S NAME CAPITAL ONE VISA HELD JOINTLY SEARS IN WIFE'S NAME OR WRITE "NONE" 24. OTHER DEBTS (Specify): ANYTHING THAT DOES NOT FALL IN THE PRIOR PAGES CAN BE ADDED HERE, LIKE: DR SMITH DDS FOR CHILD'S ORTHODONTICS

OR WRITE "NONE"

Total from #18 25. TOTAL DEBTS FROM CONTINUATION SHEET

Number of pages attached, if any

26. TOTAL DEBTS $

27. (Specify number): pages are attached as continuation sheets. Total owing

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: TODAY'S DATE

YOUR PRINTED NAME (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

FL-142 [Rev. January 1, 2005] SCHEDULE OF ASSETS AND DEBTS Page 4 of 4 (Family Law)

This is the Form Number

YOUR NAME HERE

YOUR STREET ADDRESS HERE YOUR CITY, STATE, and ZIP CODE HERE

IN PRO PER SAMPLE
COUNTY NAME HERE

COURT’S PHYSICAL ADDRESS HERE
COURT’S MAILING ADDRESS HERE
COURT’S CITY, STATE, and ZIP CODE HERE

FILL THIS OUT EXACTLY AS THE INFORMATION
APPEARS ON YOUR OTHER DOCUMENTS

COURT CASE NUMBER HERE

FILL OUT YOUR EMPLOYER’S INFORMATION HERE.
IF YOU DO NOT HAVE A JOB, GIVE THE INFORMATION
FROM YOUR LAST JOB.

FILL OUT YOUR AGE AND WHAT GRADE IN
SCHOOL YOU COMPLETED. IF YOU HAVE
ANY SPECIAL LICENSES, FILL OUT THAT
INFORMATION AS WELL.

DATE PRINT SIGN

FILL THIS OUT EXACTLY AS THE INFORMATION APPEARS ON YOUR OTHER DOCUMENTS COURT CASE NUMBER HERE

YOU MUST ATTACH YOUR LAST TWO PAY STUBS. REMEMBER TO CROSS OUT YOUR SOCIAL SECURITY NUMBER.

YOU MUST LIST ALL OF YOUR INCOME, BEFORE TAXES, IN THIS AREA

IN THIS COLUMN YOU WILL LIST

WHAT YOU RECEIVED LAST MONTH FOR EACH SOURCE

IN THIS COLUMN YOU WILL LIST

THE AVERAGE YOU RECEIVED

FROM THE LAST 12 MONTHS FOR EACH SOURCE

YOU MUST LIST ALL OF YOUR INVESTMENT INCOME, BEFORE TAXES, IN THIS AREA

IF YOU ARE

SELF-

EMPLOYED

CHECK THIS BOX IF YOU RECEIVED A ONE-TIME SOURCE OF INCOME, LIKE LOTTERY OR INHERITANCE, AND WRITE WHERE YOU RECEIVE THE MONEY AND HOW MUCH YOU RECEIVED

CHECK THIS BOX IF YOU HAVE HAD A SIGNIFICANT CHANGE IN INCOME AND STATE WHAT THAT CHANGE WAS

WRITE IN ANY DEDUCTIONS YOU PAID LAST MONTH FOR THE ITEMS LISTED

STATE WHAT YOU HAVE IN YOUR SAVINGS AND CHECKING ACCOUNTS, ANY STOCKS, BONDS, AND/OR REAL/PERSONAL PROPERTY

FILL THIS OUT EXACTLY AS THE INFORMATION APPEARS ON YOUR OTHER DOCUMENTS COURT CASE NUMBER HERE

WRITE DOWN WHO LIVE WITH YOU, THEIR AGE AND RELATION TO YOU, HOW MUCH THEY MAKE BEFORE TAXES, AND WHETHER THEY PAY ANY EXPENSES FOR THE HOME

LIST ALL OF YOUR MONTHLY EXPENSES HERE FOR THE ITEMS LISTED

ADD UP ALL OF THE EXPENSES YOU LISTED FOR A TOTAL TO PUT HERE

WRITE HOW MUCH OF THE EXPENSES ARE PAID BY OTHERS

LIST HERE ANY PAYMENTS YOU ARE MAKING FOR CAR LOANS, STUDENT LOANS, MORTGAGES, CREDIT CARDS, ETC., THE NAME OF THE COMPANY YOU ARE PAYING, HOW MUCH YOU PAY EACH MONTH, WHAT IS STILL OWED, AND THE DATE OF YOUR LAST PAYMENT

