Fresno — Response to Request for Order

Source: https://www.fresno.courts.ca.gov/system/files/forms-and-filings/response-request-order_1.pdf

Sparse pages use OCR; original PDF remains authoritative.

Instructions for Responding to Request for Order WHEN TO USE THIS PACKET Use this packet if you want to respond to “Request for Order” paperwork that was served on you. If you have an existing case, the Petitioner and Respondent never change; the Petitioner is the person who started the case in the beginning and will remain as the petitioner. There is a filing fee to file the enclosed forms, unless you are eligible for a “Fee Waiver” which is available as a separate packet. STEPS TO RESPOND:

1. The following forms in this packet are to be completed. Please refer to FL-320 INFO to know which exact forms you will need in your case. L] Responsive Declaration to Request for Order FL-320 L] Attached Declaration MC-031 CJ Declaration under Uniform Child Custody Jurisdiction Act FL-105 LI Income and Expense Declaration FL-150 L] Proof of Service by Mail FL-335
2. You will need to make at least 2 additional copies of each form you fill out and any attachments you are including. One copy will be for you; another copy will be for the other party. The original is for the court.
3. One copy of the forms will need to be served to the other parent.
4. The server must complete and sign the “Proof of Service by Mail.”
5. File your Responsive Declaration paperwork and the proof of service. NOTE: You have a certain amount of days to respond to the other party’s request. You can check for the specific time frame on page 1 of FL-300 that was served to you. Revised 7/3/2025

aeXyitE i iae@h Information Sheet: Responsive Declaration to Request for Order (4) If you received a Request for Order (form FL-300): Carefully read the papers you received to make sure you understand what orders are being requested. Note the date, time, and location of the court hearing. Check to see if the court ordered a specific date for filing and serving your Responsive Declaration to Request for Order (form FL-320). If you need more time before the hearing to prepare a responsive declaration or talk with a lawyer, you may ask the court to continue the hearing date. For more information, consult with a lawyer or contact the the Family Law Facilitator or Self-Help Center in your court (see item (8)). (2) USE Responsive Declaration to Request for Order (form FL-320) Use form FL-320 to let the court and the other party know that you agree or disagree with each of the requests made in the Request for Order (form FL-300). e If you disagree, use form FL-320 to describe the orders you would like the court to make. If you do not file and serve form FL-320, the court can still make orders without your input. (3) DO NOT USE Responsive Declaration to Request for Order (form FL-320) to: Ask for court orders that were not requested in the Request for Order (form FL-300). Instead, file and serve your own Request for Order (form FL-300) to ask for orders about other issues. Respond to Request for Domestic Violence Restraining Order (form DV-100). Instead, you must use Response to Request for Domestic Restraining Order (form DV-120). Respond to Request to Change or End Restraining Order (form DV-300 or form JV-255 when the juvenile case is closed and the order was granted under the Domestic Violence Prevention Act). Instead, you must use Response to Request to End or Change Restraining Order (form DV-320). (4) Forms checklist a. Form FL-320, Responsive Declaration to Request for Order, is the basic form you need. Depending on the requests made in the Request for Order (form FL-300), you may need other forms. For child custody or visitation (parenting time) orders, you may need to complete some of these forms: (] FL-105, Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (-] FL-311, Child Custody and Visitation (Parenting Time) Application Attachment DIE 2, Request for Child Abduction Prevention Orders (] FL-341(C), Children’s Holiday Schedule Attachment ( FL-341(D), Additional Provisions—Physical Custody Attachment For child support, you need: (J A current form FL-150, Income and Expense Declaration. You may use form FL-155, Financial Statement (Simplified), instead of form FL-150 if you meet the requirements listed on page 2 of form FL-155. Notice: * The court will order child support based on the income of the parents.

• Child support normally continues until the child is 18 years and has graduated from high school.
• You must give the court information about your finances. If you do not, the child support order will be based on information about your income that the court receives from other sources. For spousal or domestic partner support or orders about your finances, you need these forms: (J FL-150, Income and Expense Declaration (] FL-157, Spousal or Parmer Support Declaration Attachment (if the request is to change a support judgment) For attorney’s fees and costs, you need these forms (except in Domestic Violence Prevention Act cases): (] FL-150, Income and Expense Declaration C] Fl 3, Supporting Declaration for Attorney's Fees and Costs (or provide the information in a declaration) (] FL-319, Request for Attorney’s Fees and Costs Attachment (or provide the information in a declaration) If you plan on having witnesses testify at the hearing. you need this form: (J FL-321, Witness List Ju Form Approved for Optional Use Information Sheet: Responsive Declaration to FL-320-INFO, Page 1 of 3 ial Council of California ca.gov Request for Order > (Family Law)

abexyite|\ix@) Information Sheet: Responsive Declaration to Request for Order To respond to a Request for Order, you must: Complete the top part (caption) of the form Complete the top portion including your name, address, and telephone number, the court address, the names of all the parties in the case, and the case number. Also, print or type the same hearing date, time, and department that appears on the Request for Order (form FL-300). (6) Specify a response to orders requested Items 1-8: Each item on the form matches the item numbers on the Request for Order (form FL-300). Complete item 1. Next, mark the same box that is marked on form FL-300. Then, specify if you consent (agree) or do not consent to (disagree with) the orders requested. If you disagree, describe the order you would like the court to make. Note: You may file one form FL-150 to respond to items 3, 4, and 6. Item 9: Use the space to explain your responses to items 1-8. Include the reasons why you do not agree with the orders requested by the other party and why the court should make the orders you described. If you need more space, write your responses on a separate sheet of paper and attach it to the form (Attached Declaration (form MC-031) may be used for this purpose). Sign and date: Print your name, sign, and write the date you signed form FL-320. (7) Next steps: file or serve your paperwork You must file your paperwork with the court clerk at least 9 court days before the hearing. If the court orders a shorter time to file your papers, file them by the date specified in the order. Make 2 copies of your original paperwork. Then, do one of the following before the filing deadline: « Take your paperwork and copies to the court clerk to process (or e-file them, if available in your county). The clerk will keep the original and give you back copies with a court stamp on them. Have a stamped copy served; or

• Have an unstamped copy of your paperwork served before you take (or e-file) the originals and copies to the court clerk to file. Be sure the original documents are not served. L320 ere err Tin Gar ae row counrvae omy JRF OF CALIFORNIA, COUNTY OF PETITIONER: RESPONDENT: OTHER PARENTIPARTY: RESPONSIVE DECLARATION TO REQUEST FOR ORDER Read information Sheet, Responsive Decleration fo Request for Order (fom §:1-420.1NEO) for mare information about this form

1. [COL RESTRAINING ORDER INFORMATION 8 Lo] No domestc violence restrainngiprotective orders are now in effect between the parties in this case. bo. [=] 1 egtee that one oF mote domestic violence restraining/protective orders are now in effect between the parties in tris case. (2 cuito custopy [5 WisITATION (PARENTING TIME) 8 LJ I consentto the order requested for child custody (legal and physical custody). b [EJ | consent tothe order requested for visitation (parenting time. 1c. [J fdenct consent to te order requested for [_] tit custody) visita but consent to the folowing order: tie o [ cHito support

2. Thave completed and filed a curent income and Expense Decteraton (orm #1 180) or, if eligible, a euent Finavicial ‘Statement (Simpitied) (tom FL-155) to support my responsive declaration b. [2] teonsentto the order requested. ¢ [E] ! consent fo guidatine support 4, [=] f do not consent tothe order requested [—] but! consent tothe folowing order 4, [£2] SPOUSAL OR DOMESTIC PARTNER SUPPORT ‘2 T have completed and fled a current Income and Expense Declaration {totm =1.1%1}) to support my responsive deciaration ©. [7 Neonsentto the order requested, &. [J | donot consantta tha order requested [("] but | consentto the folowing order RESPONSIVE DECLARATION TO REQUEST FOR ORDER Pay filing fees Generally, you do not have to pay a fee to file the Responsive Declaration. However, if you have never filed any papers in the case, you may have to pay a “first appearance fee,” which, in general, everyone has to pay when filing court papers in a case for the first time. If you cannot afford to pay the filing fee, you can ask the court to waive the fees. To do so, complete and file form FW-001, Request to Waive Court Fees, and form FW-003, Order on Court Fee Waiver. (9) Serve your papers on the other party “Service” is the act of giving your legal papers to all persons named as parties in the case so that they know what orders you want the court to make. Note: If a party has a lawyer in the case, the papers should be served on that party’s lawyer. Rev. July 1, 2025 Information Sheet: Responsive Declaration to FL-320-INFO, Page 2 of 3 Request for Order > (Family Law)

ix ylIeit@8 Information Sheet: Responsive Declaration to Request for Order How to “serve” Server. You cannot serve the papers. Have someone else (who is at least 18 years old) do it. The “server” can be a friend, a relative who is not involved in your case, a county sheriff, or a professional process server. aaa — Personal service. = aN Your papers may be (¢ =i ey } . Snare IWF Je eK served by “personal AN As mon service.” Personal fy as kh &_) | service means that ima) 7 L as FT your server walks up to each person to be served, makes sure they are the right person, and then gives a copy of all the papers to each person. and mails them to the address of each party ; being served (or to the party’s lawyer, if applicable.) The server must be 18 years of age or over and must live or work in the county where the mailing took place. Service by mail. “Service by mail” means that your server places copies of all the documents in a sealed envelope US. MAIL Deadline for service Personal service or service by mail on the other party must be completed at least 9 court days before the court hearing. If the court has ordered a shorter time to serve your responsive papers, be sure to have them served by the date specified in the court order. Server must complete a Proof of Service After personal service, the server should complete a form FL-330, Proof of Personal Service. Form FO, Information Sheet for Proof of Personal Service, has instructions to help the person complete the form. After service by mail, the server should complete form FL-335, Proof of Service by Mail. Form FL-335-INFO, Information Sheet for Proof of Service by Mail, has instructions to help the person complete the form. File the Proof of Service before your hearing date The Proof of Service shows the judge that the person received a copy of your Responsive Declaration to Request for Order. Make three copies of the completed Proof of Service. Take the original and copies to the court clerk as soon as possible before your hearing. The clerk will keep the original and give you back the copies stamped “Filed.” Bring a copy stamped “Filed” to your hearing. (If unstamped copies of your paperwork were served, you can file the completed Proof of Service when you file the original Responsive Declaration.) Participate in child custody mediation or child custody recommending counseling If the Request for Order includes a court order for you to attend mediation or child custody recommending counseling, the date, time, and location is found on page | of the Request for Order. For more information, read Child Custody FL-314-INFO). Get ready for your hearing « Take at least two copies of your documents and filed forms to the hearing. Include a filed Proof of Service form.

• Find more information about preparing for the hearing at the following web link: selfhelp.courts.ca.gov/tips-your-day-court. Still have questions or need help?
• Contact the Family Law Facilitator or Self-Help Center for information, local rules, and referrals to local legal services providers. Go to selfhelp.courts.ca.gov/court-based-self-help- services. « Talk to a lawyer if you want legal advice. someone to go to court with you, or other legal help. Find an attorney through your local bar association, the State Bar of California at www.calbar.ca.gov, or the Lawyer Referral Service at 1-866-442-2529. For free and low-cost legal help (if you qualify), go to www.lawhelpcalifornia.org. Rev. July 1, 2025 Information Sheet: Responsive Declaration to FL-320-INFO, Page 3 of 3 Request for Order (Family Law)

FORM INSTRUCTIONS PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY eye vame YOUR NAME streetaol YOUR ADDRESS SAM PLE ow CITY, STATE, ZIPCODE = |S 2omms emai anopte¥ OUR TELEPHONE NUMBER ON LY ATTORNEY FOR (name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF |Fresno DO N OT STREET ADDRESS Fresno County Superior Court sererens: 13300" street WRITE ON erancHname, {Fresno CA 93724-2220 PETITIONER: PARTY WHO INITIALLY OPENED CASE TH IS CO PY 1 RESPONDENT: |THE OTHER PARTY OTHER PARENT/PARTY: RESPONSIVE DECLARATION TO REQUEST FOR ORDER CASE NUMBER HEARING DATE TIME DEPARTMENT OR ROOM [COURT CASE NUMBER| FL-320 Read Information Sheet: Responsive Declaration to Request for Order (form FL-320-INEO) for more information about this form

1. [-] RESTRAINING ORDER INFORMATION a. [__] No domestic violence restraining/protective orders are now in effect between the parties in this case. b. [-] | agree that one or more domestic violence restraining/protective orders are now in effect between the parties in this case. {2 [-]\CHILD CUSTODY \ SITATION (PARENTING TIME) sent to the order requested for visitation (parenting time). t consent to the order requested for [-] child custody [__] visitation (parenting time) FOLLOW THE NUMBERS THE OTHER PARTY MARKED ON THE FL-300, AND CHECK WHETHER YOU AGREE 5 1 45 1 3 2 997 1327 48 25 95.277031 OR 5 1 45 1 3 3 1057 1327 186 25 95.277031 DISAGREE WITH WHAT THE OTHER PARTY HAS REQUESTED
2. [|)CHILD SUPPORT IF YOU DISAGREE, TELL THE COURT WHAT YOU WANT -~Thave completed and filed a current Income and Expense Declaration (form FL-150) &r, if eligible, a current Financial Statement (Simplified) (form FL-155) to support my responsive declaration. b. [__] | consent to the order requested. c. [-] I consent to guideline support. d. [-_] | do not consent to the order requested [| but! consent to the following order:
3. [-] SPOUSAL OR DOMESTIC PARTNER SUPPORT a. | have completed and filed a current Income and Expense Declaration (form FL-150) to support my responsive declaration. b. [-] I consent to the order requested. c. [] | do not consent to the order requested [_| but! consent to the following order:

Form Adopted for Mandatory Use RESPONSIVE DECLARATION TO REQUEST FOR ORDER Code of Civil Procedure, § 1005 Judicial Council of California Cal. Rules of Court, rule 5.92 FL-320 [Rev. July 1, 2025] courts.ca.aov

FL-320 RESPONDENT:|THE OTHER PARTY OTHER PARENT/PARTY: [COURT CASE NUMBER| PETITIONER/PARTY WHO INITIALLY OPENED CASE CASE NUMBER 5. [] PROPERTY CONTROL a. [] | consent to the order requested. b. [_] | donot consent to the order requested [—] but! consent to the following order: =) TTORNEY'S FEES AND COSTS eT hav leted and filed a current Income and Expense Declaration (form FL-150 ) to support my responsive declaration. b. [have completed and fi declaration that addresses ° | consent to the orde, FOLLOW THE NUMBERS THE OTHER PARTY MARKED ON THE FL-300, d\ =] sent to t AND CHECK WHETHER YOU — “AGREE OR DISAGREE" WITH WHAT THE OTHER PARTY HAS REQUESTED G. BER onoens reat IF YOU DISAGREE, TELL THE COURT WHAT YOU WANT ar fT | consent to the order requested. b. | do not consent to the order requested {-] but I consent to the following order: J 8. [| TIME FOR SERVICE / TIME UNTIL HEARING a. | consent to the order requested b. | do not consent to the order requested but | consent to the following order: longer than 10 pages, unless the court gives me permission. Attachment_9. 9.(C))racts TO SUPPORT my responsive declaration are listed below. The facts that | write and attach Crepe cannot be a TELL THE COURT WHY THE LISTED REQUEST OF THE OTHER PARTY SHOULD NOT BE GRANTED EXPLAIN WHY YOU WANT WHAT YOU ARE ASKING FOR AND PROVIDE FACTS AND/OR EVIDENCE TO SUPPORT YOUR REQUEST IF YOU NEED ADDITIONAL SPACE, YOU MAY ATTACH FORM MC-031

| declare under penalty of perjury under the laws of the State of California that the information provided in this form and all attachments

is true and correct. Date: | TODAY'S DATE [ PRINT YOUR NAME HERE | > [SIGN YOUR NAME HERE | (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) FL-820 (Rev. July 1, 2025] RESPONSIVE DECLARATION TO REQUEST FOR ORDER Page 2 of 2

MC-031 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: PARTY WHO INITIALLY OPENED CASE THE OTHER PARTY CASE NUMBER: [COURT CASE NUMBER] DECLARATION (This form must be attached to another form or court paper before it can be filed in court.) BRIEFLY EXPLAIN YOUR REQUEST BASED ON WHAT BOX YOU CHECKED ON THE FL-320

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

Date: |TODAY'S DATE [PRINT YOUR NAME HERE | [ SIGN YOUR NAME HERE | (TYPE OR PRINT NAME) i | Attorney for i | Respondent (SIGNATURE OF DECLARANT) CC) Plaintit © [C) Petitioner [J Defendant (] other (Specify): Form Approved for Optional Use (E[*| Essential Judicial Council of California MC-031 [Rev. July 1, 2005] cebcom | {2)Forms- ATTACHED DECLARATION

FORM INSTRUCTIONS FL-105/GC-120 ATTORNEY OR PARTY WITHOUT ATTORNEY NAME; FIRM NAME: street aoored YOUR ADDRESS CITY: TELEPHONE NO. ewaiaopress|¥ OUR TELEPHONE NUMBER P YOUR NAME CITY, STATE, ZIP CODE F ATTORNEY FOR (name). STATE BAR NUMBER: ZIP CODE: FOR COURT USE ONLY SAMPLE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: Fresno County Superior Court 1130 O Street Fresno CA 93724-2220 DO NOT WRITE ON PETITIONER: RESPONDENT: (This section applies to cases other than probate guardianships.) THE OTHER PARTY PARTY WHO INITIALLY OPENED CASE OTHER PARTY: CHILD'S NAME (Juvenile cases only): THIS COPY! (This section applies only to probate guard GUARDIANSHIP OF (name): LT EAVE BLANK CHECK THE APPROPRIATE BOX CASE NUMBER: ( Minor DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) [COURT CASE NUMBER]

1. lam (check one): [[] a party to this proceeding to determine custody of a child [] the authorized representative of the | WRITE IN THE NUMBER OF CHILDREN minor children who are subject to this proceeding, as follows (list oldest child first): There are (specify number):

