Santa Barbara — SC-4028*

Source: https://www.santabarbara.courts.ca.gov/system/files/sc4028.pdf

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ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY

ATTORNEY FOR (NAME):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA Santa Barbara–Anacapa Santa Maria-Cook Lompoc Division 1100 Anacapa Street 312-C East Cook Street 115 Civic Center Plaza Santa Barbara, CA 93101 Santa Maria, CA 93454 Lompoc, CA 93436

PETITIONER:

RESPONDENT:

CASE NUMBER:

FINANCIAL DOCUMENT EXCHANGE COMPLIANCE DECLARATION (Wage Earner/Unemployed)

I, ___________________________________________ (name of party) declare the following:

1. This declaration is made in connection with: (check and complete all that apply)

   A case management conference, family centered case resolution conference, status conference, trial setting conference, or other Court Conference that is scheduled for _______________ (date) at ____________ (time).

A request for order, order to show cause, or other Motion that will be or has been filed by _________________________ (party) and is scheduled for _______________ (date) at ____________ (time). 2. During the previous two years (check all that apply): (a) I am, or was, employed as a wage earner (b) I am, or was, unemployed (c) I am, or was, self-employed (d) I am, or was, the beneficial owner of thirty percent (30%) or more of a business entity. If you checked boxes 2(c) or 2(d), do not use this form. Instead, use form SC-4029 FINANCIAL DOCUMENT EXCHANGE COMPLIANCE DECLARATION (SELF-EMPLOYED/ BUSINESS OWNER) 3. (Check only if applicable) (a) I previously filed form SC-4028 on _____________ (date) and all information on that form is complete and current as of the date stated below. (If you check this box, skip to the end of this form, fill in your name and the date, and sign this form.) (b) I have good cause not to complete this form at all and request to be excused from complying with Local Rule 1419 because ______________________________________________________________ or see attachment 3(b). (If you can provide some documents, do not check this box and complete the remainder of the form.) 4. Except as stated below, the documents set forth below were served on __________________________ (party), on _________________ (date). 5. Federal income tax returns, including all schedules, for the two prior years: (check and complete all that apply) All tax returns for the two prior years were served on the date stated in item 4. All tax returns for the two prior years were served on the date stated in item 4, except tax returns for tax years __________________ (list tax years from tax returns or state “all”) which were not served because these tax returns were: served as part of a previous Local Rule 1419 document exchange on _______________ (date) served as an attachment to an Income and Expense Declaration (Form FL-150) served on __________________ (date)

Form Adopted for Mandatory Use FINANCIAL DOCUMENT EXCHANGE COMPLIANCE Page 1 Santa Barbara Superior Court DECLARATION (Wage Earner/Unemployed) SC-4028 [New January 2019] Print Form Clear Form

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(Item 5 continued) served with a Declaration of Disclosure (Form FL-140) served on ______________ (date) received from the other party (explain other reason) _________________________________________________________ see attachment 5.

6. Personal bank account statements and corresponding check registers for all accounts for the prior 12 months: (check and complete all that apply) All bank account statements and check registers for all accounts for the prior 12 months were served on the date stated in item 4. All bank account statements and check registers for all accounts for the prior 12 months were served on the date stated in item 4, except ___________________________________________________ (list each document by type and dates or state “all”) which were not served because these documents were: served as part of a previous Local Rule 1419 document exchange on _______________ (date) served as an attachment to an Income and Expense Declaration (Form FL-150) served on __________________ (date) served with a Declaration of Disclosure (Form FL-140) served on ______________ (date) received from the other party (explain other reason) __________________________________________________________ see attachment 6.

7. Pay stubs for the last 2 months: (check and complete all that apply) All pay stubs for the last 2 months were served on the date stated in item 4. All pay stubs for the last 2 months were served on the date stated in item 4, except ________________ (list dates or state “all”) which were not served because these documents were: served as part of a previous Local Rule 1419 document exchange on _______________ (date) served as an attachment to an Income and Expense Declaration (Form FL-150) served on __________________ (date) served with a Declaration of Disclosure (Form FL-140) served on ______________ (date) received from the other party (explain other reason) _________________________________________________________ see attachment 7.

8. IRS W-2 and 1099 forms not attached to federal tax returns for the prior year: (check and complete all that apply) There are no IRS W-2 and 1099 forms that were not attached to federal tax returns. All IRS W-2 and 1099 forms that were not attached to federal tax returns forms for tax were served on the date stated in item 4. All IRS W-2 and 1099 forms that were not attached to federal tax returns forms for tax were served on the date stated in item 4, except __________________ (list form number and tax years from tax forms) were not served because these tax forms were: served as part of a previous Local Rule 1419 document exchange on _______________ (date) served as an attachment to an Income and Expense Declaration (Form FL-150) served on __________________ (date) served with a Declaration of Disclosure (Form FL-140) served on ______________ (date) received from the other party (explain other reason) ________________________________________________________ see attachment 8.

Form Adopted for Mandatory Use FINANCIAL DOCUMENT EXCHANGE COMPLIANCE Page 2 Santa Barbara Superior Court DECLARATION (Wage Earner/Unemployed) SC-4028 [New January 2019] Print Form Clear Form

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9. Complete disclosure. (Check one) All documents that are within my possession, custody, or control that are required to be served pursuant to Local Rule 1419 have been served or service is excused for the reasons set forth in this declaration and its attachments. I have filed, or I am filing concurrently with the filing of this declaration, a request for order or order to show cause requesting that the court excuse or limit the documents I am required to serve under Local Rule

   1419. I have not complied with Local Rule 1419 at this time because _________________________________

         see attachment 9.

I, __________________________ (name of party) declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: (Signature of Party)

Form Adopted for Mandatory Use FINANCIAL DOCUMENT EXCHANGE COMPLIANCE Page 3 Santa Barbara Superior Court DECLARATION (Wage Earner/Unemployed) SC-4028 [New January 2019] Print Form Clear Form