FILL THIS OUT EXACTLY AS THE INFORMATION APPEARS ON YOUR OTHER DOCUMENTS COURT CASE NUMBER HERE

FILL OUT THIS PAGE ONLY IF YOU ARE

PAYING CHILD SUPPORT

WRITE IN THE NUMBER OF CHILDREN UNDER 18 YOU ARE/WILL BE PAYING CHILD SUPPORT FOR AND HOW MUCH TIME EACH PARENT SPENDS WITH THEM

CHECK WHETHER YOU DO OR DO NOT HAVE HEALTH INSURANCE FOR THE CHILDREN. IF YOU DO HAVE HEALTH INSURANCE, WRITE IN HOW MUCH YOU PAY, NOT HOW MUCH YOUR EMPLOYER PAYS

WRITE IN ANY OTHER EXPENSES YOU PAY FOR THE CHILDREN

WRITE DOWN ANY EXTREME HARDSHIPS YOU HAVE IN THIS AREA. WRITE DOWN THE AMOUNT AND FOR HOW MANY MONTHS.

FL-141

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

YOUR NAME
YOUR ADDRESS
CITY, STATE, ZIP CODE

TELEPHONE NO.: FAX NO. (Optional): PRELIMINARY is to be

E-MAIL ADDRESS (Optional): completed in the beginning of If you are representing yourself indicate the following: “IN PRO PER” ATTORNEY FOR (Name): your action & is REQUIRED.

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS

STREET ADDRESS:
1100 I STREET
MAILING ADDRESS: P.O. BOX 1098
CITY AND ZIP CODE: MODESTO, CA 95353

BRANCH NAME:
FINAL is NOT required
PETITIONER:
PETITIONER’S NAME AS ON PETITION although may be waived
mutually by both parties.
RESPONDENT: RESPONDENT’S NAME AS ON PETITION

DECLARATION REGARDING SERVICE OF DECLARATION CASE NUMBER:

Select the boxOF DISCLOSURE AND INCOME AND EXPENSE DECLARATION for “You” Petitioner’s Preliminary Respondent’s Final

1. I am the attorney for petitioner respondent in this matter. Select the box for “You”

2. Petitioner’s respondent’s Preliminary Declaration of Disclosure (form FL-140) and current* Income and Expense
   Declaration (form FL-150) were served on attorney for the other party REQUIRED

Date of by: personal service mail other (specify): SELECT THE BOX FOR EITHER THE Service Check to either serve by “MAIL” or by “PERSONAL” service OTHER PARTY OR ATTORNEY on (date): This is the ONLY step in which you may serve the documents 3. Petitioner’s respondent’s Final Declaration of Disclosure (form FL-140) and current Income and Expense Declaration (form FL-150) were served on attorney for the other party Date of by: personal service mail other (sp ecify): Service The Final is NOT required although if your matter is set for “TRIAL” on (date): you must submit within 45 days prior to your “TRIAL”

4. Service of petitioner's respondent's preliminary final declaration of disclosure

Select the current income and expense declaration has been waived as follows: applicable a. The parties agreed to waive final declaration of disclosure requirements under Family Code section 2105(d). The box(es) waiver was filed on (date): b. The party has failed to comply with disclosure requirements and the court granted the request for voluntary waiver of receipt under Family Code section 2107 on (date):

c. This is a default proceeding. Petitioner waives the final declaration disclosure requirements under Family Code

DATE HERE section 2110.

• "Current" is defined as completed within the past three months providing no facts have changed. (Cal. Rules of Court, rule 5.128.)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: PRINT YOUR NAME SIGN HERE

(TYPE OR PRINT NAME) (SIGNATURE)

NOTE: File this document with the court.
Do not file a copy of the Preliminary or Final Declaration of Disclosure or any
attachments to either declaration of disclosure with this document.