• proceeding to determine custody of a child. Full Name Date of birth Place of birth (city and state) a. [OLDEST CHILD'S NAME | [MMIDD/YYYY | __|[CITY & STATE WHERE CHILD WAS BORN | b. [NEXT OLDEST CHILD'S NAME] [MM/DDIYYYY | _|LC!TY & STATE WHERE CHILD WAS BORN | c. [NEXT OLDEST CHILD'S NAME] [MM/DD/YYYY | _|[CITY & STATE WHERE CHILD WAS BORN | d. [NEXT OLDEST CHILD'S NAME] [MM/DD/YYYY | |[CITY & STATE WHERE CHILD WAS BORN | (}€nackthis box you rs CHECK THIS BOX IF Additional Children” at} APPLICABLE lailad if oll o£ the Jailed lorm MC-020 or a separate piece of paper, write FL-105, 5 1 107 1 1 11 1412 1310 121 18 96.095886 Attachment 5 1 107 1 1 12 1539 1310 16 21 97.014030 2, 4 1 107 1 2 0 813 1339 626 22 -1 5 1 107 1 2 1 813 1342 111 18 95.221085 information 5 1 107 1 2 2 933 1341 29 18 95.976471 for 5 1 107 1 2 3 968 1341 50 18 96.698013 each 5 1 107 1 2 4 1027 1340 102 19 95.836533 additional 5 1 107 1 2 5 1135 1340 52 21 96.882629 child, 5 1 107 1 2 6 1198 1340 39 18 96.953094 and 5 1 107 1 2 7 1243 1340 63 18 96.985298 attach 5 1 107 1 2 8 1315 1340 18 17 96.891335 to 5 1 107 1 2 9 1342 1339 36 18 96.959084 this 5 1 107 1 2 10 1385 1339 54 22 96.426559 form.) 2 1 108 0 0 0 931 1382 605 60 -1 3 1 108 1 0 0 931 1382 605 60 -1 4 1 108 1 1 0 944 1382 592 25 -1 5 1 108 1 1 1 944 1385 53 17 96.901978 listed 5 1 108 1 1 2 1007 1384 15 18 96.713020 in 5 1 108 1 1 3 1032 1384 42 18 96.713020 item 5 1 108 1 1 4 1083 1384 11 18 96.811882 2 5 1 108 1 1 5 1104 1384 49 17 96.822594 have 5 1 108 1 1 6 1163 1383 45 18 96.866074 lived 5 1 108 1 1 7 1217 1383 86 23 96.745262 together 5 1 108 1 1 8 1310 1383 28 17 96.965134 for 5 1 108 1 1 9 1345 1382 32 18 96.914787 the 5 1 108 1 1 10 1386 1383 36 22 96.862907 past 5 1 108 1 1 11 1429 1382 36 18 96.970070 five 5 1 108 1 1 12 1473 1387 63 20 96.803612 years. 4 1 108 1 2 0 931 1418 564 24 -1 5 1 108 1 2 1 931 1420 103 18 96.524467 residence 5 1 108 1 2 2 1042 1420 70 22 96.956055 history 5 1 108 1 2 3 1119 1419 29 18 96.829079 for 5 1 108 1 2 4 1154 1419 31 18 96.829079 the 5 1 108 1 2 5 1192 1419 46 22 96.978546 past 5 1 108 1 2 6 1245 1418 39 18 96.924667 five 5 1 108 1 2 7 1291 1423 68 18 96.897278 years. 5 1 108 1 2 8 1369 1418 15 18 95.617928 If 5 1 108 1 2 9 1388 1418 26 18 94.593674 the 5 1 108 1 2 10 1421 1418 74 17 94.593674 current 2 1 109 0 0 0 925 1390 3 76 -1 3 1 109 1 0 0 925 1390 3 76 -1 4 1 109 1 1 0 925 1390 3 76 -1 5 1 109 1 1 1 925 1390 3 76 95.000000 2 1 110 0 0 0 640 1458 289 7 -1 3 1 110 1 0 0 640 1458 289 7 -1 4 1 110 1 1 0 640 1458 289 7 -1 5 1 110 1 1 1 640 1458 289 7 95.000000 2 1 111 0 0 0 148 1381 755 72 -1 3 1 111 1 0 0 148 1381 755 72 -1 4 1 111 1 1 0 148 1381 755 63 -1 5 1 111 1 1 1 148 1389 17 17 70.867867 3. 5 1 111 1 1 2 187 1393 17 13 70.867867 a. 5 1 111 1 1 3 221 1381 132 63 0.000000 [_beneck 5 1 111 1 1 4 362 1381 38 63 46.958389 this 5 1 111 1 1 5 410 1381 32 63 79.965515 box 5 1 111 1 1 6 462 1381 59 63 33.109737 there 5 1 111 1 1 7 530 1381 17 63 44.065128 is 5 1 111 1 1 8 557 1381 42 63 64.874710 oy 5 1 111 1 1 9 609 1381 131 63 44.707581 OMICHECK 5 1 111 1 1 10 748 1401 59 20 96.621101 THIS 5 1 111 1 1 11 818 1401 55 20 94.367004 BOX 5 1 111 1 1 12 882 1400 21 20 96.169174 IF 4 1 111 1 2 0 227 1422 588 31 -1 5 1 111 1 2 1 227 1423 87 23 96.143272 (Provide 5 1 111 1 2 2 323 1423 32 18 96.143272 the 5 1 111 1 2 3 363 1423 74 18 96.726837 current 5 1 111 1 2 4 444 1423 84 17 96.562431 address 5 1 111 1 2 5 631 1422 2 2 35.207642 h 5 1 111 1 2 6 646 1433 169 20 91.124672 APPLICABLE 2 1 112 0 0 0 186 1945 17 18 -1 3 1 112 1 0 0 186 1945 17 18 -1 4 1 112 1 1 0 186 1945 17 18 -1 5 1 112 1 1 1 186 1945 17 18 92.440971 b. 2 1 113 0 0 0 640 1391 3 77 -1 3 1 113 1 0 0 640 1391 3 77 -1 4 1 113 1 1 0 640 1391 3 77 -1 5 1 113 1 1 1 640 1391 3 77 95.000000 2 1 114 0 0 0 227 1450 413 23 -1 3 1 114 1 0 0 227 1450 413 23 -1 4 1 114 1 1 0 227 1450 413 23 -1 5 1 114 1 1 1 227 1453 83 17 77.478661 address 5 1 114 1 1 2 318 1452 17 18 96.804581 is 5 1 114 1 1 3 343 1452 121 18 96.850021 confidential 5 1 114 1 1 4 471 1451 62 18 96.477661 under 5 1 114 1 1 5 539 1451 70 22 96.965126 Family 5 1 114 1 1 6 617 1450 23 19 86.895996 Co 2 1 115 0 0 0 938 1447 465 24 -1 3 1 115 1 0 0 938 1447 465 24 -1 4 1 115 1 1 0 938 1447 465 24 -1 5 1 115 1 1 1 938 1449 38 18 96.709740 box 5 1 115 1 1 2 984 1449 39 17 96.715599 and 5 1 115 1 1 3 1029 1448 78 23 96.932823 provide 5 1 115 1 1 4 1115 1448 44 22 96.781464 only 5 1 115 1 1 5 1166 1448 31 17 96.976875 the 5 1 115 1 1 6 1205 1448 50 17 97.011993 state 5 1 115 1 1 7 1263 1447 22 18 96.992188 of 5 1 115 1 1 8 1289 1447 114 22 96.450027 residence.) 2 1 116 0 0 0 225 1472 1351 17 -1 3 1 116 1 0 0 225 1472 1351 17 -1 4 1 116 1 1 0 225 1472 1351 17 -1 5 1 116 1 1 1 225 1472 1351 17 95.000000 2 1 117 0 0 0 2

ovide 5 1 115 1 1 4 1115 1448 44 22 96.781464 only 5 1 115 1 1 5 1166 1448 31 17 96.976875 the 5 1 115 1 1 6 1205 1448 50 17 97.011993 state 5 1 115 1 1 7 1263 1447 22 18 96.992188 of 5 1 115 1 1 8 1289 1447 114 22 96.450027 residence.) 2 1 116 0 0 0 225 1472 1351 17 -1 3 1 116 1 0 0 225 1472 1351 17 -1 4 1 116 1 1 0 225 1472 1351 17 -1 5 1 116 1 1 1 225 1472 1351 17 95.000000 2 1 117 0 0 0 224 1539 1352 17 -1 3 1 117 1 0 0 224 1539 1352 17 -1 4 1 117 1 1 0 224 1539 1352 17 -1 5 1 117 1 1 1 224 1539 1352 17 95.000000 2 1 118 0 0 0 229 1588 337 5 -1 3 1 118 1 0 0 229 1588 337 5 -1 4 1 118 1 1 0 229 1588 337 5 -1 5 1 118 1 1 1 229 1588 337 5 95.000000 2 1 119 0 0 0 607 1549 2 66 -1 3 1 119 1 0 0 607 1549 2 66 -1 4 1 119 1 1 0 607 1549 2 66 -1 5 1 119 1 1 1 607 1549 2 66 95.000000 2 1 120 0 0 0 940 1547 2 62 -1 3 1 120 1 0 0 940 1547 2 62 -1 4 1 120 1 1 0 940 1547 2 62 -1 5 1 120 1 1 1 940 1547 2 62 95.000000 2 1 121 0 0 0 1323 1544 2 63 -1 3 1 121 1 0 0 1323 1544 2 63 -1 4 1 121 1 1 0 1323 1544 2 63 -1 5 1 121 1 1 1 1323 1544 2 63 95.000000 2 1 122 0 0 0 581 1600 744 17 -1 3 1 122 1 0 0 581 1600 744 17 -1 4 1 122 1 1 0 581 1600 744 17 -1 5 1 122 1 1 1 581 1600 744 17 95.000000 2 1 123 0 0 0 229 1623 336 5 -1 3 1 123 1 0 0 229 1623 336 5 -1 4 1 123 1 1 0 229 1623 336 5 -1 5 1 123 1 1 1 229 1623 336 5 95.000000 2 1 124 0 0 0 945 1629 632 9 -1 3 1 124 1 0 0 945 1629 632 9 -1 4 1 124 1 1 0 945 1629 632 9 -1 5 1 124 1 1 1 945 1629 632 9 95.000000 2 1 125 0 0 0 224 1631 1353 17 -1 3 1 125 1 0 0 224 1631 1353 17 -1 4 1 125 1 1 0 224 1631 1353 17 -1 5 1 125 1 1 1 224 1631 1353 17 95.000000 2 1 126 0 0 0 1364 1658 190 3 -1 3 1 126 1 0 0 1364 1658 190 3 -1 4 1 126 1 1 0 1364 1658 190 3 -1 5 1 126 1 1 1 1364 1658 190 3 95.000000 2 1 127 0 0 0 618 1661 699 8 -1 3 1 127 1 0 0 618 1661 699 8 -1 4 1 127 1 1 0 618 1661 699 8 -1 5 1 127 1 1 1 618 1661 699 8 95.000000 2 1 128 0 0 0 247 1680 310 7 -1 3 1 128 1 0 0 247 1680 310 7 -1 4 1 128 1 1 0 247 1680 310 7 -1 5 1 128 1 1 1 247 1680 310 7 95.000000 2 1 129 0 0 0 555 1705 65 1 -1 3 1 129 1 0 0 555 1705 65 1 -1 4 1 129 1 1 0 555 1705 65 1 -1 5 1 129 1 1 1 555 1705 65 1 95.000000 2 1 130 0 0 0 555 1769 65 1 -1 3 1 130 1 0 0 555 1769 65 1 -1 4 1 130 1 1 0 555 1769 65 1 -1 5 1 130 1 1 1 555 1769 65 1 95.000000 2 1 131 0 0 0 555 1833 65 1 -1 3 1 131 1 0 0 555 1833 65 1 -1 4 1 131 1 1 0 555 1833 65 1 -1 5 1 131 1 1 1 555 1833 65 1 95.000000 2 1 132 0 0 0 617 1664 4 206 -1 3 1 132 1 0 0 617 1664 4 206 -1 4 1 132 1 1 0 617 1664 4 206 -1 5 1 132 1 1 1 617 1664 4 206 95.000000 2 1 133 0 0 0 888 1703 73 1 -1 3 1 133 1 0 0 888 1703 73 1 -1 4 1 133 1 1 0 888 1703 73 1 -1 5 1 133 1 1 1 888 1703 73 1 95.000000 2 1 134 0 0 0 887 1766 75 2 -1 3 1 134 1 0 0 887 1766 75 2 -1 4 1 134 1 1 0 887 1766 75 2 -1 5 1 134 1 1 1 887 1766 75 2 95.000000 2 1 135 0 0 0 888 1830 73 2 -1 3 1 135 1 0 0 888 1830 73 2 -1 4 1 135 1 1 0 888 1830 73 2 -1 5 1 135 1 1 1 888 1830 73 2 95.000000 2 1 136 0 0 0 222 1488 1354 376 -1 3 1 136 1 0 0 225 1488 1351 372 -1 4 1 136 1 1 0 293 1488 1218 31 -1 5 1 136 1 1 1 293 1493 63 17 96.220535 Dates 5 1 136 1 1 2 365 1492 22 18 96.812233 of 5 1 136 1 1 3 395 1492 109 18 96.440681 residence 5 1 136 1 1 4 694 1490 119 18 96.549278 Residence 5 1 136 1 1 5 987 1489 77 18 95.801781 Person 5 1 136 1 1 6 1074 1488 53 18 96.817398 child 5 1 136 1 1 7 1137 1488 52 18 96.804001 lived 5 1 136 1 1 8 1197 1488 45 17 96.743340 with 5 1 136 1 1 9 1251 1488 39 17 96.890366 and 5 1 136 1 1 10 1392 1501 119 18 92.783440 Relationshi 4 1 136 1 2 0 326 1506 1200 42 -1 5 1 136 1 2 1 326 1517 145 31 96.573761 (Month/Year) 5 1 136 1 2 2 687 1519 57 23 97.002037 (City, 5 1 136 1 2 3 753 1519 66 22 96.869438 State) 5 1 136 1 2 4 994 1518 103 22 96.595154 complete 5 1 136 1 2 5 1105 1518 82 17 96.004913 current 5 1 136 1 2 6 1195 1517 88 17 96.002869 address 5 1 136 1 2 7 1507 1506 19 17 45.827187 ‘P 4 1 136 1 3 0 234 1551 1308 28 -1 5 1 136 1 3 1 234 1561 52 16 96.901520 From: 5 1 136 1 3 2 406 1559 24 16 96.168587 To 5 1 136 1 3 3 438 1559 69 20 96.168587 present 5 1 136 1 3 4 615 1555 128 20 96.537628 CURRENT 5 1 136 1 3 5 751 1554 129 21 96.427658 ADDRESS 5 1 136 1 3 6 964 1554 68 18 93.284035 NAME 5 1 136 1 3 7 1041 1554 16 18 90.162361 & 5 1 136 1 3 8 1065 1554 115 18 96.743912 CURRENT 5 1 136 1 3 9 1188 1553 114 18 96.449219 ADDRESS 5 1 136 1 3 10 1306 1547 15 33 93.140053 | 5 1 136 1 3 11 1342 1566 12 10 76.394867 || 5 1 136 1 3 12 1373 1551 169 18 96.127419 RELATIONSHIP 4 1 136 1 4 0 229 1573 1293 57 -1 5 1 136 1 4 1 229 1582 144 48 19.907122 [MMIDDIYYYY 5 1 136 1 4 2 406 1581 143 49 2.350607 [MMIDDIVYYY 5 1 136 1 4 3 646 1587 54 20 96.512985 FOR 5 1 136 1 4 4 709 1587 51 20 96.512985 THE 5 1 136 1 4 5 770 1587 79 20 96.360680 CHILD 5 1 136 1 4 6 952 1583 32 18 97.005272 OF 5 1 136 1 4 7 993 1583 97 18 96.709412 PERSON 5 1 136 1 4 8 1100 1583 71 17 95.214798 CHILD 5 1 136 1 4 9 1181 1582 64 18 95.214798 LIVES 5 1 136 1 4 10 1254 1582 58 18 90.266716 WITH 5 1 136 1 4 11 1330 1573 32 19 35.138130 |S] 5 1 136 1 4 12 1391 1580 25 18 90.329346 OF 5 1 136 1 4 13 1424 1580 98 18 96.602982 PERSON 4 1 136 1 5 0 643 1609 865 27 -1 5 1 136 1 5 1 643 1616 110 16 96.653046 Confidential 5 1 136 1 5 2 762 1616 33 20 96.755737 (list 5 1 136 1 5 3 801 1616 45 15 96.961800 state 5 1 136 1 5 4 853 1615 44 20 96.597557 only) 5 1 136 1 5 5 945 1612 50 23 0.000000 {___] 5 1 136 1 5 6 1009 1614 110 16 96.843437 Confidential 5 1 136 1 5 7 1127 1613 33 20 96.813591 (list 5 1 136 1 5 8 1166 1613 44 16 96.979233 state 5 1 136 1 5 9 1217 1613 44 20 96.696060 only) 5 1 136 1 5 10 1403 1609 26 18 96.575577 TO 5 1 136 1 5 11 1439 1609 69 18 96.197067 CHILD 4 1 136 1 6 0 234 1653 200 16 -1 5 1 136 1 6 1 234 1653 52 16 96.927689 From: 5 1 136 1 6 2 406 1653 28 15 96.668694 To: 4 1 136 1 7 0 671 1670 165 20 -1 5 1 136 1 7 1 671 1671 51 19 96.257988 THE 5 1 136 1 7 2 732 1670 104 20 93.668213 CHILD'S 4

