IDSC | Supreme Court
Full Name of Party Filing Document?Mailing Address (Street or Post Office Box)City, State and Zip Code?Telephone?Email AddressIN THE DISTRICT COURT FOR THE JUDICIAL DISTRICTFOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF ,Petitioner,vs.,Respondent.Case No. AFFIDAVIT VERIFYING INCOMEI hereby state under oath that the following information is true:A.GROSS INCOME (I.R.F.L.P. 126 Section F)(PARENT) (PARENT)1.Wages, salary, commissions, bonuses, etc. ________2.Rent, royalties, trade, or business income, etc. ________(net of ordinary & necessary expenses)3.Interest, dividends, pensions, annuities, etc. ________4.Social security, worker's compensation, unemploymentbenefits, disability, veterans' benefits, etc. ________5.Public assistance, welfare for self (not children) ________6.Alimony ________7.Grants, distributions from trusts, etc. ________8.Other ________9.SUBTOTAL ________B.DEDUCTIONS FROM GROSS INCOME (PARENT)(PARENT)(I.R.F.L.P. 126 Sections F and G)1.Straight line depreciation on assets ________2.One-half of self-employment Social Security taxes ________3.Child support & alimony from another relationship ________4.Support for child of another relationship livingin the home ________5.DEDUCTIONS SUBTOTAL ________C.GROSS INCOME, AS ADJUSTED ________(line B5 subtracted from line A9)D. FRINGE BENEFITS (I.R.F.L.P. Section F.2) ________(i.e. car, housing, room and board) E.POTENTIAL INCOME (I.R.F.L.P. Section F.3) ________Potential earned income + Potential unearned incomeF.GUIDELINES INCOME (C + D + E) ________G.MONTHLY I.C.S.G. INCOME (F12 months) ________ CERTIFICATION UNDER PENALTY OF PERJURYI certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct.Date: Typed/printed Signature ................
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