Form Adopted for Mandatory Use DECLARATION REGARDING SERVICE OF DECLARATION OF Family Code, §§ 2104, 2105, 2106, Judicial Council of California FL-141 [Rev. July 1, 2011] DISCLOSURE AND INCOME AND EXPENSE DECLARATION www.courts.ca.gov2107, 2112 (Family Law)

FL-140

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

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 PARENT/PARTY:

DECLARATION OF DISCLOSURE CASE NUMBER:
Petitioner's Preliminary
Respondent's Final

DO NOT FILE DECLARATIONS OF DISCLOSURE OR FINANCIAL ATTACHMENTS WITH THE COURT

In a dissolution, legal separation, or nullity action, both a preliminary and a final declaration of disclosure must be served on the other party with certain exceptions. Neither disclosure is filed with the court. Instead, a declaration stating that service of disclosure documents was completed or waived must be filed with the court (see form FL-141). In summary dissolution cases, each spouse or domestic partner must exchange preliminary disclosures as described in Summary Dissolution Information (form FL-810). Final disclosures are not required (see Family Code section 2109). In a default judgment case that is not a stipulated judgment or a judgment based on a marital settlement agreement, only the petitioner is required to complete and serve a preliminary declaration of disclosure. A final disclosure is not required of either party (see Family Code section 2110). Service of preliminary declarations of disclosure may not be waived by an agreement between the parties. Parties who agree to waive final declarations of disclosure must file their written agreement with the court (see form FL-144). The petitioner must serve a preliminary declaration of disclosure at the same time as the Petition or within 60 days of filing the Petition. The respondent must serve a preliminary declaration of disclosure at the same time as the Response or within 60 days of filing the Response. The time periods may be extended by written agreement of the parties or by court order (see Family Code section 2104(f)). Attached are the following:

1. A completed Schedule of Assets and Debts (form FL-142) or A Property Declaration (form FL-160) for (specify):
   Community and Quasi-Community Property Separate Property.

2. A completed Income and Expense Declaration (form FL-150).

3. All tax returns filed by the party in the two years before the date that the party served the disclosure documents.

4. A statement of all material facts and information regarding valuation of all assets that are community property or in which the community has an interest (not a form).

5. A statement of all material facts and information regarding obligations for which the community is liable (not a form).

6. An accurate and complete written disclosure of any investment opportunity, business opportunity, or other income-producing opportunity presented since the date of separation that results from any investment, significant business, or other income - producing opportunity from the date of marriage to the date of separation (not a form).

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:

(TYPE OR PRINT NAME) SIGNATURE

Form Adopted for Mandatory Judicial Council of California Use DECLARATION OF DISCLOSURE Family Code,2105,§§ 2102,2106, 2104,2112 FL-140 [Rev. July 1, 2013] (Family Law) www.courts.ca.gov

THIS FORM SHOULD NOT BE FILED WITH THE COURT FL-142

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NO.:

ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS

PETITIONER:

RESPONDENT:

SCHEDULE OF ASSETS AND DEBTS CASE NUMBER:
Petitioner's Respondent's
— INSTRUCTIONS —

List all your known community and separate assets or debts. Include assets even if they are in the possession of another person, including your spouse. If you contend an asset or debt is separate, put P (for Petitioner) or R (for Respondent) in the first column (separate property) to indicate to whom you contend it belongs.

All values should be as of the date of signing the declaration unless you specify a different valuation date with the description. For additional space, use a continuation sheet numbered to show which item is being continued.

SEP. DATE CURRENT GROSS AMOUNT OF MONEY

ITEM ASSETS DESCRIPTION PROP. ACQUIRED FAIR MARKET OWED OR NO. VALUE ENCUMBRANCE

$ $

1. REAL ESTATE (Give street addresses and attach copies of deeds with legal descriptions and latest lender's statement.)

2. HOUSEHOLD FURNITURE, FURNISHINGS, APPLIANCES (Identify.)

3. JEWELRY, ANTIQUES, ART, COIN COLLECTIONS, etc. (Identify.)

Form Approved for Optional Use SCHEDULE OF ASSETS AND DEBTS Code of Civil Procedure, §§ 2030(c), 2033.5 Judicial Council of California FL-142 [Rev. January 1, 2005] (Family Law)

SEP. DATE CURRENT GROSS AMOUNT OF MONEY ASSETS DESCRIPTION ITEM PROP. ACQUIRED FAIR MARKET OWED OR NO. VALUE ENCUMBRANCE $ $ 4. VEHICLES, BOATS, TRAILERS (Describe and attach copy of title document.)