6.979233 state 5 1 136 1 5 9 1217 1613 44 20 96.696060 only) 5 1 136 1 5 10 1403 1609 26 18 96.575577 TO 5 1 136 1 5 11 1439 1609 69 18 96.197067 CHILD 4 1 136 1 6 0 234 1653 200 16 -1 5 1 136 1 6 1 234 1653 52 16 96.927689 From: 5 1 136 1 6 2 406 1653 28 15 96.668694 To: 4 1 136 1 7 0 671 1670 165 20 -1 5 1 136 1 7 1 671 1671 51 19 96.257988 THE 5 1 136 1 7 2 732 1670 104 20 93.668213 CHILD'S 4 1 136 1 8 0 226 1696 1349 53 -1 5 1 136 1 8 1 226 1706 127 27 2.463799 [Elmmporvvvy 5 1 136 1 8 2 369 1701 12 36 93.488426 | 5 1 136 1 8 3 393 1705 4 3 59.776096 | 5 1 136 1 8 4 411 1705 13 27 36.099564 4 5 1 136 1 8 5 429 1703 104 46 0.000000 aurooryyy 5 1 136 1 8 6 671 1702 165 20 95.924873 ADDRESSES 5 1 136 1 8 7 1020 1705 75 19 93.296654 NAME 5 1 136 1 8 8 1105 1704 17 20 89.750580 & 5 1 136 1 8 9 1131 1704 128 20 95.710564 CURRENT 5 1 136 1 8 10 1375 1723 169 18 96.365936 RELATIONSHIP 5 1 136 1 8 11 1550 1696 25 36 34.238743 [| 4 1 136 1 9 0 477 1733 47 12 -1 5 1 136 1 9 1 477 1733 47 12 95.291725 CHILD 4 1 136 1 10 0 222 1730 1353 46 -1 5 1 136 1 10 1 222 1731 12 45 47.206757 | 5 1 136 1 10 2 244 1731 91 45 18.673944 |sraRTinc 5 1 136 1 10 3 377 1732 11 44 59.596176 | 5 1 136 1 10 4 381 1752 123 20 42.235443 |_|stopre 5 1 136 1 10 5 662 1735 53 20 96.420555 FOR 5 1 136 1 10 6 724 1735 52 20 96.534828 THE 5 1 136 1 10 7 784 1734 72 23 95.643417 PAST 5 1 136 1 10 8 992 1736 128 21 96.472649 ADDRESS 5 1 136 1 10 9 1130 1736 35 20 96.806786 OF 5 1 136 1 10 10 1176 1735 107 21 70.123398 PERSON 5 1 136 1 10 11 1321 1730 43 24 0.000000 |<— 5 1 136 1 10 12 1392 1752 25 18 94.605843 OF 5 1 136 1 10 13 1426 1752 98 18 74.132957 PERSON 5 1 136 1 10 14 1554 1763 21 2 62.910076 [| 4 1 136 1 11 0 234 1766 1277 39 -1 5 1 136 1 11 1 234 1773 88 32 9.684858 Flareact 5 1 136 1 11 2 406 1780 12 16 41.157623 Thar 5 1 136 1 11 3 429 1772 70 31 53.535370 EACH 5 1 136 1 11 4 676 1767 56 20 95.949875 FIVE 5 1 136 1 11 5 741 1766 91 21 95.949875 YEARS 5 1 136 1 11 6 987 1769 79 20 62.584568 CHILD 5 1 136 1 11 7 1077 1769 75 19 96.974380 LIVED 5 1 136 1 11 8 1161 1768 65 20 96.810143 WITH 5 1 136 1 11 9 1237 1768 53 20 96.921227 FOR 5 1 136 1 11 10 1404 1781 27 18 93.071945 TO 5 1 136 1 11 11 1441 1781 70 18 93.071945 CHILD 4 1 136 1 12 0 253 1799 1323 30 -1 5 1 136 1 12 1 253 1812 76 12 96.341316 ADDRESS 5 1 136 1 12 2 429 1810 77 13 39.324005 ADDRESS 5 1 136 1 12 3 669 1799 39 20 91.785614 GO 5 1 136 1 12 4 719 1799 22 20 91.785614 IN 5 1 136 1 12 5 751 1799 88 20 94.916283 THESE 5 1 136 1 12 6 967 1801 51 20 42.557926 THE 5 1 136 1 12 7 1029 1801 68 20 42.557926 PAST 5 1 136 1 12 8 1107 1801 56 19 95.786491 FIVE 5 1 136 1 12 9 1172 1800 89 20 96.492836 YEARS 5 1 136 1 12 10 1270 1800 39 20 96.318214 GO 5 1 136 1 12 11 1554 1823 22 6 45.564125 {| 4 1 136 1 13 0 225 1824 1023 40 -1 5 1 136 1 13 1 225 1824 27 40 34.986008 rl 5 1 136 1 13 2 381 1833 43 27 0.904579 Td 5 1 136 1 13 3 709 1831 90 20 96.294067 BOXES 5 1 136 1 13 4 1029 1834 23 19 96.656403 IN 5 1 136 1 13 5 1062 1833 87 20 95.673180 THESE 5 1 136 1 13 6 1159 1832 89 21 96.135780 BOXES 2 1 137 0 0 0 886 1547 6 322 -1 3 1 137 1 0 0 886 1547 6 322 -1 4 1 137 1 1 0 886 1547 6 322 -1 5 1 137 1 1 1 886 1547 6 322 95.000000 2 1 138 0 0 0 958 1666 4 201 -1 3 1 138 1 0 0 958 1666 4 201 -1 4 1 138 1 1 0 958 1666 4 201 -1 5 1 138 1 1 1 958 1666 4 201 95.000000 2 1 139 0 0 0 1315 1701 51 1 -1 3 1 139 1 0 0 1315 1701 51 1 -1 4 1 139 1 1 0 1315 1701 51 1 -1 5 1 139 1 1 1 1315 1701 51 1 95.000000 2 1 140 0 0 0 1315 1764 52 2 -1 3 1 140 1 0 0 1315 1764 52 2 -1 4 1 140 1 1 0 1315 1764 52 2 -1 5 1 140 1 1 1 1315 1764 52 2 95.000000 2 1 141 0 0 0 1315 1828 52 2 -1 3 1 141 1 0 0 1315 1828 52 2 -1 4 1 141 1 1 0 1315 1828 52 2 -1 5 1 141 1 1 1 1315 1828 52 2 95.000000 2 1 142 0 0 0 1362 1544 7 328 -1 3 1 142 1 0 0 1362 1544 7 328 -1 4 1 142 1 1 0 1362 1544 7 328 -1 5 1 142 1 1 1 1362 1544 7 328 95.000000 2 1 143 0 0 0 1550 1544 6 328 -1 3 1 143 1 0 0 1550 1544 6 328 -1 4 1 143 1 1 0 1550 1544 6 328 -1 5 1 143 1 1 1 1550 1544 6 328 95.000000 2 1 144 0 0 0 1314 1664 5 201 -1 3 1 144 1 0 0 1314 1664 5 201 -1 4 1 144 1 1 0 1314 1664 5 201 -1 5 1 144 1 1 1 1314 1664 5 201 95.000000 2 1 145 0 0 0 618 1858 700 14 -1 3 1 145 1 0 0 618 1858 700 14 -1 4 1 145 1 1 0 618 1858 700 14 -1 5 1 145 1 1 1 618 1858 700 14 95.000000 2 1 146 0 0 0 570 1482 3 416 -1 3 1 146 1 0 0 570 1482 3 416 -1 4 1 146 1 1 0 570 1482 3 416 -1 5 1 146 1 1 1 570 1482 3 416 95.000000 2 1 147 0 0 0 224 1484 3 415 -1 3 1 147 1 0 0 224 1484 3 415 -1 4 1 147 1 1 0 224 1484 3 415 -1 5 1 147 1 1 1 224 1484 3 415 95.000000 2 1 148 0 0 0 396 1549 4 350 -1 3 1 148 1 0 0 396 1549 4 350 -1 4 1 148 1 1 0 396 1549 4 350 -1 5 1 148 1 1 1 396 1549 4 350 95.000000 2 1 149 0 0 0 554 1682 4 199 -1 3 1 149 1 0 0 554 1682 4 199 -1 4 1 149 1 1 0 554 1682 4 199 -1 5 1 149 1 1 1 554 1682 4 199 95.000000 2 1 150 0 0 0 423 1682 4 199 -1 3 1 150 1 0 0 423 1682 4 199 -1 4 1 150 1 1 0 423 1682 4 199 -1 5 1 150 1 1 1 423 1682 4 199 95.000000 2 1 151 0 0 0 378 1683 4 200 -1 3 1 151 1 0 0 378 1683 4 200 -1 4 1 151 1 1 0 378 1683 4 200 -1 5 1 151 1 1 1 378 1683 4 200 95.000000 2 1 152 0 0 0 246 1684 4 199 -1 3 1 152 1 0 0 246 1684 4 199 -1 4 1 152 1 1 0 246 1684 4 199 -1 5 1 152 1 1 1 246 1684 4 199 95.000000 2 1 153 0 0 0 247 1877 311 7 -1 3 1 153 1 0 0 247 1877 311 7 -1 4 1 153 1 1 0 247 1877 311 7 -1 5 1 153 1 1 1 247 1877 311 7 95.000000 2 1 154 0 0 0 932 1480 6 415 -1 3 1 154 1 0 0 932 1480 6 415 -1 4 1 154 1 1 0 932 1480 6 415 -1 5 1 154 1 1 1 932 1480 6 415 95.000000 2 1 155 0 0 0 1364 1870 191 2 -1 3 1 155 1 0 0 1364 1870 191 2 -1 4 1 155 1 1 0 1364 1870 191 2 -1 5 1 155 1 1 1 1364 1870 191 2 95.000000 2 1 156 0 0 0 1574 1477 6 415 -1 3 1 156 1 0 0 1574 1477 6 415 -1 4 1 156 1 1 0 1574 1477 6 415 -1 5 1 156 1 1 1 1574 1477 6 415 95.000000 2 1 157 0 0 0 1339 1478 6 415 -1 3 1 157 1 0 0 1339 1478 6 415 -1 4 1 157 1 1 0 1339 1478 6

6 415 95.000000 2 1 155 0 0 0 1364 1870 191 2 -1 3 1 155 1 0 0 1364 1870 191 2 -1 4 1 155 1 1 0 1364 1870 191 2 -1 5 1 155 1 1 1 1364 1870 191 2 95.000000 2 1 156 0 0 0 1574 1477 6 415 -1 3 1 156 1 0 0 1574 1477 6 415 -1 4 1 156 1 1 0 1574 1477 6 415 -1 5 1 156 1 1 1 1574 1477 6 415 95.000000 2 1 157 0 0 0 1339 1478 6 415 -1 3 1 157 1 0 0 1339 1478 6 415 -1 4 1 157 1 1 0 1339 1478 6 415 -1 5 1 157 1 1 1 1339 1478 6 415 95.000000 2 1 158 0 0 0 224 1886 1353 17 -1 3 1 158 1 0 0 224 1886 1353 17 -1 4 1 158 1 1 0 224 1886 1353 17 -1 5 1 158 1 1 1 224 1886 1353 17 95.000000 2 1 159 0 0 0 273 1906 55 47 -1 3 1 159 1 0 0 273 1906 55 47 -1 4 1 159 1 1 0 273 1906 55 47 -1 5 1 159 1 1 1 273 1906 55 47 95.000000
2 1 160 0 0 0 224 1942 49 79 -1 3 1 160 1 0 0 224 1942 49 79 -1 4 1 160 1 1 0 224 1942 49 79 -1 5 1 160 1 1 1 224 1942 49 79 45.927353 x 2 1 161 0 0 0 893 1923 76 2 -1 3 1 161 1 0 0 893 1923 76 2 -1 4 1 161 1 1 0 893 1923 76 2 -1 5 1 161 1 1 1 893 1923 76 2 95.000000 2 1 162 0 0 0 303 1903 1003 24 -1 3 1 162 1 0 0 303 1903 1003 24 -1 4 1 162 1 1 0 303 1903 1003 24 -1 5 1 162 1 1 1 303 1908 88 18 92.698410 dditional 5 1 162 1 1 2 400 1908 108 17 96.339371 addresses 5 1 162 1 1 3 517 1911 33 14 96.339371 are 5 1 162 1 1 4 559 1907 53 18 96.872284 listed 5 1 162 1 1 5 621 1911 24 13 96.969315 on 5 1 162 1 1 6 653 1906 121 18 96.058479 Attachment 5 1 162 1 1 7 783 1905 30 18 96.750130 3a. 5 1 162 1 1 8 823 1905 62 22 93.219948 (Form 5 1 162 1 1 9 895 1904 84 20 92.281021 MC-020 5 1 162 1 1 10 987 1909 45 17 96.358139 may 5 1 162 1 1 11 1038 1904 25 18 96.004005 be 5 1 162 1 1 12 1072 1903 51 18 96.946869 used 5 1 162 1 1 13 1130 1903 29 18 96.971855 for 5 1 162 1 1 14 1165 1903 35 18 95.925911 this 5 1 162 1 1 15 1207 1903 99 22 95.925911 purpose.) 2 1 163 0 0 0 287 1938 1262 57 -1 3 1 163 1 0 0 287 1938 1262 57 -1 4 1 163 1 1 0 331 1938 1207 24 -1 5 1 163 1 1 1 331 1944 23 18 91.457848 ck 5 1 163 1 1 2 362 1944 36 18 96.826950 this 5 1 163 1 1 3 407 1944 37 17 94.422928 box 5 1 163 1 1 4 452 1943 12 18 94.422928 if 5 1 163 1 1 5 470 1943 53 18 95.629005 there 5 1 163 1 1 6 532 1943 15 18 95.629005 is 5 1 163 1 1 7 556 1947 53 14 96.996376 more 5 1 163 1 1 8 617 1943 44 17 96.461349 than 5 1 163 1 1 9 670 1947 38 13 96.781891 one 5 1 163 1 1 10 717 1942 46 18 96.781891 child 5 1 163 1 1 11 773 1941 38 18 94.422333 and 5 1 163 1 1 12 820 1941 22 18 94.422333 all 5 1 163 1 1 13 850 1941 31 18 96.658211 the 5 1 163 1 1 14 890 1941 82 18 96.658211 children 5 1 163 1 1 15 981 1940 50 18 93.284630 have 5 1 163 1 1 16 1039 1940 34 18 86.088638 nof 5 1 163 1 1 17 1080 1939 46 18 96.596771 lived 5 1 163 1 1 18 1135 1939 87 23 96.915245 together 5 1 163 1 1 19 1228 1939 28 18 96.977531 for 5 1 163 1 1 20 1263 1939 31 18 96.284225 the 5 1 163 1 1 21 1303 1939 44 22 96.842255 past 5 1 163 1 1 22 1354 1938 36 18 96.748154 five 5 1 163 1 1 23 1397 1943 58 18 96.425301 years. 5 1 163 1 1 24 1465 1938 73 23 91.552681 (Attach 4 1 163 1 2 0 287 1967 1262 28 -1 5 1 163 1 2 1 287 1972 284 23 0.000000 form&L-105(A)/GC-120(A) 5 1 163 1 2 2 580 1972 40 18 96.912605 and 5 1 163 1 2 3 626 1971 29 18 96.848503 list 5 1 163 1 2 4 662 1971 50 18 96.192024 each 5 1 163 1 2 5 721 1971 56 18 96.192024 other 5 1 163 1 2 6 783 1970 64 18 93.708130 child's 5 1 163 1 2 7 855 1970 74 18 95.966148 current 5 1 163 1 2 8 936 1969 84 18 95.582375 address 5 1 163 1 2 9 1028 1969 39 18 95.582375 and 5 1 163 1 2 10 1075 1969 47 18 96.328262 their 5 1 163 1 2 11 1128 1969 101 17 95.382828 residence 5 1 163 1 2 12 1237 1968 70 23 95.382828 history 5 1 163 1 2 13 1314 1967 29 18 95.165718 for 5 1 163 1 2 14 1349 1968 31 17 95.165718 the 5 1 163 1 2 15 1387 1968 40 22 96.373070 past 5 1 163 1 2 16 1434 1967 35 18 96.970284 five 5 1 163 1 2 17 1477 1967 72 23 96.720177 years.) 2 1 164 0 0 0 1494 1997 82 15 -1 3 1 164 1 0 0 1494 1997 82 15 -1 4 1 164 1 1 0 1494 1997 82 15 -1 5 1 164 1 1 1 1494 1997 36 15 91.599777 Page 5 1 164 1 1 2 1537 1997 5 12 91.599777 1 5 1 164 1 1 3 1550 1997 14 12 89.599915 of 5 1 164 1 1 4 1569 1997 7 12 89.599915 2 2 1 165 0 0 0 145 2008 1437 19 -1 3 1 165 1 0 0 145 2008 1437 19 -1 4 1 165 1 1 0 145 2008 1437 19 -1 5 1 165 1 1 1 145 2008 1437 19 95.000000 2 1 166 0 0 0 146 2032 192 55 -1 3 1 166 1 0 0 146 2032 192 55 -1 4 1 166 1 1 0 147 2032 190 16 -1 5 1 166 1 1 1 147 2033 35 13 96.965340 Form 5 1 166 1 1 2 188 2033 59 15 94.365814 Adopted 5 1 166 1 1 3 253 2032 18 13 68.814079 for 5 1 166 1 1 4 289 2033 48 11 44.831543 Ylandatot 4 1 166 1 2 0 146 2051 192 14 -1 5 1 166 1 2 1 146 2052 52 13 92.086700 Judicial 5 1 166 1 2 2 204 2052 53 12 92.086700 Council 5 1 166 1 2 3 262 2052 14 12 92.661049 of 5 1 166 1 2 4 291 2051 47 13 12.787895 Saliforni 4 1 166 1 3 0 147 2071 190 16 -1 5 1 166 1 3 1 147 2071 139 16 56.389114 FL-108/GC-120 5 1 166 1 3 2 264 2061 33 33 51.605865 [Rev 5 1 166 1 3 3 304 2071 33 12 0.303707 Janu 2 1 167 0 0 0 296 2079 1277 40 -1 3 1 167 1 0 0 296 2079 1277 40 -1 4 1 167 1 1 0 1190 2079 6 9 -1 5 1 167 1 1 1 1190 2079 6 9 80.170982 T 4 1 167 1 2 0 296 2094 1277 25 -1 5 1 167 1 2 1 296 2101 19 18 74.770470 IF 5 1 167 1 2 2 321 2100 46 17 95.122337 YOU 5 1 167 1 2 3 376 2100 57 16 96.468010 HAVE 5 1 167 1 2 4 441 2100 62 16 96.401764 MORE 5 1 167 1 2 5 510 2099 57 16 96.080719 THAN 5 1 167 1 2 6 569 2090 12 33 96.910316 2 5 1 167 1 2 7 593 2099 107 16 96.137566 CHILDREN 5 1 167 1 2 8 710 2098 107 16 96.186913 INVOLVED 5 1 167 1 2 9 825 2098 18 16 96.777420 IN 5 1 167 1 2 10 851 2097 41 16 96.826729 THE 5 1 167 1 2 11 900 2097 57 16 95.878525 CASE, 5 1 167 1 2 12 971 2097 74 16 96.506508 CHECK 5 1 167 1 2 13 1053 2096 44 16 93.273270 BOX 5 1 167 1 2 14 1105 2096 16 16 93.184036 b. 5 1 167 1 2 15 1129 2096 45 16 96.512161 AND 5 1 167 1 2 16 1182 2095 114 17 96.512161 COMPLETE 5 1 167 1 2 17 1305 2095 60 16 93.286613 FORM 5 1 167 1 2 18 1373 2094 200 18 88.614594 FL-105(A)/GC-120(A) 2 1 168 0 0 0 370 2009 21 14 -1 3 1 168 1 0 0 370 2009 21 1

