Ventura — Declaration in Support of Dissomaster Calculations

Source: https://ventura.courts.ca.gov/system/files/vn115.pdf

Case Name Case No. D.A. File No.

DECLARATION IN SUPPORT OF DISSOMASTER TM CALCULATIONS

I, HEREBY DECLARE AS FOLLOWS:

1. I am the Petitioner/Respondent in the above entitled matter. I have personal knowledge of all the matters set forth herein, except as to those matters stated upon information and belief, as to those matters, I believe them to be true.

2. There is/are minor child(ren) of this relationship.

3. I have primary physical custody of the child(ren) approximately % of the time, as compared to the
   other parent.

4. My federal income tax filing status is: single married filing separately married filing Jointly head of household with exemption(s).

5. My gross monthly income is , from the following sources:

   Regular wages and salary .
   Self-employment income . (After the cost of doing business)
   Other . Source

   Irregular income .

6. I have the following regular monthly deductions or expenses:

   Mandatory retirement Medical Insurance costs

   401K or deferred compensation Child care

   Mortgage interest Property Tax Union dues

   Child support/spousal support paid to another relationship

7. I estimate the other party's gross monthly income to be Based on

8. I support other child(ren) of mine, in my home.

9. I receive support for other child(ren) of

10. I am experiencing extreme financial hardship(s) caused by:

    and I request the Court

    grant me a monthly deduction in the amount of to accommodate these circumstances.

I hereby declare under penalty of perjury under the laws of the State of California, that the foregoing statements are

true and correct. Executed in Ventura County on .

Optional Form VN115 Rev. 07/01/03 Signature