5. SAVINGS ACCOUNTS (Account name, account number, bank, and branch. Attach copy of latest statement.)

6. CHECKING ACCOUNTS (Account name and number, bank, and branch. Attach copy of latest statement.)

7. CREDIT UNION, OTHER DEPOSIT ACCOUNTS (Account name and number, bank, and branch. Attach copy of latest statement.)

8. CASH (Give location.)

9. TAX REFUND

10. LIFE INSURANCE WITH CASH SURRENDER OR LOAN VALUE (Attach copy of declaration page for each policy.)

FL-142 [Rev. January 1, 2005] SCHEDULE OF ASSETS AND DEBTS Page 2 of 4 (Family Law)

SEP. DATE CURRENT GROSS AMOUNT OF MONEY ITEM ASSETS DESCRIPTION PROP. ACQUIRED FAIR MARKET OWED OR NO. VALUE ENCUMBRANCE $ $ 11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS (Give certificate number and attach copy of the certificate or copy of latest statement.)

12. RETIREMENT AND PENSIONS (Attach copy of latest summary plan documents and latest benefit statement.)

13. PROFIT - SHARING, ANNUITIES, IRAS, DEFERRED COMPENSATION (Attach copy of latest statement.)

14. ACCOUNTS RECEIVABLE AND UNSECURED NOTES (Attach copy of each.)

15. PARTNERSHIPS AND OTHER BUSINESS INTERESTS (Attach copy of most current K-1 form and Schedule C.)

16. OTHER ASSETS

17. TOTAL ASSETS FROM CONTINUATION SHEET

18. TOTAL ASSETS $ $

FL-142 [Rev. January 1, 2005] SCHEDULE OF ASSETS AND DEBTS Page 3 of 4 (Family Law)

ITEM DEBTS—SHOW TO WHOM OWED SEP. TOTAL DATE NO. PROP. OWING INCURRED

$

19. STUDENT LOANS (Give details.)

20. TAXES (Give details.)

21. SUPPORT ARREARAGES (Attach copies of orders and statements.)

22. LOANS—UNSECURED (Give bank name and loan number and attach copy of latest statement.)

23. CREDIT CARDS (Give creditor's name and address and the account number. Attach copy of latest statement.)

24. OTHER DEBTS (Specify):

25. TOTAL DEBTS FROM CONTINUATION SHEET

26. TOTAL DEBTS $

27. (Specify number): pages are attached as continuation sheets.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

FL-142 [Rev. January 1, 2005] SCHEDULE OF ASSETS AND DEBTS Page 4 of 4 (Family Law)

FL-150 PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY

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 STANISLAUS STREET ADDRESS: 1100 I STREET MAILING ADDRESS: P.O. BOX 1098 CITY AND ZIP CODE: MODESTO, CA 95353 BRANCH NAME: PETITIONER: RESPONDENT: OTHER PARTY/PARENT/CLAIMANT: INCOME AND EXPENSE DECLARATION CASE NUMBER:

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

Attach copies a. Employer: of your pay b. Employer's address: stubs for last c. Employer's phone number: two months d. Occupation: (black out e. Date job started: Social f. If unemployed, date job ended: Security g. I work about hours per week. numbers). 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 No If no, highest grade completed (specify): c. Number of years of college completed (specify): Degree(s) obtained (specify): d. Number of years of graduate school completed (specify): Degree(s) obtained (specify): e. I have: professional/occupational license(s) (specify): vocational training (specify):

3. Tax information a. I last filed taxes for tax year (specify year): b. My tax filing status is single head of household married, filing separately married, filing jointly with (specify name): c. 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)

Form Adopted for Mandatory Use INCOME AND EXPENSE DECLARATION Family Code, §§ 2030–2032, 2100–2113, Judicial Council of California 3552, 3620–3634, 4050–4076, 4300–4339 FL-150 [Rev. January 1, 2019] www.courts.ca.gov

FL-150 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARTY/PARENT/CLAIMANT:

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) ........................................................................................................................................................... $ c. Commissions or bonuses .........................................................................................................................................................................$ d. Public assistance (for example: TANF, SSI, GA/GR) currently receiving .............................................$ e. Spousal support from this marriage from a different marriage federally taxable* $ f. Partner support from this domestic partnership from a different domestic partnership $ g. Pension/retirement fund payments ...................................................................................................................................................$ h. Social Security retirement (not SSI) .................................................................................................................................................$ i. Disability: Social Security (not SSI) State disability (SDI) Private insurance $ j. Unemployment compensation ...............................................................................................................................................................$ k. Workers' compensation .............................................................................................................................................................................$ l. 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 Last month 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 Total 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)