5 1 167 1 2 12 971 2097 74 16 96.506508 CHECK 5 1 167 1 2 13 1053 2096 44 16 93.273270 BOX 5 1 167 1 2 14 1105 2096 16 16 93.184036 b. 5 1 167 1 2 15 1129 2096 45 16 96.512161 AND 5 1 167 1 2 16 1182 2095 114 17 96.512161 COMPLETE 5 1 167 1 2 17 1305 2095 60 16 93.286613 FORM 5 1 167 1 2 18 1373 2094 200 18 88.614594 FL-105(A)/GC-120(A) 2 1 168 0 0 0 370 2009 21 14 -1 3 1 168 1 0 0 370 2009 21 14 -1 4 1 168 1 1 0 370 2009 21 14 -1 5 1 168 1 1 1 370 2009 21 14 95.000000 2 1 169 0 0 0 526 2020 872 21 -1 3 1 169 1 0 0 526 2020 872 21 -1 4 1 169 1 1 0 526 2020 872 21 -1 5 1 169 1 1 1 526 2025 17 16 68.750710 IF 5 1 169 1 1 2 550 2025 41 16 68.750710 THE 5 1 169 1 1 3 599 2024 122 17 96.118988 CHILD(REN) 5 1 169 1 1 4 729 2023 43 17 96.910789 HAS 5 1 169 1 1 5 780 2023 61 16 96.111427 LIVED 5 1 169 1 1 6 848 2023 28 16 96.814140 AT 5 1 169 1 1 7 883 2022 62 17 96.536552 MORE 5 1 169 1 1 8 952 2022 57 16 96.196304 THAN 5 1 169 1 1 9 1017 2022 11 16 95.244461 4 5 1 169 1 1 10 1035 2021 131 17 96.761261 ADDRESSES 5 1 169 1 1 11 1175 2021 18 16 96.882362 IN 5 1 169 1 1 12 1200 2021 41 16 96.574577 THE 5 1 169 1 1 13 1249 2020 53 17 96.538422 LAST 5 1 169 1 1 14 1310 2021 10 15 96.464333 5 5 1 169 1 1 15 1327 2020 71 16 90.788673 YEARS, 2 1 170 0 0 0 524 2034 880 12 -1 3 1 170 1 0 0 524 2034 880 12 -1 4 1 170 1 1 0 524 2034 880 12 -1 5 1 170 1 1 1 524 2034 880 12 95.000000 2 1 171 0 0 0 339 2019 4 65 -1 3 1 171 1 0 0 339 2019 4 65 -1 4 1 171 1 1 0 339 2019 4 65 -1 5 1 171 1 1 1 339 2019 4 65 95.000000 2 1 172 0 0 0 465 2064 475 6 -1 3 1 172 1 0 0 465 2064 475 6 -1 4 1 172 1 1 0 465 2064 475 6 -1 5 1 172 1 1 1 465 2064 475 6 95.000000 2 1 173 0 0 0 465 2046 993 21 -1 3 1 173 1 0 0 465 2046 993 21 -1 4 1 173 1 1 0 465 2046 993 21 -1 5 1 173 1 1 1 465 2051 75 16 96.328972 CHECK 5 1 173 1 1 2 547 2051 47 16 93.176735 THIS 5 1 173 1 1 3 602 2050 102 16 86.928802 BOX_AND 5 1 173 1 1 4 711 2049 86 17 95.556274 CREATE 5 1 173 1 1 5 805 2049 29 16 96.836670 AN 5 1 173 1 1 6 843 2048 156 17 87.249046 ATTACHMENT 3a" AND LIST THE ADDITIONAL ADDRESSES x

FL-105/GC-120 CASE NAME: [PETITIONER'S LAST NAME VS RESPONDENT'S LAST NAME] CASE NUMBER: [COURT CASE NUMBER] 4. Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case t custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding? La ves_ D0 .— (If yes, attach a copy of the orders if you have one and provide the following information): » Court Court order Your Proceeding Case number | (name, state or tribe, | or judgment | Name of each child | connection to | Case status location) (date) the case a. [] Family b. (J) Gtardianship DEALS WITH THE CUSTODY AND/OR VISITATION OF THE CHILD(REN) IN THIS CASE. IF YES, COMPLETE THE c. [] Other INFORMATION IN THIS SECTION. IF NO, SKIP TO NUMBER 5 Proceeding Case Number Court (name, state or tribe, location) d. [] Juvenile e. [] Adoption lowing information): 5. ne or more domestic violence restraining/protective orders are anthgrovide the fo. now in effect. (Attach a copy of the orders if you have one Court County State or Tribe Case Number (if known) Orders expire (date) a. [] Criminal b. [] Family CHECK THIS BOX IF THERE IS A DOMESTIC c. [] Juvenile COMPLETE THE INFORMATION IN THIS SECTION d. [] Other | a. Name and address of person: (If yes, provide the following information): c. Name and address of person: ZN b. Name and address of person: 6. Do you know of any person who is not a party to this proceeding who has physical custody of or claims to have rights to custody of or visitation with any child in this case? T_lyes [ 1] 0 fal TELL THE COURT IF THERE IS ANYONE ELSE THAT CLAIMS TO HAVE CUSTODY AND/OR VISITATION ORDERS TI TT Name of each child: [] Has physical custody [__] Claims custody rights [] Claims visitation rights [J Has physical custody [] Claims custody rights [] Claims visitation rights Name of each child: (-] Has physical custody [] Claims custody rights [-~] Claims visitation rights Name of each child: 7. [] Number of pages attached:

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

Date| TODAY'S DATE [| PRINT YOUR NAME HERE | (NAME OF DECLARANT) » SIGN YOUR NAME HERE | (SIGNATURE OF DECLARANT) NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody proceeding in a California court or any other court concerning a child subject to this proceeding. FL-105/GC-120 [Rev. January 1, 2025] DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

FORM INSTRUCTIONS FL-105(A)GC-120(A) CASE NAME: [PETITIONER'S LAST NAME VS RESPONDENT'S LAST NAME] CASE NUMBER: [COURT CASE NUMBER| ATTACHMENT TO DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) Instructions: /f al/ the children subject to the proceeding have not lived together for the last five years, use as many copies of this form as needed to list all the children. Number each item and each page consecutively, and attach all pages to form FL-105/GC-120. Name of child:[NEXT OLDEST CHILD'S NAME] ~~ history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (Ifnot the same, 3. b. = provide the information below.) (Provide the child's current address and their residence CHECK THIS Dat f resid Resid Pi hild lived with (1 d ates of residence ‘esidence erson child lived with (name ani . . Bon OREN (Month/Year) (City, State) complete current address) Relationship HAVE BEEN | From: To present CURRENT ADDRESS NAME & CURRENT ADDRESS || Ro oNon. OF P| IN chins ar [MMIDDINYYY | [MMrDDIYYY FOR THE CHILD OF PERSON CHILD LIVES WITH TO CHILD ADDRESSES [_] Confidential (list state only) _|[__] Confidential (list state only) From: To: IF THIS CHILD HAS NOT BEEN From: To: LIVING AT THE SAME ADDRESS AS THE CHILD ABOVE, FILL OUT WHERE THE CHILD HAS BEEN From: To: LIVING FOR THE PAST 5 YEARS From: To: 3. b. Name of child: [NEXT OLDEST CHILD'S NAME] (Provide the child's current address and their residence ~~ history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) provide the information below.) 7 Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (ifnot the same, ee THe Dates of residence Residence Person child lived with (name and Relationshi CHILDREN (Month/Year) (City, State) complete current address) P HAVE BEEN ||": To present CURRENT ADDRESS NAME & CURRENT ADDRESS | _ [RELATIONSHIP

| OF P

LIVING AT FOR THE CHILD OF PERSON CHILD LIVES WITH TO CHILD ADORESSES = — [___] Confidential (list state only) _|[__] Confidential (list state only) IF THIS CHILD HAS NOT BEEN LIVING AT THE SAME ADDRESS From: To: AS THE CHILD ABOVE, FILL OUT WHERE THE CHILD HAS BEEN LIVING FOR THE PAST 5 YEARS From: To: From: To: Page of Form Adopted for Mandatory Use Judicial Council of California FL-105(AVGC-120(A) {Rev. January 1, 2025] ATTACHMENT TO DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) Family Code, § 3400 et seq.; Probate Code, §§ 1510(f), 1512 www. courts.ca.gov

FORM INSTRUCTIONS FL-105(A)IGC-120(A) CASE NAME: [PETITIONER'S LAST NAME VS RESPONDENT'S LAST NAME] CASE NUMBER: [COURT CASE NUMBER] ATTACHMENT TO DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) Instructions: /f all the children subject to the proceeding have not lived together for the last five years, use as many copies of this form as needed to list all the children. Number each item and each page consecutively, and attach all pages to form FL-105/GC-120. 3. b. ___ Name of child:[NEXT OLDEST CHILD'S NAME] (Provide the child's current address and their residence history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (If not the same, Fs provide the information below.) CHECK THIS BOX IF THE Dates of residence Residence Person child lived with (name and Relationship CHILDREN (Month/Year) (City, State) complete current address) HAVE BEEN | From: To present CURRENT ADDRESS NAME & CURRENT ADDRESS |! iets ae Me [MMIDDTYYY_]|MMIDDIYYYY | FOR THE CHILD OF PERSON CHILD LIVES WITH TO CHILD ADDRESSES [__] Confidential (list state only) _|[__] Confidential (list state only) From: To: IF THIS CHILD HAS NOT BEEN From: To: LIVING AT THE SAME ADDRESS AS THE CHILD ABOVE, FILL OUT WHERE THE CHILD HAS BEEN From: To: LIVING FOR THE PAST 5 YEARS From: To: 3. b. Name of child: [NEXT OLDEST CHILD'S NAME] (Provide the child's current address and their residence ~~ history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) 7 CHECK THIS BOX IF THE CHILDREN HAVE BEEN LIVING AT THE SAME ADDRESSES Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (If not the same, provide the information below.) Dates of residence Residence Person child lived with (name and Relationshi (Month/Year) (City, State) complete current address) P From: To present CURRENT ADDRESS NAME & CURRENT ADDRESS d REA TIONSHIP

| OF P

[MM/DDIYYYY | [MMIDDIYYYY | FOR THE CHILD OF PERSON CHILD LIVES WITH TO Gta {_] Confidential (list state only) [] Confidential (list state only) From: To: IF THIS CHILD HAS NOT BEEN LIVING AT THE SAME ADDRESS From: To: AS THE CHILD ABOVE, FILL OUT WHERE THE CHILD HAS BEEN LIVING FOR THE PAST 5 YEARS From: To: From: To: Page of Form Adopted for Mandatory Use Judicial Council of California FL-105(A)/GC-120(A) [Rev. January 1, 2025] DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) ATTACHMENT TO Family Code, § 3400 et seq.; Probate Code, §§ 1510(f), 1512 yaww.courts.ca.gov

FORM INSTRUCTIONS FL-150 PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: vamel YOUR NAME ~ YOUR ADDRESS city: CITY, STATE, ZIP CODE STATE: ZIP CODE: TeLeH¥QUR TELEPHONE NUMBER FAX NO.: E-MAIL ADDRESS: NOTE: YOU MUST WRITE YOUR NAME AND THE OTHER PARTY'S FOR COURT USE ONLY SAMPLE ONLY ATTORNEY FOR (name): NAME THE EXACT SAME WAY THROUGHOUT YOUR FORMS DO NOT SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET AODRESS:| Fragno County Superior Court MAILING ADDRESS: wan CITY AND ZIP CODE: 1130 0 Street Fresno CA 93724-2220 BRANCH NAME: WRITE ON PETITIONER: [PARTY WHO INITIALLY OPENED CASE THIS COPY! RESPONDENT: [THE OTHER PARTY OTHER PARTY/PARENT/CLAIMANT: INCOME AND EXPENSE DECLARATION CASE NUMBER COURT CASE NUMBER 1. Employment (Give information on your current job or, if you're unemployed, your most rece! nt job.) FILL OUT YOUR EMPLOYER'S INFORMATION HERE. IF YOU DO NOT HAVE A JOB, GIVE THE INFORMATION FROM YOUR LAST a. Employer: otyourpay b. Employer's address: stubs for last | ©: Employer's phone number: two months d. Occupation: (black out e. Date job started: Social f. If unemployed, date job ended: Security g. |! work about hours per week. numbers). h. I get paid $ gross (before taxes) JOB AND WHEN YOUR JOB ENDED (NAME OF EMPLOYER, ADDRESS, PHONE NUMBER, JOB TITLE, DATE OF EMPLOYMENT AND SALARY) [-] per week per hour. [-~] per month (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 5 1 61 1 1 4 400 1141 100 18 91.705978 1—Other 5 1 61 1 1 5 507 1141 66 18 96.454544 Jobs at the top.) TELL THE COURT ABOUT YOUR EDUCATION INCLUDING ANY DEGREES 2. Age and education OR LICENSES YOU EARNED a. My age is (specify): YOUR AGE b. | have completed high school or the equivalent: No If no, highest grade completed (spec/{GRADE FINISHED c. Number of years of college completed. ify): Degree(s) obtained (specify): [DEGREE EARNED d. Number of years of gradu: ool completed (specify): {] Degree(s) obtained (specify): [DEGREE EARNED e. Ihave: fessional/occupational license(s) (specify): [LICENSES EARNED FILL OUTYOUR [] vocational training (specify): [JOB TRAINING COMPLETED] INFORMATION FROM THE . . PAST YEAR YOU FILED 3. Tax Information TAXES. REMEMBER TO a. [] I last filed taxes for tax year (specify year): NOTE HOW YOU FILED b. My tax filing status is single head of household married, filing separately |(SINGLE, ETC.), WHERE y 9 a . g 5 9 Sep y YOU FILED, (CA, ETC.)AND [-] married, filing jointly with (specify name): HOW MANY EXEMPTIONS c. I file state tax returns in [] California [] other (specify state): YOU CLAIMED (1, ETC.) d. I claim the following number of exemptions (including myself) on my taxes (specify): 4. Other party's income. | estimate the gross monthly income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain): |HOW MUCH DO YOU THINK UP WITH THAT AMOUNT? IF YOU DO NOT KNOW, EXPLAIN WHY YOU DO NOT KNOW THE OTHER PARTY EARNS BEFORE TAXES? HOW DID YOU COME (If you need more space to answer any questions on this form, attach an 8 1/2-by-1T-inch sheet of paper and write the question number before your answer.) Number of pages attached:

| 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: [TODAY'S DATE SIGN YOUR NAME HERE |

[PRINT YOUR NAME HERE | (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

Form Adopted for Mandatory Use Judicial Council of California FL-150 [Rev. September 1, 2024] INCOME AND EXPENSE DECLARATION Family Code, §§ 2030-2032, 2100-2113, 3552, 3620-3634, 4050-4076, 4300-4339 www. courts.ca.gov

FORM INSTRUCTIONS FL-150 PETITIONER: [PARTY WHO INITIALLY OPENED CASE | CASE NUMBER: RESPONDENT: [THE OTHER PARTY | COURT CASE NUMBER 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.) [LIST ALL OF YOUR INCOME, BEFORE TAXES, IN THIS AREA ] 5. Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.) Average Last month monthly a. Salary or wages (gross, before taxeS)..........ccsccsssssssssssseseessneesssesssecessssisecsssssecsssivetscessinnerssenseseessavenee $ IN THIS IN THIS b. Overtime (gross, before taxes) COLUMN COLUMN c. Commissions or bonuses . LIST AERA d. Public assistance (for example: TANF, ssl, GA/GR) [] currently receiving 2... cccccccccceseeeeeeeeee $ von | AMOUNT e. Spousal support [] from this marriage [] froma different marriage [7] federally taxable* $1 peceivep You f. Partner support [] from this domestic partnership [] from a different domestic partnership $| LAST RECEIVED g. Pension/retirement fund payments.......... $ oe roe h. Social Security retirement (not SSI!) : row MONTHS i. Disability: [~~] Social Security (not SSI) [__] State disability (SDI) | [[] Private insurance $] source | | FROM EACH j. Unemployment compensation...........ccccccccesssesesssesssseessseesseesssssessessssutesisersnsvessisstsvensesevesiesssesesetaseees $| THAT SOURCE kK. Workers! COMpensation.........ccccccssesssessesssessesesssecsesscssessussvssessvavsveasssessievavssessueareateatestssseereasscarsaveeavereesee g| APPLIES ApLOES J. 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 $ LIST ALL OF YOUR b. Rental property incom $ |INVESTMENT INCOME, Trust incom: $ AFTER EXPENSES AND c. st i Eee ceeeceeceesssseeeeeessnsseeeenenneeeeeenssiunnnnseeeesiissssssseesssssssnsentssssasesteesnssnneteensnneeeereteseeaseeesse BEFORE TAXES, IN THIS d. Other (specify): $ TAREA 7. Income from self-employment, after business expenses for all bUSINESSES................ccccccssceseesseseeseens $ !amthe [] owner/sole proprietor © [] business partner [] other (specify): Number of years in this business (specify): IF YOU ARE SELF-EMPLOYED, COMPLETE i THIS SECTION AND ATTACH A TWO YEAR Name of business (specify): PROFIT & LOSS STATEMENT/SCHEDULE C Type of business (specify): FROM YOUR LAST FEDERAL TAX RETURN 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. itional income. | received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and amount): CHECK THIS BOX IF YOU RECEIVED A ONE-TIME SOURCE OF INCOME, (LOTTERY OR INHERITANCE) AND WRITE WHERE YOU RECEIVED THE MONEY AND THE AMOUNT 9. hange in income. My financial situation has changed significantly over the last 12 months because (specify): IF YOU HAD A MAJOR CHANGE IN INCOME IN THE PAST 12 MONTHS, STATE WHAT THE CHANGE WAS | 10. Deductions Last month a. Required union dues $ [FILL OUT THIS b. Required retirement payments (not Social Security, FICA, 401(k), or IRA) $| SECTION IF c. Medical, hospital, dental, and other health insurance premiums (total monthly amount) 8 vRONEY d. Child support that | pay for children from other relationships $| pEDUCTED e. Spousal support that | pay by court order from a different marriage [] federally tax deductible ..5 | FOR ANY OF f. Partner support that | pay by court order from a different domestic partnership...........cccc.csscscssssesssesssesseeesaseeseessseeeeee $ est es g._ Necessary job-related expenses not reimbursed by my employer (attach explanation labeled Question 5 1 59 2 7 14 1313 1765 51 23 54.252541 109) ..002. $ MONTH'S [LIST WHAT YOU HAVE IN YOUR SAVINGS AND CHECKING ACCOUNTS, ANY STOCKS, BONDS, AND/OR REAL PROPERTY | PAYCHECK 11. Assets a. Cash and checking accounts, savings, credit union, money market, and other deposit acco b. Stocks, bonds, and other assets | could easily sell c. Allother property, [—] real and [-] personal (estimate fair market value minus the debts you owe)...
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. FL450 (Rev. September 1, 2024] INCOME AND EXPENSE DECLARATION Page 2 of 4

