11.07.2015 Views

Local Rule - State of Indiana

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Gross IncomePer week bi-weekly per month yearlyNet IncomePer week bi-weekly per month yearlyB. EMPLOYMENT HISTORY FOR LAST 5 YEARSEmployer Dates <strong>of</strong> employment Compensation (perwk/mo/yr)C. INCOME SUMMARY1. GROSS WEEKLY INCOME from: Salaryand wages, including commissions, bonuses,allowances and over-time $Note: If paid monthly, determine weekly income bydividing monthly income by 4.3Pensions & RetirementSocial SecurityDisability and unemployment insurancePublic Assistance (welfare, AFDC payments, etc.)Food stampsChild support received for any child(ren) not born<strong>of</strong> the parties to this marriageDividends and InterestRents receivedAll other sources (specify)8

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