
©SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY DROSC13f-091511
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AFI
Case No.
3. YOUR EDUCATION/TRAINING: List name of school, length of time there, year of last attendance,
and degree earned:
A. High School:
B. College:
C. Post-Graduate:
D. Occupational Training:
4. YOUR GROSS MONTHLY INCOME:
List all income you receive from any source, whether private or governmental, taxable or not.
List all income payable to you individually or payable jointly to you and your spouse.
Use a monthly average for items that vary from month to month.
Multiply weekly income and deductions by 4.33. Multiply biweekly income by 2.165 to arrive at
the total amount for the month.
A. Gross salary/wages per month $
Attach copies of your two most recent pay stubs.
Rate of Pay $ per [ ] hour [ ] week [ ] month [ ] year
B. Expenses paid for by your employer:
1. Automobile $
2. Auto expenses, such as gas, repairs, insurance $
3. Lodging $
4. Other (Explain) $
C. Commissions/Bonuses $
D. Tips $
E. Self-employment Income (See below) $
F. Social Security benefits $
G. Worker's compensation and/or disability income $
H. Unemployment compensation $
I. Gifts/Prizes $
J. Payments from prior spouse $
K. Rental income (net after expenses) $
L. Contributions to household living expense by others $
M. Other (Explain:) $
(Include dividends, pensions, interest, trust income, annuities
or royalties.)
TOTAL: $
5. SELF-EMPLOYMENT INCOME (if applicable):
If you are self-employed, attach of a copy of the Schedule C for your business from your last tax
return and the most recent income/expense statement from your business.
If self employed, provide the following information:
Name, address and telephone no. of business:
Type of business entity:
State and Date of incorporation:
Nature of your interest:
Nature of business:
Percent ownership:
Number of shares of stock: