IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
If you have a different pay period than the choices given below, or your pay varies (for instance if you have more than one job and different pay periods), estimate your total average pay as closely as possible and convert it to a monthly pay amount. Enter it here as monthly.
If you receive a regular paycheck from an employer, then choose your pay rate and pay period below, and the income table will calculate monthly totals for you, based on your pay stub deductions. However, if you have multiple jobs with different pay periods, are self-employed, retired, etc, choose “monthly” here so that no further calculations will be done on your entries in the income table.
Pay rate $
Your Gross Monthly pay is $
If this doesn’t seem right, please double-check your entry, or calculate your monthly gross wages manually and enter it above as “Monthly”.
SECTION I. PRESENT MONTHLY GROSS INCOME
Attach extra sheets to your printed form, if needed to cover extra items and
descriptions. Items included under “other” should be listed separately with
separate dollar amounts. Where you calculate amounts, make sure and use MONTHLY
amounts for all the following sections, unless otherwise noted.
The online form makes conversions between other pay periods to monthy, as far as
|1. Monthly gross salary or wages
|2. Monthly bonuses, commission, allowances, overtime, tips and similar payments
|3. Monthly business income from sources such as self-employment, partnerships, close corporations, and/or independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) (Attach sheet itemizing such income and expenses.)
|4. Monthly disability benefits/SSI received
|5. Monthly Workers’ Compensation received
|6. Monthly Unemployment Compensation received
|7. Monthly pension, retirement, or annuity payments received
|8. Monthly Social Security Benefits received
|9. Monthly Alimony payment actually received 9a. From this case: $
9b. From other case(s): $
|9. $ 0
|10. Monthly interest and dividends received
|11. Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income)
(Attach sheet itemizing such income and expense items.)
|12. Monthly income from royalties, trusts, or estates
|13. Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses
|14. Monthly gains derived from dealing in property (not including nonrecurring gains)
|15. Any other income of a recurring nature (list source)
|16. Any other income of a recurring nature (list source)
|17. PRESENT MONTHLY GROSS INCOME TOTAL:
||17. $ 0.00
SECTION III. ASSETS AND LIABILITIES
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item is “nonmarital,” meaning it belongs to only one of you and should not be divided. You should indicate to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if property/debt was owned/owed by one spouse before the marriage. See the “General Information for Self-Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for definitions of “marital” and “nonmarital” assets and liabilities.)
B. LIABILITIES (DEBTS):
C. CONTINGENT ASSETS AND LIABILITIES:
INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts assumed by another), you must list them here.
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