Net Worth Statement Form (Gender Neutral) (00067581-5).DOC
(State whether your income has changed during the year preceding date of this affidavit. If so, please explain.) Attach most recent W-2, 1099s, K1s and income tax returns. List any amount deducted from gross income for retirement benefits or tax deferred savings. (b) To the extent not already included in gross income in (a) above: 1. ................
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