• 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: CASE NUMBER: RESPONDENT: OTHER PARTY/PARENT/CLAIMANT:

12. The following people live with me: 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 b. Yes No c. Yes No d. Yes No e. Yes No 13. Average monthly expenses Estimated expenses Actual expenses Proposed needs a. Home: h. Laundry and cleaning .............................................$ (1) Rent or mortgage ..................$ i. Clothes ............................................................................$ If mortgage: j. Education ..........................................................................$ (a) average principal: $ k. Entertainment, gifts, and vacation ................$ (b) average interest: $ l. Auto expenses and transportation (2) Real property taxes ......................................$ (insurance, gas, repairs, bus, etc.) ..............$ (3) Homeowner's or renter's insurance m. Insurance (life, accident, etc.; do not include (if not included above) ...............................$ auto, home, or health insurance) $ (4) Maintenance and repair .............................$ n. Savings and investments ....................................$ b. Health-care costs not paid by insurance .... $ o. Charitable contributions ......................................$ c. Child care .......................................................................$ p. Monthly payments listed in item 14 d. Groceries and household supplies ...............$ (itemize below in 14 and insert total here) $ e. Eating out .......................................................................$ q. Other (specify): ........................................................$ f. Utilities (gas, electric, water, trash) ...........$ g. Telephone, cell phone, and e-mail ...............$ r. TOTAL EXPENSES (a-q) (do not add in the amounts in a(1)(a) and (b)) $

s. Amount of expenses paid by others $

14. Installment payments and debts not listed above Paid to For Amount Balance Date of last payment $ $ $ $ $ $ $ $ $ $ $ $

15. Attorney fees (This 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: CASE NUMBER: RESPONDENT: OTHER PARTY/PARENT/CLAIMANT:

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 expenses for the children in this case Amount per month a. Child care 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) ....................................................................................................................................................... $

    c. (1) Expenses for my minor children who are from other relationships and 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 Page 4 of 4

FL-141

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

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 PARENT/PARTY:

DECLARATION REGARDING SERVICE OF DECLARATION OF CASE NUMBER:
DISCLOSURE AND INCOME AND EXPENSE DECLARATION
Petitioner's Preliminary
Respondent's Final

1. I am the attorney for petitioner respondent in this matter.

2. Petitioner's Respondent's Preliminary Declaration of Disclosure (form FL-140), current* Income and Expense

   Declaration (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community and Separate Property Declarations (form FL-160) with appropriate attachments, all tax returns filed by the party in the two years before service of the preliminary disclosures, and all other required information under Family Code section 2104 were served on: the other party the other party's attorney by personal service mail Other (specify): on (date):

3. Petitioner's Respondent's Final Declaration of Disclosure (form FL-140), current* Income and Expense Declaration

   (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community or Separate Property Declarations (form FL-160) with attachments, and the material facts and information required by Family Code section 2105 were served on:

   the other party other party's attorney by personal service mail
   Other (specify):

   on (date):

4. Service of Petitioner's Respondent's preliminary final declaration of disclosure
   current income and expense declaration has been waived as follows:

   a. The parties agreed to waive final declaration of disclosure requirements under Family Code section 2105(d.) (Form FL-144 may be used for this purpose.) The waiver was filed on (date): is being filed at the same time as this form. b. The party has failed to comply with disclosure requirements, and the court has granted the request for voluntary waiver of receipt under Family Code section 2107 on (date): c. This is a default proceeding that does not include a stipulated judgment or settlement agreement. Petitioner waives final disclosure requirements under Family Code section 2110.

*Current is defined as completed within the past three months providing no facts have changed. (Cal. Rules of Court, rule 5.260.)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:

SIGNATURE (TYPE OR PRINT NAME)

NOTE: File this document with the court. Do not file a copy of the Preliminary or Final Declaration of Disclosure or any attachments to either declaration of disclosure with this document.

Form Adopted for Mandatory Use DECLARATION REGARDING SERVICE OF DECLARATION OF Family Code, §§ 2102, 2104, Judicial Council of California 2105, 2106, 2112 FL-141 [Rev. July 1, 2013] DISCLOSURE AND INCOME AND EXPENSE DECLARATION www.courts.ca.gov (Family Law)