FORM INSTRUCTIONS FL-150 PETITIONER: [PARTY WHO INITIALLY OPENED CASE | CASE NUMBER: RESPONDENT: [THE OTHER PARTY ] COURT CASE NUMBER 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 LIST ANYONE WHO LIVES WITH YOU (INCLUDING CHILD(REN), ROOMATES, Cd Yes | No . FAMILY, ETC.), THEIR AGE, THEIR RELATION TO YOU, HOW MUCH THEY MAKE c. BEFORE TAXES, AND WHETHER THEY PAY ANY EXPENSES FOR THE HOME [J] Yes [] No d. [] Yes [] No e. [] Yes [] No 13. Average monthly expenses [ Estimated expenses [| Actual expenses [] Proposed needs CHECK ONE] a. Home: hj] LIST ALL OF YOUR MONTHLY’! (1) ] Rent or (—_] mortgage.......... $ T) expenses 5 1 37 1 12 10 1078 695 8 48 26.922970 | 5 1 37 1 12 11 1105 717 49 3 61.872887 [> 4 1 37 1 13 0 268 740 1031 23 -1 5 1 37 1 13 1 268 741 12 18 66.774048 If 5 1 37 1 13 2 287 741 104 22 96.085320 mortgage: 5 1 37 1 13 3 896 741 10 18 85.501556 j. 5 1 37 1 13 4 920 732 9 31 93.695633 | 5 1 37 1 13 5 931 741 57 16 96.430573 HERE 5 1 37 1 13 6 996 740 42 17 94.814934 FOR 5 1 37 1 13 7 1045 740 41 16 93.245949 THE 5 1 37 1 13 8 1103 749 156 4 0.000000 |.-..-..-.---.-:00 5 1 37 1 13 9 1290 749 9 3 0.000000 . 4 1 37 1 14 0 267 766 1027 28 -1 5 1 37 1 14 1 267 771 27 23 96.016190 (a) 5 1 37 1 14 2 309 775 84 18 96.734184 average 5 1 37 1 14 3 402 770 93 23 96.821426 principal: 5 1 37 1 14 4 551 769 10 18 93.161987 $ 5 1 37 1 14 5 898 766 101 20 45.160873 k.|_ITEMS 5 1 37 1 14 6 1007 766 73 16 92.908859 LISTED 5 1 37 1 14 7 1105 767 34 20 78.910393 Jifts, 5 1 37 1 14 8 1149 766 38 18 93.192505 and 5 1 37 1 14 9 1196 766 98 18 92.431328 vacation.. 4 1 37 1 15 0 268 801 1016 26 -1 5 1 37 1 15 1 268 804 26 23 91.185104 (b) 5 1 37 1 15 2 309 808 84 18 96.995354 average 5 1 37 1 15 3 402 803 83 18 96.156113 interest: 5 1 37 1 15 4 551 801 10 19 93.002594 $ 5 1 37 1 15 5 898 803 9 17 58.590149 1. 5 1 37 1 15 6 930 804 48 18 93.144112 Auto 5 1 37 1 15 7 987 808 99 18 95.422203 expenses 5 1 37 1 15 8 1094 803 38 18 96.940529 and 5 1 37 1 15 9 1140 802 144 23 95.754898 transportation 4 1 37 1 16 0 228 826 1181 41 -1 5 1 37 1 16 1 228 844 28 23 96.760834 (2) 5 1 37 1 16 2 269 844 46 18 96.047752 Real 5 1 37 1 16 3 324 845 86 21 96.047752 property 5 1 37 1 16 4 417 844 63 17 96.449905 taxes. 5 1 37 1 16 5 697 840 28 19 72.752083 _$ 5 1 37 1 16 6 932 833 113 22 96.846962 (insurance, 5 1 37 1 16 7 1055 837 42 18 96.530983 gas, 5 1 37 1 16 8 1107 832 77 22 96.158348 repairs, 5 1 37 1 16 9 1194 831 41 21 92.858681 bus, 5 1 37 1 16 10 1245 831 142 22 16.803474 etc.)............. 5 1 37 1 16 11 1401 826 8 19 50.321217 4 2 1 38 0 0 0 1278 904 110 11 -1 3 1 38 1 0 0 1278 904 110 11 -1 4 1 38 1 1 0 1278 904 110 11 -1 5 1 38 1 1 1 1278 904 110 11 95.000000 2 1 39 0 0 0 1197 941 188 4 -1 3 1 39 1 0 0 1197 941 188 4 -1 4 1 39 1 1 0 1197 941 188 4 -1 5 1 39 1 1 1 1197 941 188 4 95.000000 2 1 40 0 0 0 520 950 178 4 -1 3 1 40 1 0 0 520 950 178 4 -1 4 1 40 1 1 0 520 950 178 4 -1 5 1 40 1 1 1 520 950 178 4 95.000000 2 1 41 0 0 0 889 985 693 7 -1 3 1 41 1 0 0 889 985 693 7 -1 4 1 41 1 1 0 889 985 693 7 -1 5 1 41 1 1 1 889 985 693 7 95.000000 2 1 42 0 0 0 882 891 4 120 -1 3 1 42 1 0 0 882 891 4 120 -1 4 1 42 1 1 0 882 891 4 120 -1 5 1 42 1 1 1 882 891 4 120 95.000000 2 1 43 0 0 0 634 964 52 52 -1 3 1 43 1 0 0 634 964 52 52 -1 4 1 43 1 1 0 634 964 52 52 -1 5 1 43 1 1 1 634 964 52 52 95.000000 2 1 44 0 0 0 736 997 156 3 -1 3 1 44 1 0 0 736 997 156 3 -1 4 1 44 1 1 0 736 997 156 3 -1 5 1 44 1 1 1 736 997 156 3 95.000000 2 1 45 0 0 0 336 1028 365 4 -1 3 1 45 1 0 0 336 1028 365 4 -1 4 1 45 1 1 0 336 1028 365 4 -1 5 1 45 1 1 1 336 1028 365 4 95.000000 2 1 46 0 0 0 1579 788 6 272 -1 3 1 46 1 0 0 1579 788 6 272 -1 4 1 46 1 1 0 1579 788 6 272 -1 5 1 46 1 1 1 1579 788 6 272 95.000000 2 1 47 0 0 0 890 1057 693 6 -1 3 1 47 1 0 0 890 1057 693 6 -1 4 1 47 1 1 0 890 1057 693 6 -1 5 1 47 1 1 1 890 1057 693 6 95.000000 2 1 48 0 0 0 893 1094 679 5 -1 3 1 48 1 0 0 893 1094 679 5 -1 4 1 48 1 1 0 893 1094 679 5 -1 5 1 48 1 1 1 893 1094 679 5 95.000000 2 1 49 0 0 0 335 1104 365 4 -1 3 1 49 1 0 0 335 1104 365 4 -1 4 1 49 1 1 0 335 1104 365 4 -1 5 1 49 1 1 1 335 1104 365 4 95.000000 2 1 50 0 0 0 891 990 5 180 -1 3 1 50 1 0 0 891 990 5 180 -1 4 1 50 1 1 0 891 990 5 180 -1 5 1 50 1 1 1 891 990 5 180 95.000000 2 1 51 0 0 0 595 1144 104 22 -1 3 1 51 1 0 0 595 1144 104 22 -1 4 1 51 1 1 0 595 1144 104 22 -1 5 1 51 1 1 1 595 1144 104 22 95.000000 2 1 52 0 0 0 894 1165 679 5 -1 3 1 52 1 0 0 894 1165 679 5 -1 4 1 52 1 1 0 894 1165 679 5 -1 5 1 52 1 1 1 894 1165 679 5 95.000000 2 1 53 0 0 0 591 1180 112 11 -1 3 1 53 1 0 0 591 1180 112 11 -1 4 1 53 1 1 0 591 1180 112 11 -1 5 1 53 1 1 1 591 1180 112 11 95.000000 2 1 54 0 0 0 901 1206 309 5 -1 3 1 54 1 0 0 901 1206 309 5 -1 4 1 54 1 1 0 901 1206 309 5 -1 5 1 54 1 1 1 901 1206 309 5 95.000000 2 1 55 0 0 0 1226 1225 365 6 -1 3 1 55 1 0 0 1226 1225 365 6 -1 4 1 55 1 1 0 1226 1225 365 6 -1 5 1 55 1 1 1 1226 1225 365 6 95.000000 2 1 56 0 0 0 900 1208 2 83 -1 3 1 56 1 0 0 900 1208 2 83 -1 4 1 56 1 1 0 900 1208 2 83 -1 5 1 56 1 1 1 900 1208 2 83 95.000000 2 1 57 0 0 0 1208 1207 2 87 -1 3 1 57 1 0 0 1208 1207 2 87 -1 4 1 57 1 1 0 1208 1207 2 87 -1 5 1 57 1 1 1 1208 1207 2 87 95.000000 2 1 58 0 0 0 1226 1228 2 55 -1 3 1 58 1 0 0 1226 1228 2 55 -1 4 1 58 1 1 0 1226 1228 2 55 -1 5 1 58 1 1 1 1226 1228 2 55 95.000000 2 1 59 0 0 0 1588 1226 2 56 -1 3 1 59 1 0 0 1588 1226 2 56 -1 4 1 59 1 1 0 1588 1226 2 56 -1 5 1 59 1 1 1 1588 1226 2 56 95.000000 2 1 60 0 0 0 1226 1278 365 6 -1 3 1 60 1 0 0 1226 1278 365 6 -1 4 1 60 1 1 0 1226 1278 365 6 -1 5 1 60 1 1 1 1226 1278 365 6 95.000000 2 1 61 0 0 0 184 1288 1390 11 -1 3 1 61 1 0 0 184 1288 1390 11 -1 4 1 61 1 1 0 184 1288 1390 11 -1 5 1 61 1 1 1 184 1288 1390 11 95.000000

226 2 56 -1 3 1 59 1 0 0 1588 1226 2 56 -1 4 1 59 1 1 0 1588 1226 2 56 -1 5 1 59 1 1 1 1588 1226 2 56 95.000000 2 1 60 0 0 0 1226 1278 365 6 -1 3 1 60 1 0 0 1226 1278 365 6 -1 4 1 60 1 1 0 1226 1278 365 6 -1 5 1 60 1 1 1 1226 1278 365 6 95.000000 2 1 61 0 0 0 184 1288 1390 11 -1 3 1 61 1 0 0 184 1288 1390 11 -1 4 1 61 1 1 0 184 1288 1390 11 -1 5 1 61 1 1 1 184 1288 1390 11 95.000000 2 1 62 0 0 0 150 857 1428 475 -1 3 1 62 1 0 0 150 857 1428 475 -1 4 1 62 1 1 0 228 857 1165 42 -1 5 1 62 1 1 1 228 877 27 22 96.267120 (3) 5 1 62 1 1 2 269 876 141 18 94.819984 Homeowner's 5 1 62 1 1 3 419 880 22 14 93.249718 or 5 1 62 1 1 4 449 876 75 17 60.601715 renter's 5 1 62 1 1 5 534 879 101 14 96.955231 insurance 5 1 62 1 1 6 683 857 9 2 0.000000 . 5 1 62 1 1 7 898 871 23 13 92.464066 m. 5 1 62 1 1 8 932 867 102 17 96.833008 Insurance 5 1 62 1 1 9 1042 866 41 23 96.617355 (life, 5 1 62 1 1 10 1093 865 93 21 93.306107 accident, 5 1 62 1 1 11 1196 866 42 19 89.919449 etc.; 5 1 62 1 1 12 1248 865 24 17 96.907196 do 5 1 62 1 1 13 1281 865 32 17 96.993561 not 5 1 62 1 1 14 1321 864 72 18 96.789337 include 4 1 62 1 2 0 268 890 1141 38 -1 5 1 62 1 2 1 268 905 20 23 96.383110 (if 5 1 62 1 2 2 295 906 30 17 96.344955 not 5 1 62 1 2 3 334 905 87 18 93.065262 included 5 1 62 1 2 4 430 904 270 23 0.000000 ADOVE)........csecseesseeeeees 5 1 62 1 2 5 886 925 6 2 82.217827 | 5 1 62 1 2 6 931 896 50 20 37.345856 auto, 5 1 62 1 2 7 992 895 61 21 92.939049 home, 5 1 62 1 2 8 1063 899 20 13 92.939049 or 5 1 62 1 2 9 1091 894 62 18 94.350548 health 5 1 62 1 2 10 1163 894 114 22 95.303772 insurance). 5 1 62 1 2 11 1401 890 8 17 27.925362 $ 4 1 62 1 3 0 228 925 1181 35 -1 5 1 62 1 3 1 228 938 27 22 96.779732 (4) 5 1 62 1 3 2 269 937 133 18 96.535904 Maintenance 5 1 62 1 3 3 411 937 38 17 96.338219 and 5 1 62 1 3 4 459 936 59 23 77.123825 repair 5 1 62 1 3 5 886 958 6 2 24.155121 [ 5 1 62 1 3 6 898 934 17 13 24.155121 n. 5 1 62 1 3 7 932 929 82 22 96.685577 Savings 5 1 62 1 3 8 1023 928 36 18 96.257614 and 5 1 62 1 3 9 1069 928 125 18 96.257614 investments 5 1 62 1 3 10 1401 925 8 18 89.789619 $ 4 1 62 1 4 0 188 958 1221 40 -1 5 1 62 1 4 1 188 977 17 18 91.919434 b. 5 1 62 1 4 2 228 977 120 18 91.919434 Health-care 5 1 62 1 4 3 357 977 54 17 96.955925 costs 5 1 62 1 4 4 420 976 33 17 96.955925 not 5 1 62 1 4 5 461 975 41 23 96.801407 paid 5 1 62 1 4 6 512 975 23 23 93.279015 by 5 1 62 1 4 7 544 975 89 18 87.423874 insuranc 5 1 62 1 4 8 898 970 17 13 61.818596 0. 5 1 62 1 4 9 931 964 107 18 96.572021 Charitable 5 1 62 1 4 10 1046 964 133 18 21.932159 contributions. 5 1 62 1 4 11 1183 977 207 4 0.000000 ..........-...eeene 5 1 62 1 4 12 1401 958 8 19 87.589958 $ 4 1 62 1 5 0 259 997 1035 21 -1 5 1 62 1 5 1 259 1015 2 3 0.000000 . 5 1 62 1 5 2 912 1013 3 2 90.909393 . 5 1 62 1 5 3 932 998 69 18 96.698402 Monthly 5 1 62 1 5 4 1034 998 88 18 96.792328 payments 5 1 62 1 5 5 1131 997 53 18 96.658669 listed 5 1 62 1 5 6 1194 997 16 18 96.658669 in 5 1 62 1 5 7 1219 997 42 17 96.798439 item 5 1 62 1 5 8 1272 997 22 17 96.898125 14 4 1 62 1 6 0 202 1003 856 30 -1 5 1 62 1 6 1 202 1030 2 3 58.381176 . 5 1 62 1 6 2 264 1015 3 17 50.816452 I 5 1 62 1 6 3 898 1003 11 17 53.632607 P 5 1 62 1 6 4 1002 1003 11 18 90.062737 ly 5 1 62 1 6 5 1022 1003 36 18 86.869347 pay! 4 1 62 1 7 0 189 1015 1220 46 -1 5 1 62 1 7 1 189 1020 11 13 8.375969 c. 5 1 62 1 7 2 228 1015 52 18 94.326881 Child 5 1 62 1 7 3 289 1019 44 13 94.477806 care 5 1 62 1 7 4 892 1020 24 41 51.586384 a 5 1 62 1 7 5 932 1027 81 23 96.622528 (itemize 5 1 62 1 7 6 1021 1027 62 18 96.622528 below 5 1 62 1 7 7 1089 1026 17 18 96.964882 in 5 1 62 1 7 8 1117 1027 22 17 96.976562 14 5 1 62 1 7 9 1148 1026 41 18 96.921722 and 5 1 62 1 7 10 1195 1026 58 17 96.850555 insert 5 1 62 1 7 11 1260 1026 44 17 96.757027 total 5 1 62 1 7 12 1311 1025 72 22 92.548859 here)... 5 1 62 1 7 13 1402 1022 7 18 63.432919 § 4 1 62 1 8 0 187 1049 1222 38 -1 5 1 62 1 8 1 187 1054 17 18 92.561134 d. 5 1 62 1 8 2 227 1054 100 18 96.807915 Groceries 5 1 62 1 8 3 336 1053 38 18 96.792313 and 5 1 62 1 8 4 383 1053 109 18 93.289581 household 5 1 62 1 8 5 501 1052 198 23 71.066788 supplies................. 5 1 62 1 8 6 716 1049 9 19 92.872849 $ 5 1 62 1 8 7 898 1070 11 17 63.874519 fq. 5 1 62 1 8 8 931 1064 59 18 84.007301 Other 5 1 62 1 8 9 998 1064 94 22 7.913170 (apecily): 5 1 62 1 8 10 1401 1061 8 15 33.018513 y 4 1 62 1 9 0 188 1078 901 35 -1 5 1 62 1 9 1 188 1096 17 13 88.990265 e. 5 1 62 1 9 2 228 1091 64 22 96.241241 Eating 5 1 62 1 9 3 301 1091 32 17 94.671455 out. 5 1 62 1 9 4 683 1087 43 19 22.246174 S$ 5 1 62 1 9 5 912 1080 3 2 53.178413 - 5 1 62 1 9 6 1087 1078 2 3 16.877937 : 4 1 62 1 10 0 253 1108 1106 26 -1 5 1 62 1 10 1 253 1132 25 2 24.395552 sg: 5 1 62 1 10 2 431 1131 2 2 0.000000 . 5 1 62 1 10 3 898 1115 11 12 50.173355 tr. 5 1 62 1 10 4 931 1110 78 18 96.406403 TOTAL 5 1 62 1 10 5 1018 1109 125 19 96.656563 EXPENSES 5 1 62 1 10 6 1160 1114 11 13 96.543579 (a 5 1 62 1 10 7 1223 1109 25 17 90.503624 ‘do 5 1 62 1 10 8 1256 1109 33 17 96.469025 not 5 1 62 1 10 9 1295 1108 40 18 96.105896 add 5 1 62 1 10 10 1342 1108 17 18 95.815712 in 4 1 62 1 11 0 188 1109 1362 61 -1 5 1 62 1 11 1 188 1132 11 17 92.703476 f. 5 1 62 1 11 2 229 1132 74 17 79.205566 Utilities 5 1 62 1 11 3 312 1131 49 23 95.482727 (gas, 5 1 62 1 11 4 371 1131 80 20 96.977005 electric, 5 1 62 1 11 5 460 1131 62 20 96.977005 water, 5 1 62 1 11 6 532 1130 60 22 96.946411 trash) 5 1 62 1 11 7 717 1128 10 18 93.150909 $ 5 1 62 1 11 8 932 1139 31 18 96.869690 the 5 1 62 1 11 9 972 1139 89 18 95.367363 amounts 5 1 62 1 11 10 1069 1138 16 18 96.918228 in 5 1 62 1 11 11 1094 1109 69 51 48.204842 Sa 5 1 62 1 11 12 1172 1109 36 46 28.372936 ae 5 1 62 1 11 13 1222 1109 31 51 31.564411 oy) 5 1 62 1 11 14 1364 1112 186 58 35.588196 37 4 1 62 1 12 0 187 1150 1386 73 -1 5 1 62 1 12 1 187 1176 17 18 93.161858 g. 5 1 62 1 12 2 226 1171 116 23 96.733635 Telephone, 5 1 62 1 12 3 352 1171 34 17 96.781792 cell 5 1 62 1 12 4 3

