This video is intended only to provide general legal information about how to fill out a Short Form Financial Statement.
The information in this video is not intended to be relied upon as legal advice. For legal advice you should consult an attorney.
By continuing with this video, you are agreeing to the statement above.
[A sample Short Form Financial Statement Section 2 appears on screen]
All Questions in this section must be answered. Do not leave any blank lines and do not write N/A. If a line does not apply to you, simply put a zero.
Paragraph 2: Gross Weekly Income.
In this section you will report your income to the court before taxes are taken out of your pay. There are different types of income that can be reported on a financial statement. We will highlight the sections with the most common questions.
[A finger graphic points to section a) - Base pay from.]
If your income is from salary or wages, you will need a paystub or W2 form to complete Part 2(a), (b) and (c) in order to provide the best information.
If you do not know where to find your paystub, contact your employer. As you may know, paystubs may look different from job to job. As we go through this section, a sample paystub will pop up and circle areas to show you where information may be found.
Notice that this form asks for weekly income.
[A sample pay stub appears circling "Period Beginning," "Period Ending," "Pay Date," and their associated dates]
If you receive income bi-weekly, meaning every two weeks, you would divide the gross amount you receive by two.
[Gross Pay of $1,600 is circled in red and pops out next to a divided by 2 equation. A black arrow points to the equation value, $800, now written in the first form field]
If you receive income monthly, divide the number by 4.3. 4.3 is the number used to divide monthly amounts because some months have five weeks rather than four weeks.
If your income fluctuates or changes, you should figure out an average amount that you make and write down that your income changes.
[$0 is written in the second form field.]
You may also wish to write a note to tell the Court how you came to that number.
["Month of June 2024 $500 divided by 4.3" is slowly written on screen. A black arrow writes the equation value, $116.2, now written in the third form field.]
[A finger graphic points to section c) Part-time job.]
If you have a part-time job or work overtime hours, you must add that information, regardless of whether it is part of your regularly worked hours. You can always add a note on the financial statement to explain if that income is not a regular part of your income.
[A finger graphic points to section d) Self-employment.]
If you are self-employed, you will need an additional form called Schedule A to complete this section. This video will not show how to fill out this form.
[Form fields 4 through 9 are filled with $0]
If you use your personal vehicle to provide ride-share services, like Uber or Lyft, you should complete a Schedule A first.
[A finger graphic points to Section j) Social Security.]
Write any money you get from the Social Security Administration for yourself or on behalf of your children. If you receive Supplemental Security Income (“SSI”), you may write this into sections k or l but you should write “SSI” next to the category.
[$0 is written in form field 10, black arrows point to form fields 11 and 12, and "SSI" is written to the left of section l) Public Assistance.]
If you receive Social Security Disability (“SSDI”), you should write “SSDI” next to disability.
["SSDI" is written under section k) Disability.]
If you receive some SSI and some SSDI, be sure to separate them to show how much of each you receive.
["SSI" and "SSDI" are removed from the sample form.]
With any type of Social Security benefits, it is important to identify the type of social security you are receiving because it may make a difference in calculating child support.
[A finger graphic points to section k) Disability.]
Disability is any money you receive from a private source for a disability, like an insurance company, or you may choose to add your SSI or SSDI benefits here. Again, make sure you write down the kind of social security you are receiving.
[A finger graphic points to section l) Public Assistance.]
Public Assistance refers to the money you receive from the government from programs like TAFDC, EAEDC, WIC, or SNAP, also known as welfare, cash benefits or food stamps. You must write how much you receive as a weekly amount from the government by dividing the monthly amount by 4.3. Write a note that lets the court know each type of benefit you have included in your income.
["SNAP, TAFDC, and SSI" are written on the sample page. A black arrow points to form field 12, now with $41.86 written in it.]
[A finger graphic points to section m.]
If you receive child support for any of your children, even if it is for children who are not part of this case, list it here.
[A check mark appears in the box next to "Child Support" in section m.]
You can always add a short note explaining if the child support listed is for the children you are talking about in this case or if it is child support for children who are not part of this case. For example, if you have two children and you receive child support from different parents, list the total amount you receive for child support and write a note saying how much you receive for each child.
["$50 for child not involved in case. $75 for child involved (monthly)($125 divided by 4.3)" is written in the space between the form sections and fillable form fields. A black arrow points to form field 13, now with $29.07 written in it.]
If you are not receiving court ordered payments of child support at the time you are completing your financial statement because the other parent is not making payments, you should write “0” on that line.
[A finger graphic points to section n) Rental from income producing property.]
Rental from income producing property: You will need an additional form called Schedule B to complete this section. We will not go over how to complete a Schedule B in this video.
[$0 is written in form field 14 and 15.]
Contributions from household member(s): If you live with someone who contributes to your household, you may list their financial contributions here.
[$0 is written in form field 16, 17, and 18.]
Total Gross Weekly Income or Receipts: Add all of the income you listed on the first page and write it here.
[The values input into the sample form fields pop out and show + signs between them. A black arrow points to the total amount of the form fields, $987.21, now written in section r) Total Gross Weekly Income/Receipts.]
If you are getting food stamps or any other cash benefit from the government, make sure you make a note about it below the total.
["*total includes benefits" is written below the gross total.]