11 10 1069 1138 16 18 96.918228 in 5 1 62 1 11 11 1094 1109 69 51 48.204842 Sa 5 1 62 1 11 12 1172 1109 36 46 28.372936 ae 5 1 62 1 11 13 1222 1109 31 51 31.564411 oy) 5 1 62 1 11 14 1364 1112 186 58 35.588196 37 4 1 62 1 12 0 187 1150 1386 73 -1 5 1 62 1 12 1 187 1176 17 18 93.161858 g. 5 1 62 1 12 2 226 1171 116 23 96.733635 Telephone, 5 1 62 1 12 3 352 1171 34 17 96.781792 cell 5 1 62 1 12 4 395 1171 71 22 96.950745 phone, 5 1 62 1 12 5 476 1170 36 18 96.529228 and 5 1 62 1 12 6 521 1170 69 17 96.186745 e-mail. 5 1 62 1 12 7 682 1167 44 20 7.344456 S$ 5 1 62 1 12 8 898 1188 10 13 53.643681 =. 5 1 62 1 12 9 931 1184 89 17 91.599152 Amount 5 1 62 1 12 10 1028 1183 22 18 96.834152 of 5 1 62 1 12 11 1057 1187 106 18 96.834152 expenses 5 1 62 1 12 12 1173 1182 32 22 56.403919 Pad 5 1 62 1 12 13 1227 1153 24 70 91.984810 by 5 1 62 1 12 14 1262 1153 106 70 60.615993 others 5 1 62 1 12 15 1402 1176 7 19 53.393345 5 5 1 62 1 12 16 1418 1150 155 56 26.141024 al 4 1 62 1 13 0 967 1204 484 26 -1 5 1 62 1 13 1 967 1214 44 16 90.687950 ADD 5 1 62 1 13 2 1019 1214 27 16 96.439888 UP 5 1 62 1 13 3 1053 1214 40 16 95.837624 ALL 5 1 62 1 13 4 1100 1213 42 16 96.241592 THE 4 1 62 1 14 0 610 1233 933 31 -1 5 1 62 1 14 1 610 1261 4 3 0.000000 . 5 1 62 1 14 2 907 1240 112 16 96.425964 EXPENSES 5 1 62 1 14 3 1027 1239 43 17 96.425964 YOU 5 1 62 1 14 4 1078 1239 74 16 96.240196 LISTED 5 1 62 1 14 5 1160 1239 44 16 96.750404 FOR 5 1 62 1 14 6 1273 1234 67 16 95.983406 WRITE 5 1 62 1 14 7 1348 1233 49 16 95.983406 HOW 5 1 62 1 14 8 1403 1233 57 16 96.580620 MUCH 5 1 62 1 14 9 1468 1233 28 16 96.613228 OF 5 1 62 1 14 10 1502 1233 41 16 96.661316 THE 4 1 62 1 15 0 150 1258 1428 26 -1 5 1 62 1 15 1 150 1263 28 18 95.752686 14. 5 1 62 1 15 2 188 1262 125 18 96.794312 Installment 5 1 62 1 15 3 321 1262 109 22 96.581902 payments 5 1 62 1 15 4 439 1261 40 18 96.674408 and 5 1 62 1 15 5 488 1261 61 18 96.660591 debts 5 1 62 1 15 6 559 1261 36 17 96.487091 not 5 1 62 1 15 7 603 1260 60 18 96.451553 listed 5 1 62 1 15 8 672 1260 68 18 96.451553 above 5 1 62 1 15 9 935 1266 15 15 55.086941 A 5 1 62 1 15 10 956 1265 70 17 55.086941 TOTAL 5 1 62 1 15 11 1033 1265 28 16 94.596931 TO 5 1 62 1 15 12 1068 1265 41 16 96.688019 PUT 5 1 62 1 15 13 1117 1264 57 16 96.253410 HERE 5 1 62 1 15 14 1238 1259 112 17 96.884750 EXPENSES 5 1 62 1 15 15 1357 1259 42 16 96.396133 ARE 5 1 62 1 15 16 1405 1259 46 16 96.559311 PAID 5 1 62 1 15 17 1459 1259 28 16 96.109734 BY 5 1 62 1 15 18 1493 1258 85 16 96.654449 OTHERS 4 1 62 1 16 0 198 1296 1337 36 -1 5 1 62 1 16 1 198 1307 44 18 96.356483 Paid 5 1 62 1 16 2 251 1307 19 18 94.523903 to 5 1 62 1 16 3 633 1305 34 17 96.998009 For 5 1 62 1 16 4 809 1296 14 36 85.604706 / 5 1 62 1 16 5 1020 1298 81 31 96.109673 Amount 5 1 62 1 16 6 1174 1297 84 31 96.338234 Balance 5 1 62 1 16 7 1325 1300 48 18 96.523468 Date 5 1 62 1 16 8 1382 1300 17 18 80.665749 of 5 1 62 1 16 9 1405 1300 34 17 80.665749 last 5 1 62 1 16 10 1446 1300 89 22 96.574059 payment 2 1 63 0 0 0 184 1327 1391 11 -1 3 1 63 1 0 0 184 1327 1391 11 -1 4 1 63 1 1 0 184 1327 1391 11 -1 5 1 63 1 1 1 184 1327 1391 11 95.000000 2 1 64 0 0 0 355 1357 1044 9 -1 3 1 64 1 0 0 355 1357 1044 9 -1 4 1 64 1 1 0 355 1357 1044 9 -1 5 1 64 1 1 1 355 1357 1044 9 95.000000 2 1 65 0 0 0 364 1345 1029 118 -1 3 1 65 1 0 0 364 1345 1029 118 -1 4 1 65 1 1 0 1019 1345 166 15 -1 5 1 65 1 1 1 1019 1347 11 13 0.000000 g 5 1 65 1 1 2 1173 1345 12 14 22.205185 g 4 1 65 1 2 0 426 1364 899 22 -1 5 1 65 1 2 1 426 1370 45 16 96.510696 LIST 5 1 65 1 2 2 478 1369 56 17 96.128853 HERE 5 1 65 1 2 3 541 1369 45 16 96.230980 ANY 5 1 65 1 2 4 594 1368 116 17 95.583130 PAYMENTS 5 1 65 1 2 5 717 1368 45 16 96.960945 YOU 5 1 65 1 2 6 770 1367 44 17 96.875298 ARE 5 1 65 1 2 7 822 1367 83 16 96.753853 MAKING 5 1 65 1 2 8 914 1367 43 16 96.623505 FOR 5 1 65 1 2 9 964 1366 89 16 96.663422 VEHICLE 5 1 65 1 2 10 1061 1365 77 19 96.193771 LOANS, 5 1 65 1 2 11 1147 1365 99 16 96.506729 STUDENT 5 1 65 1 2 12 1254 1364 71 17 96.142227 LOANS 4 1 65 1 3 0 386 1390 986 24 -1 5 1 65 1 3 1 386 1395 142 19 96.711662 MORTGAGES, 5 1 65 1 3 2 537 1395 79 16 96.252838 CREDIT 5 1 65 1 3 3 623 1394 79 19 96.605156 CARDS, 5 1 65 1 3 4 710 1393 46 17 96.725677 ETC. 5 1 65 1 3 5 764 1393 45 16 96.266769 AND 5 1 65 1 3 6 817 1393 41 16 96.463333 THE 5 1 65 1 3 7 866 1392 60 17 95.810860 NAME 5 1 65 1 3 8 934 1392 28 16 96.920502 OF 5 1 65 1 3 9 969 1392 41 16 96.243690 THE 5 1 65 1 3 10 1017 1391 107 17 96.155624 COMPANY 5 1 65 1 3 11 1130 1391 45 16 96.890038 YOU 5 1 65 1 3 12 1182 1391 44 16 96.653870 ARE 5 1 65 1 3 13 1234 1390 85 16 96.073097 PAYING. 5 1 65 1 3 14 1327 1390 45 16 96.455086 LIST 4 1 65 1 4 0 406 1415 945 23 -1 5 1 65 1 4 1 406 1421 52 16 96.514214 HOW 5 1 65 1 4 2 465 1421 61 16 96.389969 MUCH 5 1 65 1 4 3 533 1420 45 16 96.662048 YOU 5 1 65 1 4 4 587 1420 42 16 96.437889 PAY 5 1 65 1 4 5 637 1420 57 16 96.793900 EACH 5 1 65 1 4 6 703 1419 81 19 96.647209 MONTH, 5 1 65 1 4 7 792 1419 63 16 96.703896 WHAT 5 1 65 1 4 8 863 1418 18 17 95.751198 IS 5 1 65 1 4 9 889 1418 57 16 96.836761 STILL 5 1 65 1 4 10 953 1418 70 18 96.896828 OWED, 5 1 65 1 4 11 1030 1417 44 16 96.896828 AND 5 1 65 1 4 12 1081 1417 42 16 96.037834 THE 5 1 65 1 4 13 1131 1416 56 17 95.736450 DATE 5 1 65 1 4 14 1195 1416 27 16 96.519547 OF 5 1 65 1 4 15 1229 1416 60 16 96.596733 YOUR 5 1 65 1 4 16 1297 1415 54 17 96.445152 LAST 4 1 65 1 5 0 364 1441 1029 22 -1 5 1 65 1 5 1 364 1447 108 16 95.779915 PAYMENT. 5 1 65 1 5 2 479 1447 44 15 95.779915 ADD 5 1 65 1 5 3 531 1446 28 16 96.208656 UP 5 1 65 1 5 4 566 1446 41 16 95.850471 ALL 5 1 65 1 5 5 615 1446 27 16 96.285812 OF 5 1 65 1 5 6 650 1445 41 16 96.514938 THE 5 1 65 1 5 7 699 1445 104 16 96.275299 MONTHLY 5 1 65 1 5 8 811 1444 101 16 96.648834 PAYMENT 5 1 65 1 5 9 919 1443 106 17 96.152359 AMOUNTS 5 1 65 1 5 10 1032 1443 44 16 96.378258 AND 5 1 65 1 5 11 1084 1443 41 16 96.827042 PUT 5 1 65 1 5 12 1131 1442 42 16 96.047417 THE 5 1 65 1 5 13 1180 1

446 41 16 95.850471 ALL 5 1 65 1 5 5 615 1446 27 16 96.285812 OF 5 1 65 1 5 6 650 1445 41 16 96.514938 THE 5 1 65 1 5 7 699 1445 104 16 96.275299 MONTHLY 5 1 65 1 5 8 811 1444 101 16 96.648834 PAYMENT 5 1 65 1 5 9 919 1443 106 17 96.152359 AMOUNTS 5 1 65 1 5 10 1032 1443 44 16 96.378258 AND 5 1 65 1 5 11 1084 1443 41 16 96.827042 PUT 5 1 65 1 5 12 1131 1442 42 16 96.047417 THE 5 1 65 1 5 13 1180 1442 70 16 96.635887 TOTAL 5 1 65 1 5 14 1258 1442 18 16 96.457420 IN 5 1 65 1 5 15 1285 1441 48 16 96.457420 ITEM 5 1 65 1 5 16 1342 1441 27 16 93.305557 13. 5 1 65 1 5 17 1378 1445 15 16 91.360085 p. 2 1 66 0 0 0 1397 1370 177 4 -1 3 1 66 1 0 0 1397 1370 177 4 -1 4 1 66 1 1 0 1397 1370 177 4 -1 5 1 66 1 1 1 1397 1370 177 4 95.000000 2 1 67 0 0 0 184 1377 174 4 -1 3 1 67 1 0 0 184 1377 174 4 -1 4 1 67 1 1 0 184 1377 174 4 -1 5 1 67 1 1 1 184 1377 174 4 95.000000 2 1 68 0 0 0 1397 1412 178 4 -1 3 1 68 1 0 0 1397 1412 178 4 -1 4 1 68 1 1 0 1397 1412 178 4 -1 5 1 68 1 1 1 1397 1412 178 4 95.000000 2 1 69 0 0 0 184 1419 173 4 -1 3 1 69 1 0 0 184 1419 173 4 -1 4 1 69 1 1 0 184 1419 173 4 -1 5 1 69 1 1 1 184 1419 173 4 95.000000 2 1 70 0 0 0 1396 1357 4 111 -1 3 1 70 1 0 0 1396 1357 4 111 -1 4 1 70 1 1 0 1396 1357 4 111 -1 5 1 70 1 1 1 1396 1357 4 111 95.000000 2 1 71 0 0 0 354 1364 4 110 -1 3 1 71 1 0 0 354 1364 4 110 -1 4 1 71 1 1 0 354 1364 4 110 -1 5 1 71 1 1 1 354 1364 4 110 95.000000 2 1 72 0 0 0 1397 1454 178 4 -1 3 1 72 1 0 0 1397 1454 178 4 -1 4 1 72 1 1 0 1397 1454 178 4 -1 5 1 72 1 1 1 1397 1454 178 4 95.000000 2 1 73 0 0 0 184 1462 174 3 -1 3 1 73 1 0 0 184 1462 174 3 -1 4 1 73 1 1 0 184 1462 174 3 -1 5 1 73 1 1 1 184 1462 174 3 95.000000 2 1 74 0 0 0 355 1465 1044 9 -1 3 1 74 1 0 0 355 1465 1044 9 -1 4 1 74 1 1 0 355 1465 1044 9 -1 5 1 74 1 1 1 355 1465 1044 9 95.000000 2 1 75 0 0 0 184 1497 1391 10 -1 3 1 75 1 0 0 184 1497 1391 10 -1 4 1 75 1 1 0 184 1497 1391 10 -1 5 1 75 1 1 1 184 1497 1391 10 95.000000 2 1 76 0 0 0 184 1538 1391 12 -1 3 1 76 1 0 0 184 1538 1391 12 -1 4 1 76 1 1 0 184 1538 1391 12 -1 5 1 76 1 1 1 184 1538 1391 12 95.000000 2 1 77 0 0 0 1571 1094 4 490 -1 3 1 77 1 0 0 1571 1094 4 490 -1 4 1 77 1 1 0 1571 1094 4 490 -1 5 1 77 1 1 1 1571 1094 4 490 95.000000 2 1 78 0 0 0 1165 1287 4 299 -1 3 1 78 1 0 0 1165 1287 4 299 -1 4 1 78 1 1 0 1165 1287 4 299 -1 5 1 78 1 1 1 1165 1287 4 299 95.000000 2 1 79 0 0 0 1011 1288 3 299 -1 3 1 79 1 0 0 1011 1288 3 299 -1 4 1 79 1 1 0 1011 1288 3 299 -1 5 1 79 1 1 1 1011 1288 3 299 95.000000 2 1 80 0 0 0 1318 1291 3 295 -1 3 1 80 1 0 0 1318 1291 3 295 -1 4 1 80 1 1 0 1318 1291 3 295 -1 5 1 80 1 1 1 1318 1291 3 295 95.000000 2 1 81 0 0 0 620 1296 4 293 -1 3 1 81 1 0 0 620 1296 4 293 -1 4 1 81 1 1 0 620 1296 4 293 -1 5 1 81 1 1 1 620 1296 4 293 95.000000 2 1 82 0 0 0 1018 1471 166 108 -1 3 1 82 1 0 0 1018 1471 166 108 -1 4 1 82 1 1 0 1018 1471 166 23 -1 5 1 82 1 1 1 1018 1474 12 20 92.976112 $ 5 1 82 1 1 2 1173 1471 11 21 92.706360 $ 4 1 82 1 2 0 1018 1514 166 21 -1 5 1 82 1 2 1 1018 1514 12 21 92.488693 $ 5 1 82 1 2 2 1173 1514 11 21 92.566505 $ 4 1 82 1 3 0 1019 1555 165 24 -1 5 1 82 1 3 1 1019 1559 10 20 92.561714 $ 5 1 82 1 3 2 1173 1555 11 21 91.827957 $ 2 1 83 0 0 0 184 1581 1390 10 -1 3 1 83 1 0 0 184 1581 1390 10 -1 4 1 83 1 1 0 184 1581 1390 10 -1 5 1 83 1 1 1 184 1581 1390 10 95.000000 2 1 84 0 0 0 183 1298 4 294 -1 3 1 84 1 0 0 183 1298 4 294 -1 4 1 84 1 1 0 183 1298 4 294 -1 5 1 84 1 1 1 183 1298 4 294 95.000000 2 1 85 0 0 0 1101 1598 499 5 -1 3 1 85 1 0 0 1101 1598 499 5 -1 4 1 85 1 1 0 1101 1598 499 5 -1 5 1 85 1 1 1 1101 1598 499 5 95.000000 2 1 86 0 0 0 1108 1606 483 30 -1 3 1 86 1 0 0 1108 1606 483 30 -1 4 1 86 1 1 0 1108 1606 483 30 -1 5 1 86 1 1 1 1108 1609 102 27 96.226021 ONLY 5 1 86 1 1 2 1223 1607 196 29 95.546547 COMPLETE 5 1 86 1 1 3 1433 1606 158 29 96.577927 SECTION 2 1 87 0 0 0 151 1630 939 27 -1 3 1 87 1 0 0 151 1630 939 27 -1 4 1 87 1 1 0 151 1630 939 27 -1 5 1 87 1 1 1 151 1635 28 18 94.879204 15. 5 1 87 1 1 2 188 1635 97 22 96.993156 Attorney 5 1 87 1 1 3 293 1634 45 18 96.741455 fees 5 1 87 1 1 4 348 1634 52 22 96.897507 (This 5 1 87 1 1 5 407 1633 118 18 96.879257 information 5 1 87 1 1 6 533 1633 16 18 96.877113 is 5 1 87 1 1 7 557 1632 89 23 96.897362 required 5 1 87 1 1 8 652 1632 14 18 95.966545 if 5 1 87 1 1 9 671 1632 61 18 96.110428 either 5 1 87 1 1 10 737 1632 55 22 96.645531 party 5 1 87 1 1 11 798 1631 16 18 96.573097 is 5 1 87 1 1 12 822 1631 110 22 96.419441 requesting 5 1 87 1 1 13 940 1631 86 21 95.485580 attorney 5 1 87 1 1 14 1032 1630 58 22 96.347633 fees): 2 1 88 0 0 0 187 1649 1368 122 -1 3 1 88 1 0 0 187 1649 1368 122 -1 4 1 88 1 1 0 188 1649 1327 44 -1 5 1 88 1 1 1 188 1677 17 13 96.703903 a. 5 1 88 1 1 2 227 1672 26 17 90.378952 To 5 1 88 1 1 3 262 1672 50 20 90.378952 date, 5 1 88 1 1 4 322 1671 3 18 95.044250 | 5 1 88 1 1 5 335 1671 49 18 95.572449 have 5 1 88 1 1 6 393 1671 43 22 96.340378 paid 5 1 88 1 1 7 446 1675 30 18 96.756210 my 5 1 88 1 1 8 485 1671 84 22 96.408157 attorney 5 1 88 1 1 9 577 1670 36 18 96.974335 this 5 1 88 1 1 10 622 1670 78 17 96.272972 amount 5 1 88 1 1 11 707 1669 28 18 96.272972 for 5 1 88 1 1 12 742 1668 44 18 96.694412 fees 5 1 88 1 1 13 796 1668 37 18 96.548317 and 5 1 88 1 1 14 842 1669 54 17 96.548317 costs 5 1 88 1 1 15 905 1667 95 23 93.305878 (specify): 5 1 88 1 1 16 1007 1666 12 21 93.290680 $ 5 1 88 1 1 17 1181 1649 55 44 90.428329 15. 5 1 88 1 1 18 1249 1653 29 27 96.024666 IF 5 1 88 1 1 19 1290 1652 78 28 96.619408 YOU 5 1 88 1 1 20 1383 1652 70 27 96.481071 HAD 5 1 88 1 1 21 1465 1652 50 27 96.601959 AN 4 1 88 1 2 0 189 1697 1366 31 -1 5 1 88 1 2 1 189 1705 17 18 92.855843 b. 5 1 88 1 2 2 227 1707 40 18 96.938011 The 5 1 88 1 2 3 276 1711 69 14 96.972366 source 5 1 88 1 2 4 354 1706 20 18 96.860718 of 5 1 88 1 2 5 380 1706 36 18 96.960609 this 5 1 88 1 2 6 425 1710 70 18 96.853378 money 5 1 88 1 2 7 503 1710 41 13 96.945381 was 5 1 88

27 96.481071 HAD

5 1 88 1 1 21 1465 1652 50 27 96.601959 AN 4 1 88 1 2 0 189 1697 1366 31 -1 5 1 88 1 2 1 189 1705 17 18 92.855843 b. 5 1 88 1 2 2 227 1707 40 18 96.938011 The 5 1 88 1 2 3 276 1711 69 14 96.972366 source 5 1 88 1 2 4 354 1706 20 18 96.860718 of 5 1 88 1 2 5 380 1706 36 18 96.960609 this 5 1 88 1 2 6 425 1710 70 18 96.853378 money 5 1 88 1 2 7 503 1710 41 13 96.945381 was 5 1 88 1 2 8 553 1705 96 23 96.289948 (specify): 5 1 88 1 2 9 1146 1698 204 28 96.438377 ATTORNEY 5 1 88 1 2 10 1362 1697 72 28 96.659332 AND 5 1 88 1 2 11 1446 1697 109 27 96.167282 WANT 4 1 88 1 3 0 187 1734 1366 37 -1 5 1 88 1 3 1 187 1744 16 12 89.103539 c. 5 1 88 1 3 2 228 1740 3 17 47.621235 I 5 1 88 1 3 3 241 1740 32 18 71.429932 still 5 1 88 1 3 4 282 1744 41 13 96.985886 owe 5 1 88 1 3 5 331 1739 32 18 96.962807 the 5 1 88 1 3 6 371 1739 93 22 95.731186 following 5 1 88 1 3 7 472 1738 43 18 96.782990 fees 5 1 88 1 3 8 524 1738 38 18 95.274307 and 5 1 88 1 3 9 571 1739 54 17 95.274307 costs 5 1 88 1 3 10 634 1738 18 17 96.924652 to 5 1 88 1 3 11 661 1742 30 18 96.953979 my 5 1 88 1 3 12 699 1738 86 21 96.714569 attorney 5 1 88 1 3 13 794 1736 81 23 96.992828 (specify 5 1 88 1 3 14 882 1736 45 17 94.102394 total 5 1 88 1 3 15 934 1735 70 22 92.494072 owed): 5 1 88 1 3 16 1012 1734 11 21 92.494072 $ 5 1 88 1 3 17 1149 1743 72 28 96.190826 THE 5 1 88 1 3 18 1235 1743 73 27 96.190826 OTH 5 1 88 1 3 19 1314 1742 49 28 95.918167 ER 5 1 88 1 3 20 1376 1742 116 27 95.918167 PARTY 5 1 88 1 3 21 1503 1741 50 28 87.017342 TO 2 1 89 0 0 0 189 1771 427 24 -1 3 1 89 1 0 0 189 1771 427 24 -1 4 1 89 1 1 0 189 1771 427 24 -1 5 1 89 1 1 1 189 1771 17 18 89.517982 d. 5 1 89 1 1 2 228 1773 30 22 96.756813 My 5 1 89 1 1 3 267 1772 100 23 94.259270 attorney's 5 1 89 1 1 4 376 1772 63 22 96.916763 hourly 5 1 89 1 1 5 449 1772 38 17 96.964081 rate 5 1 89 1 1 6 496 1771 15 18 96.934769 is 5 1 89 1 1 7 520 1771 96 23 95.341057 (specify): 2 1 90 0 0 0 1597 1598 4 230 -1 3 1 90 1 0 0 1597 1598 4 230 -1 4 1 90 1 1 0 1597 1598 4 230 -1 5 1 90 1 1 1 1597 1598 4 230 95.000000 2 1 91 0 0 0 1099 1601 4 230 -1 3 1 91 1 0 0 1099 1601 4 230 -1 4 1 91 1 1 0 1099 1601 4 230 -1 5 1 91 1 1 1 1099 1601 4 230 95.000000 2 1 92 0 0 0 149 1786 1446 53 -1 3 1 92 1 0 0 149 1786 1446 53 -1 4 1 92 1 1 0 149 1786 1446 53 -1 5 1 92 1 1 1 149 1818 3 18 90.896797 | 5 1 92 1 1 2 162 1817 76 19 91.176651 confirm 5 1 92 1 1 3 247 1817 35 18 97.000595 this 5 1 92 1 1 4 291 1817 31 18 96.981651 fee 5 1 92 1 1 5 330 1817 141 22 96.214958 arrangement. 5 1 92 1 1 6 1108 1789 74 27 96.414375 PAY 5 1 92 1 1 7 1196 1788 75 28 96.148422 FOR 5 1 92 1 1 8 1282 1787 107 28 95.680664 YOUR 5 1 92 1 1 9 1398 1786 197 29 95.680664 ATTORNEY 2 1 93 0 0 0 150 1849 1135 99 -1 3 1 93 1 0 0 150 1849 1135 99 -1 4 1 93 1 1 0 150 1849 1135 67 -1 5 1 93 1 1 1 150 1861 54 55 96.601860 Date: 5 1 93 1 1 2 411 1855 67 36 94.341080 DO 5 1 93 1 1 3 493 1854 102 41 95.522797 NOT 5 1 93 1 1 4 610 1853 111 37 95.659264 SIGN 5 1 93 1 1 5 741 1853 66 36 95.231873 ON 5 1 93 1 1 6 825 1852 106 36 96.205841 THIS 5 1 93 1 1 7 950 1851 128 36 96.683395 PAGE 5 1 93 1 1 8 1097 1849 188 37 96.256355 UNLESS 4 1 93 1 2 0 544 1908 608 40 -1 5 1 93 1 2 1 544 1910 316 38 96.208923 COMPLETING 5 1 93 1 2 2 878 1909 205 37 95.980286 SECTION 5 1 93 1 2 3 1104 1908 48 36 95.980286 15 2 1 94 0 0 0 317 1955 1070 22 -1 3 1 94 1 0 0 317 1955 1070 22 -1 4 1 94 1 1 0 317 1955 1070 22 -1 5 1 94 1 1 1 317 1962 46 15 95.957321 (TYPE 5 1 94 1 1 2 369 1962 22 12 96.772408 OR 5 1 94 1 1 3 398 1961 47 12 96.455490 PRINT 5 1 94 1 1 4 451 1961 44 12 96.788124 NAME 5 1 94 1 1 5 501 1961 21 12 96.598770 OF 5 1 94 1 1 6 527 1960 92 15 94.463814 ATTORNEY) 5 1 94 1 1 7 1167 1956 97 15 96.743599 (SIGNATURE 5 1 94 1 1 8 1270 1956 20 12 96.486061 OF 5 1 94 1 1 9 1295 1955 92 15 96.688004 ATTORNEY) 2 1 95 0 0 0 1101 1826 499 5 -1 3 1 95 1 0 0 1101 1826 499 5 -1 4 1 95 1 1 0 1101 1826 499 5 -1 5 1 95 1 1 1 1101 1826 499 5 95.000000 2 1 96 0 0 0 397 1840 901 9 -1 3 1 96 1 0 0 397 1840 901 9 -1 4 1 96 1 1 0 397 1840 901 9 -1 5 1 96 1 1 1 397 1840 901 9 95.000000 2 1 97 0 0 0 1294 1841 5 110 -1 3 1 97 1 0 0 1294 1841 5 110 -1 4 1 97 1 1 0 1294 1841 5 110 -1 5 1 97 1 1 1 1294 1841 5 110 95.000000 2 1 98 0 0 0 396 1847 4 107 -1 3 1 98 1 0 0 396 1847 4 107 -1 4 1 98 1 1 0 396 1847 4 107 -1 5 1 98 1 1 1 396 1847 4 107 95.000000 2 1 99 0 0 0 147 1944 1430 11 -1 3 1 99 1 0 0 147 1944 1430 11 -1 4 1 99 1 1 0 147 1944 1430 11 -1 5 1 99 1 1 1 147 1944 1430 11 95.000000 2 1 100 0 0 0 147 2003 1430 11 -1 3 1 100 1 0 0 147 2003 1430 11 -1 4 1 100 1 1 0 147 2003 1430 11 -1 5 1 100 1 1 1 147 2003 1430 11 95.000000 2 1 101 0 0 0 148 2022 1428 26 -1 3 1 101 1 0 0 148 2022 1428 26 -1 4 1 101 1 1 0 148 2022 1428 26 -1 5 1 101 1 1 1 148 2033 50 13 90.425720 FL-150 5 1 101 1 1 2 204 2033 35 15 90.198563 [Rev. 5 1 101 1 1 3 245 2032 138 16 96.752159 September 5 1 101 1 1 4 326 2025 16 30 96.889351 1, 5 1 101 1 1 5 349 2025 38 30 96.539001 2024] 5 1 101 1 1 6 647 2027 94 18 95.979668 INCOME 5 1 101 1 1 7 749 2026 51 19 96.190170 AND 5 1 101 1 1 8 809 2026 110 18 96.225479 EXPENSE 5 1 101 1 1 9 928 2024 169 19 96.438469 DECLARATION 5 1 101 1 1 10 1494 2023 36 15 93.226372 Page 5 1 101 1 1 11 1536 2022 7 12 93.226372 3 5 1 101 1 1 12 1549 2022 27 12 96.636902 of 5 1 101 1 1 13 1572 2015 8 29 96.890648 4

FORM INSTRUCTIONS FL-150 PETITIONER: [PARTY WHO INITIALLY OPENED CASE _| CASE NUMBER: RESPONDENT: [THE OTHER PARTY _| COURT CASE NUMBER OTHER PARTY/PARENT/CLAIMANT: CHILD SUPPORT INFORMATION (NOTE: Fill out this page only if your case involves child support.)

• WRITE IN THE NUMBER OF MINOR CHILD(REN) YOU HAVE WITH THE OTHER

16. Number of children | paRENT IN THIS CASE AND HOW MUCH TIME EACH PARENT SPENDS WITH THEM a. | 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.) IF YOU DO NOT KNOW A PERCENTAGE, DESCRIBE PARENTING SCHEDULE EXAMPLE: THE CHILDREN LIVE WITH ME AND ARE WITH THE OTHER PARENT EVERY 1ST AND 3RD WEEKEND FROM FRIDAY AT 6PM TO SUNDAY AT 6M
17. Children's health-care expenses @ [|] !do [_] Idono have health insurance available to me for the children through my job. b. Name of insurance company: CHECK WHETHER YOU DO OR DO NOT HAVE HEALTH INSURANCE FOR THE CHILDREN. c. in : Address of insurance company IF YOU DO HAVE HEALTH INSURANCE, WRITE THE NAME AND ADDRESS OF THE INSURANCE ~<—_COMPANY AND HOW MUCH YOU PAY, NOT HOW MUCH YOUR EMPLOYER PAYS y 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 a. Childcare so | can work or get job training............. fete es eee cee eescaeeaseeceeeesessesecevisereeces $ b. Children's health care not covered by insurance c. Travel expenses for visitation d Amount per month WRITE IN —_ ANY OTHER EXPENSES IF Children's educational or other special needs (specify below): IT APPLIES

• . . ‘ 7 ae FILL IN ITEMS a. - c. AND DESCRIBE

19. Special hardships. | ask the court to consider the following special financial circumstances THE HARDSHIP BELOW (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............ccccccsceeeseeeeee $ b. Major losses not covered by insurance (examples: fire, theft, other $ INSULOM 1OSS) 0... ce ec ecceccccscssesssesssesesseseesssesesssesestsvaseacieatesessesersesevsneavanesees c. (1) Expenses for my minor children who are from other relationships and are liVINg With MG... cececcceesceeseeeescsecscseesssceecsestevesesssseessusstsesseserssvevers (2) Names and ages of those children (specify): (3) Child support | receive for those children. $ The expenses listed in a, b, and c create an extreme financial hardship because (explain): EXPLAIN WHY THESE EXPENSES CREATE AN EXTREME FINANCIAL HARDSHIP
20. Other information | want the court to know concerning support in my case (specify): [WRITE ANY INFORMATION HERE YOU WANT THE COURT TO KNOW REGARDING CHILD SUPPORT IN THIS CASE] FL-150 [Rev. September 1, 2024] INCOME AND EXPENSE DECLARATION Page 4 of 4

FL-335 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address). FOR COURT USE ONLY IYOUR NAME YOUR ADDRESS SAMPLE CITY, STATE, ZIP CODE ONLY YOUR TELEPHONE NUMBER FAX NO, (Optona: E-MAIL ADDRESS (Optional): DO N OT ATTORNEY FOR (Name). SUPERIOR COURT OF CALIFORNIA, COUNTY OF street aporess: |Fresno County Superior Court WRITE ON MAILING S: wpe arancu name: [Fresno CA 93724-2220 PETITIONER/PLAINTIFE: [PARTY WHO INITIALLY OPENED CASE CASE NUMBER CASE NUMBER (if applicable, provide): RESPONDENT/DEFENDANT: |THE OTHER PARTY OTHER PARENT/PARTY: HEARING DATE: PROOF OF SERVICE BY MAIL HEARING TIME DEPT. _| NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330). 4. lam at least 18 years of age, not a party to this action, and | am a resident of or employed in the county where the mailing took place. 2. My residence or business address is: SERVER'S ADDRESS SERVER'S CITY, STATE, AND ZIP CODE 3. | served a copy of the following documents (specify) : WRITE IN THE NAME(S) AND THE FORM(S) OF THE DOCUMENTS BEING SERVED ON THE OTHER PARTY by enclosing them in an envelo WN a. () <epositing the-sealed envelope with the United States Postal Service with the postage fully prepaid. b. () —facing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary business practices. | am readily familiar with this business's practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. 4. The envelope was addressed and mailed as follows: a. Name of person served:|THE OTHER PARTY'S NAME | b. Address:[THE OTHER PARTY'S ADDRESS | c. Date mailed: [DATE SERVER MAILED YOUR FORMS TO THE OTHER PARTY, d. Place of mailing (city and state): |CITY AND STATE WHERE THE FORMS WERE MAILED DO NOT 5. a | | served a request to modify a child custody, visitation, or child support judgment or permanent order which included arp address verification declaration. (Declaration Regarding Address Verification—Postjudgment Request to Modify a C) YOU ARE Custody, Visitation, or Child Support Order (form FL-334) may be used for this purpose.) INCLUDING FL-334 6. | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: DATE SERVER SIGNS _ [SERVER PRINTS THEIR NAME HERE| » SERVER SIGNS HERE (TYPE OR PRINT NAME) (SIGNATURE OF PERSON COMPLETING THIS FORM)

Form Approved for Optional Use . . PROOF OF SERVICE BY MAIL Code of Civil Procedure, §§ 1013, 10134 Judicial Council of California CEB Essential www courts.ca.gov FL-335 [Rev. January 1, 2012] ceb.com | {2|Forms™

FL-320 PARTY WITHOUT ATTORNEY OR ATTORNEY NAME: FIRM NAME STREET ADDRESS CITY: TELEPHONE NO. EMAIL ADDRESS ATTORNEY FOR (name). STATE BAR NUMBER STATE: FAX NO. ZIP CODE SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: OTHER PARENT/PARTY: FOR COURT USE ONLY RESPONSIVE DECLARATION TO REQUEST FOR ORDER CASE NUMBER: HEARING DATE: TIME: DEPARTMENT OR ROOM: Read Information Sheet: Responsive Declaration to Request for Order (form FLL-320-INFO) for more information about this form.

1. [] RESTRAINING ORDER INFORMATION a. [] No domestic violence restraining/protective orders are now in effect between the parties in this case. b. [-_] | agree that one or more domestic violence restraining/protective orders are now in effect between the parties in this case.
2. [] CHILD CUSTODY [-_] VISITATION (PARENTING TIME) a. [] | consent to the order requested for child custody (legal and physical custody). b. [] I consent to the order requested for visitation (parenting time). c. [] | do not consent to the order requested for [__] but | consent to the following order:
3. [| CHILD SUPPORT a. | have completed and filed a current Income and Expense Declaration (form FL-150) or, if eligible, a current Financial [] child custody Statement (Simplified) (form FL-155) to support my responsive declaration. b. [_] I consent to the order requested. c. [] I consent to guideline support. d. [-_] | do not consent to the order requested [| but | consent to the following order:
4. SPOUSAL OR DOMESTIC PARTNER SUPPORT [] visitation (parenting time) a. | have completed and filed a current Income and Expense Declaration (form FL-150) to support my responsive declaration. b. [] I consent to the order requested. c. [__] | do not consent to the order requested [|] but! consent to the following order:

Form Adopted for Mandatory Use Judicial Couneil of California FL-320 [Rev. July 1, 2025] RESPONSIVE DECLARATION TO REQUEST FOR ORDER Code of Civil Procedure, § 1005 Cal. Rules of Court, rule 5.92 courts,ca.gov

FL-320 PETITIONER: GASE NUMBER: RESPONDENT: OTHER PARENT/PARTY: 5. [] PROPERTY CONTROL a. [] I consent to the order requested. b. [-] | do not consent to the order requested [—] but! consent to the following order: 6. [] ATTORNEY'S FEES AND COSTS a. | have completed and filed a current Income and Expense Declaration (form FL-150 ) to support my responsive declaration. b. | have completed and filed with this form a Supporting Declaration for Attomey's Fees and Costs Attachment (form FL-158) or a declaration that addresses the factors covered in that form. c. [__] I consent to the order requested. d. [-] | do not consent to the order requested [-] but | consent to the following order: 7. [|] OTHER ORDERS REQUESTED a. [—] I consent to the order requested. b. [-] | do not consent to the order requested {-] but! consent to the following order: 8. [|] TIME FOR SERVICE / TIME UNTIL HEARING a. [] I consent to the order requested. b. [-] | do not consent to the order requested {-] but! consent to the following order: 9. [] FACTS TO SUPPORT my responsive declaration are listed below. The facts that | write and attach to this form cannot be longer than 10 pages, unless the court gives me permission. [] Attachment 9.

| declare under penalty of perjury under the laws of the State of California that the information provided in this form and all attachments

is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) FL-320 (Rev. July 1, 2025] RESPONSIVE DECLARATION TO REQUEST FOR ORDER Page 2 of 2

MC-031 PLAINTIFF/PETITIONER: CASE NUMBER: DEFENDANT/RESPONDENT: DECLARATION (This form must be attached to another form or court paper before it can be filed in court.)

| 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) (CC) Attorney for (CC) Plaintitt (CQ) Petitioner () Respondent C) other (Specify): i | Defendant Form Approved for Optional Use CEB ATTACHED DECLARATION i ; | Essential Judicial Council of California MC-031 [Rev. July 1, 2005] cebcom | {2]/Forms-

MC-031 PLAINTIFF/PETITIONER CASE NUMBER: DEFENDANT/RESPONDENT: DECLARATION (This form must be attached to another form or court paper before it can be filed in court.)

| 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) (C] Attorney for =) Plaintiff © ()) Petitioner oO Respondent [_] Other (Specify):

| Defendant

Form Approved for Optional Use Judicial Council of California MC-031 [Rev. July 1, 2005] ATTACHED DECLARATION

FL-105/GC-120 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO. EMAIL ADDRESS: ATTORNEY FOR (name). SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: (This section applies to cases other than probate guardianships.) PETITIONER: RESPONDENT: OTHER PARTY: CHILD'S NAME (Juvenile cases only): (This section applies only to probate guardianship cases.) CASE NUMBER: GUARDIANSHIP OF (name): Minor DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

1. lam (check one): [] a party to this proceeding to determine custody of a child [] the authorized representative of the agency, which is a party to this proceeding to determine custody of a child.
2. There are (specify number): minor children who are subject to this proceeding, as follows (list ofdest child first): Full Name Date of birth Place of birth (city and state) a. b. c. d. [_] Check this box if you need to list more children. (On form MC-020 or a separate piece of paper, write FL-105, 5 1 29 1 1 23 1411 1309 119 18 96.901001 Attachment 5 1 29 1 1 24 1537 1309 15 21 97.000778 2, 4 1 29 1 2 0 248 1338 1189 27 -1 5 1 29 1 2 1 248 1344 106 18 96.123169 Additional 5 1 29 1 2 2 361 1343 98 18 95.088257 Children at the top, provide all requested information for each additional child, and attach to this form.)
3. a. [] Check this box if there is only one child or if all of the children listed in item 2 have lived together for the past five years. (Provide the current address of the child listed in item 2a and their residence history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) Dates of residence Residence Person child lived with and Relationshi (Month/Year) (City, State) complete current address P From: To present Confidential (list state only) [] Confidential (list state only) From: To: From: To: From: To: From: To: {] Additional addresses are listed on Attachment 3a. (Form MC-020 may be used for this purpose.) b. [] Check this box if there is more than one child and all the children have not lived together for the past five years. (Attach form FL-105(A)/GC-120(A) and list each other child's current address and their residence history for the past five years.)

‘sl Counel of Calorie DECLARATION UNDER UNIFORM CHILD CUSTODY brava Code, 818100), 1812 FL-105/GC-120 (Rev. January 1, 2025] JURISDICTION AND ENFORCEMENT ACT (UCCJEA) www.courts.ca.gov

FL-105/GC-120 CASE NAME: CASE NUMBER: 4. Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding? [J] Yes [“] No _ (If yes, attach a copy of the orders if you have one and provide the following information): Court Court order Your Proceeding Case number | (name, state or tribe, | or judgment | Name of each child | connection to | Case status location) (date) the case a. [] Family Probate 6 C4 Guardianship c. [] Other Proceeding Case Number Court (name, state or tribe, location) d. [] Juvenile e. [] Adoption 5. [] One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one and provide the following information): Court County State or Tribe Case Number (if known) Orders expire (date) a. [] Criminal b. [_] Family c. [] Juvenile d. [] Other 6. Do you know of any person who is not a party to this proceeding who has physical custody of or claims to have rights to custody of or visitation with any child in this case? [] Yes [] No __ (if yes, provide the following information): a. Name and address of person: b. Name and address of person: c. Name and address of person: [] Has physical custody (] Has physical custody [] Has physical custody {] Claims custody rights [-] Claims custody rights [-] Claims custody rights {] Claims visitation rights [] Claims visitation rights [] Claims visitation rights Name of each child: Name of each child: Name of each child: 7. [-_] Number of pages attached:

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

» (NAME OF DECLARANT) (SIGNATURE OF DECLARANT) Date: NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody proceeding in a California court or any other court concerning a child subject to this proceeding. FLAAOS/GE-120 (Rev. January 4, 2025] DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

FL-105(A)/GC-120(A) CASE NAME: CASE NUMBER: ATTACHMENT TO DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) Instructions: /f all the children subject to the proceeding have not lived together for the last five years, use as many copies of this form as needed to list all the children. Number each item and each page consecutively, and attach all pages to form FL-105/GC-120. 3. b. Name of child: (Provide the child's current address and their residence history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) [] Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (ifnot the same, provide the information below.) Dates of residence Residence Person child lived with (name and Relationshi (Month/Year) (City, State) complete current address) P From: To present {—_] Confidential (list state only) _|[__] Confidential (list state only) From: To: From: To: From: To: From: To: 3. b. Name of child: (Provide the child's current address and their residence ~~ history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) [] Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (Ifnot the same, provide the information below.) Dates of residence Residence Person child lived with (name and Relationshi (Month/Year) (City, State) complete current address) P From: To present Confidential (list state only) [] Confidential (list state only) From: To: From: To: From: To: From: To: Page of_ ily Code, § 3400 a SusiealCounelofCtfora ATTACHMENT TO brabts Code, §§ 151000, 1812 FL-105(A)/GC-120(A) DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION woww.courts,ca.gov {Rev. January 1.2025] AND ENFORCEMENT ACT (UCCJEA)

FL-105(A)IGC-120(A) CASE NAME: CASE NUMBER: ATTACHMENT TO DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) Instructions: /f all the children subject to the proceeding have not lived together for the last five years, use as many copies of this form as needed to list all the children. Number each item and each page consecutively, and attach all pages to form FL-105/GC-120. 3. b. Name of child: (Provide the child's current address and their residence history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) (] Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (If not the same, provide the information below.) Dates of residence Residence Person child lived with (name and Relationshi (Month/Year) (City, State) complete current address) P From: To present [] Confidential (list state only) |[__] Confidential (list state only) From: To: From: To: From: To: From: To: 3. b. Name of child: (Provide the child's current address and their residence ~~ history for the past five years. /f the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) [] Residence information is the same as given for the child listed in item 2a on form FL-105/GC-120. (If not the same, provide the information below.) Dates of residence Residence Person child lived with (name and Relationship - (Month/Year) (City, State) complete current address) P From: To present [_] Confidential (list state only) [] Confidential (list state only) From: To: From: To: From: To: From: To: Page of Form Adopted for Mandatory U: Family Code, § 3400 et seq.; Judeal Council of Calforia ATTACHMENT TO Pravate Cad, §§1510(0, 1812 FL-05(A)IGC-120(A) DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION wwnw,courts.ca.gov FRev. Janvary§, 2025] AND ENFORCEMENT ACT (UCCJEA)

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 STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: 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 . Employer: | of your pay . Employer's address: stubs for last | ©: Employer's phone number: two months d. Occupation: (black out e. Date job started: Social f. If unemployed, date job ended: Security g. | work about hours per week. numbers). h. I get paid $ gross (before taxes) [] permonth [] perweek [__] perhour. (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 5 1 21 1 2 4 402 1140 99 17 87.555008 1—Other 5 1 21 1 2 5 508 1139 66 18 87.547256 Jobs at the top.)
2. Age and education a. My age is (specify): b. Ihave 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. Ihave: [] professional/occupational license(s) (specify): . {__] vocational training (specify):
3. Tax information a. [] | last filed taxes for tax year (specify year): b. My tax filing statusis [-] single [-] headofhousehold [] married, filing separately [] married, filing jointly with (specify name): c. Ifile 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. | 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:

| 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. September 1, 2024] 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 and divide the total by 12.) 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 ..........sccecceeeeeceeteeeees $ e. Spousal support ["] from this marriage [] from adifferent marriage [] federally taxable* $ f. Partner support [] from this domestic partnership [_] froma different domestic partnership $ g. Pension/retirement fund payments. .$ h. Social Security retirement (not SSI) we $ i. Disability: [] Social Security (not SSI) [] State disability (SDI) | [__] Private insurance $ j. Unemployment compensation $ k. Workers’ compensation. ...........:0ccccccccscsesesteseeseseeseaee $

1. Other (military allowances, royalty payments) (specify): $
2. Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.) a. Dividends/interest $ b. Rental property income $ C. TTUSt INCOME... ccccssees ccs eessceseteestesseeeeee sesseuesteessvessecauscisciacsnssassuestisscavecsuscesesressuesnuesieesieeseeieaneeeeeees $ d. Other (specify): $
3. Income from self-employment, after business expenses for all businesses $ lamthe [] owner/sole proprietor {] business partner [] other (specify): Number of years in this business (specify): Name of business (specify): Type of business (specify): Average Last month monthly 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.
4. [__] Additional income. | received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and amount):
5. ["_] Change in income. My financial situation has changed significantly over the last 12 months because (specify):
6. Deductions Required union dues Required retirement payments (not Social Security, FICA, 401(k), or IRA Child support that | pay for children from other relationships Spousal support that | pay by court order from a different marriage [__] federally tax deductible*. Partner support that | pay by court order from a different domestic partnership g. Necessary job-related expenses not reimbursed by my employer (attach explanation labeled Question 5 1 27 1 4 14 1316 1762 51 23 94.350052 10g) mg aoo®”
7. Assets a. Cash and checking accounts, savings, credit union, money market, and other deposit accounts b. Stocks, bonds, and other assets | could easily sell c. Allother property, [_] real and [-] personal (estimate fair market value minus the debts you owe) Medical, hospital, dental, and other health insurance premiums (total monthly AMOUN)............ccsceeeseseeeteeeeee 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. September 1, 2024] INCOME AND EXPENSE DECLARATION

FL-150 PETITIONER: RESPONDENT: OTHER PARTY/PARENT/CLAIMANT: CASE NUMBER: 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..........ccccecceereeeee $ (1) J] Rent or [/_] mortgage.......... $ i. Clothes... $ If mortgage: j. Education $ (a) average principal: $ k. Entertainment, gifts, and vacation...... .$ (b) average interest: $ I. Auto expenses and transportation (2) Real property taxes... $ (insurance, gas, repairs, bus, etc.). 8 (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 repa n. Savings and investments.. b. Health-care costs not paid by insurance........ $ 0. Charitable contributions. . p. Monthly payments listed in item 14 c. Child care cececeeesesseseeesssesssereeaeess serene $ (itemize below in 14 and insert total here)... § d. Groceries and household supplies. q. Other (specify): $ e. Eating out o SE aoe : r. TOTAL EXPENSES (a-q) (do not add in f. Utilities (gas, electric, water, trash)............... $ the amounts in a(1)(a) and (b)) 5 g. Telephone, cell phone, and e-mail................. $ 3 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 information is required if either party is requesting attorney fees): a. To date, | have paid my attorney this amount for fees and costs (specify): $ b. The source of this money was (specify): c. | still owe the following fees and costs to my attorney (specify total owed): $ d. My attorney's hourly rate is (specify):

| confirm this fee arrangement.

Date: » (TYPE OR PRINT NAME OF ATTORNEY) (SIGNATURE OF ATTORNEY)

FL-150 (Rev. September 1, 2024] INCOME AND EXPENSE DECLARATION

FL-150 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARTY/PARENTICLAIMANT: CHILD SUPPORT INFORMATION (NOTE: Fill out this page only if your case involves child support.) 16. Number of children a. b a b c d 18. Additional expense for the children in this case a b. c. d

| have (specify number): children under the age of 18 with the other parent in this case.

. 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.) hildren's health-care expenses . J Ido [-—] Ido not have health insurance available to me for the children through my job.

• Name of insurance company: . Address of insurance company: . The monthly cost for the children's health insurance is or would be (specify): $ (Do not include the amount your employer pays.) Amount per month Childcare so | can work or get job training........ Children's health care not covered by insuranc Travel expenses for visitation AAA

19. Special hardships. | 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............csccccscesseseseees $ b. Major losses not covered by insurance (examples: fire, theft, other $ insured loss) qT (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 | receive for those Children.......ccccccscescescessecsecseeseeseeseenes $ he expenses listed in a, b, and c create an extreme financial hardship because (explain):
20. Other information | want the court to know concerning support in my case (specify): FL-150 [Rev. September 1, 2024] INCOME AND EXPENSE DECLARATION Page 4 of 4

FL-335 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO. FAX NO. (Optional): E-MAIL ADDRESS (Optional) ATTORNEY FOR (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: (if applicable, provide): OTHER PARENT/PARTY: HEARING DATE: PROOF OF SERVICE BY MAIL ee NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330). 4. lam atleast 18 years of age, not a party to this action, and | am a resident of or employed in the county where the mailing took place. 2. My residence or business address is: 3. [served a copy of the following documents (specify) : by enclosing them in an envelope AND a. [-] depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. b. (2) placing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary business practices. | am readily familiar with this business's practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. 4. The envelope was addressed and mailed as follows: a. Name of person served: b. Address: c. Date mailed: d. Place of mailing (city and state): 5. [] I served a request to modify a child custody, visitation, or child support judgment or permanent order which included an address verification declaration. (Declaration Regarding Address Verification—Postjudgment Request to Modify a Child Custody, Visitation, or Child Support Order (form FL-334) may be used for this purpose.) 6. | 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 PERSON COMPLETING THIS FORM) page t of 1 age 1 of Form Approved for Optional Use . . PROOF OF SERVICE BY MAIL Code of Civil Procedure, §§ 1013, 1013a Judicial Council of California CEB | Essential www.courts.ca.gov FL-335 (Rev. January 1, 2012) ¢l- | FElForms: