FL-150 - Income and Expense Declaration

Summary

Income and Expense Declaration

Text

Form ID: FL-150
Title: Income and Expense Declaration
Effective Date: 2024-09-01
Mandatory Form: yes
Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt
Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-150
Primary Download URL: https://www.courts.ca.gov/documents/fl150.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/fl150c.pdf, https://www.courts.ca.gov/documents/fl150k.pdf, https://www.courts.ca.gov/documents/fl150s.pdf, https://www.courts.ca.gov/documents/fl150t.pdf, https://www.courts.ca.gov/documents/fl150v.pdf
Form Detail Page:
Income and Expense Declaration
(FL-150)
Give your financial information to the court and to your spouse or domestic partner.  The court uses the information to make orders for support, attorneys fees, and other costs.
Get form FL-150
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(Spanish)
Tagalog
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(Tagalog)
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(Vietnamese)
Effective: September 1, 2024
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Child Support Form Packets
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Divorce Form Packets
PDF Text:
Page 1 of 4
Form Adopted for Mandatory Use 
Judicial Council of California 
FL-150 [Rev. September 1, 2024]
INCOME AND EXPENSE DECLARATION Family Code, §§ 2030–2032, 2100–2113, 
3552, 3620–3634, 4050–4076, 4300–4339 
www.courts.ca.gov
FL-150
PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
FOR COURT USE ONLY
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
1. Employment (Give information on your current job or, if you're unemployed, your most recent job.)
Attach copies 
of your pay 
stubs for last 
two months 
(black out 
Social 
Security 
numbers).
a. Employer:
b. Employer's address:
c. Employer's phone number:
d. Occupation:
e. Date job started:
f. If unemployed, date job ended:
g. I work about  hours per week.
h. I get paid $ per month per week per hour.gross (before taxes)
(If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other 
jobs. Write "Question 1—Other Jobs" at the top.)
2. Age and education
a. My age is (specify):
b. I have completed high school or the equivalent: Yes No If no, highest grade completed (specify):
c. Number of years of college completed (specify): Degree(s) obtained (specify):
d. Number of years of graduate school completed (specify): Degree(s) obtained (specify):
e. I have: professional/occupational license(s) (specify):
vocational training (specify):
3. Tax information
a. I last filed taxes for tax year (specify year):
b. My tax filing status is single head of household married, filing separately
married, filing jointly with (specify name):
c. I file state tax returns in California other (specify state):
d. I claim the following number of exemptions (including myself) on my taxes (specify):
4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $
This estimate is based on (explain):
(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the 
question number before your answer.) Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and 
any attachments is true and correct.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF DECLARANT)

FL-150 [Rev. September 1, 2024] Page 2 of 4INCOME AND EXPENSE DECLARATION
FL-150
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
CASE NUMBER:
Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax 
return to the court hearing. (Black out your Social Security number on the pay stub and tax return.)
5. Income (For average monthly, add up all the income you received in each category in the last 12 months
and divide the total by 12.) Last month
Average 
monthly
Salary or wages (gross, before taxes).....................................................................................................a. $
b. Overtime (gross, before taxes)................................................................................................................ $
c. Commissions or bonuses......................................................................................................................... $
d. Public assistance (for example: TANF, SSI, GA/GR)                                            ..................................currently receiving $
e. Spousal support  from this marriage from a different marriage federally taxable* $
f. Partner support from this domestic partnership from a different domestic partnership $
g. Pension/retirement fund payments.......................................................................................................... $
h. Social Security retirement (not SSI)......................................................................................................... $
i. Disability: Social Security (not SSI) State disability (SDI) Private insurance $
j. Unemployment compensation................................................................................................................. $
k. Workers' compensation............................................................................................................................ $
l. Other (military allowances, royalty payments) (specify): $
6. Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)
a. Dividends/interest.................................................................................................................................... $
b. Rental property income........................................................................................................................... $
c. Trust income............................................................................................................................................ $
d. Other (specify): $
7. Income from self-employment, after business expenses for all businesses......................................... $
I am the owner/sole proprietor business partner other (specify):
Number of years in this business (specify):
Name of business (specify):
Type of business (specify):
Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your 
Social Security number. If you have more than one business, provide the information above for each of your businesses.
8. Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and 
amount):
9. Change in income. My financial situation has changed significantly over the last 12 months because (specify):
10. Deductions Last month
a. Required union dues.................................................................................................................................................... $
b. Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................$
c. Medical, hospital, dental, and other health insurance premiums (total monthly amount)............................................. $
d. Child support that I pay for children from other relationships....................................................................................... $
e. Spousal support that I pay by court order from a different marriage                                                  ..........................federally tax deductible* $
f. Partner support that I pay by court order from a different domestic partnership.......................................................... $
g. Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g")......... $
11. Assets Total
a. Cash and checking accounts, savings, credit union, money market, and other deposit accounts............................... $
b. Stocks, bonds, and other assets I could easily sell.......................................................................................................$
c. All other property,                                                                (estimate fair market value minus the debts you owe).....real    and personal $
* Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change 
maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.

FL-150 [Rev. September 1, 2024] Page 3 of 4INCOME AND EXPENSE DECLARATION
FL-150
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
CASE NUMBER:
12. The following people live with me:
Name Age
How the person is 
related to me (ex: son)
That person's gross 
monthly income
Pays some of the  
household expenses?
a. Yes No
b. Yes No
c. Yes No
d. Yes No
e. Yes No
Average monthly expenses13. Estimated expenses Actual expenses Proposed needs
a. Home:
(1) Rent     or mortgage.......... $
If mortgage:
(a)  average principal: $
(b)  average interest: $
(2) Real property taxes.................................. $
(3) Homeowner's or renter's insurance 
(if not included above).............................. $
(4) Maintenance and repair........................... $
b. Health-care costs not paid by insurance........ $
c. Child care....................................................... $
d. Groceries and household supplies................. $
e. Eating out....................................................... $
f. Utilities (gas, electric, water, trash)................ $
g. Telephone, cell phone, and e-mail................. $
h. Laundry and cleaning................................... $
i. Clothes......................................................... $
j. Education..................................................... $
k. Entertainment, gifts, and vacation................ $
l. Auto expenses and transportation 
(insurance, gas, repairs, bus, etc.)............... $
m. Insurance (life, accident, etc.; do not include 
auto, home, or health insurance)................. $
n. Savings and investments............................. $
o. Charitable contributions................................ $
p. Monthly payments listed in item 14 
(itemize below in 14 and insert total here)... $
q. Other (specify): $
r. TOTAL EXPENSES (a–q) (do not add in  
the amounts in a(1)(a) and (b)) $
s. Amount of expenses paid by others $
Paid to
14. Installment payments and debts not listed above
For Amount Balance Date of last payment
$ $
$ $
$ $
$ $
$ $
$ $
Attorney fees (This information is required if either party is requesting attorney fees):15.
a. To date, I have paid my attorney this amount for fees and costs (specify): $
b. The source of this money was (specify):
c. I still owe the following fees and costs to my attorney (specify total owed): $
d. My attorney's hourly rate is (specify):
I confirm this fee arrangement.
Date:
(TYPE OR PRINT NAME OF ATTORNEY)
 (SIGNATURE OF ATTORNEY)

FL-150 [Rev. September 1, 2024] Page 4 of 4INCOME AND EXPENSE DECLARATION
CHILD SUPPORT INFORMATION 
(NOTE: Fill out this page only if your case involves child support.)
FL-150
CASE NUMBER:PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
17. Children's health-care expenses
a. I do I do not have health insurance available to me for the children through my job.
b. Name of insurance company:
c. Address of insurance company:
d. The monthly cost for the children's health insurance is or would be (specify): $
(Do not include the amount your employer pays.)
Number of children16.
a. I have (specify number): children under the age of 18 with the other parent in this case.
b. The children spend  percent of their time with me and  percent of their time with the other parent.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Additional expense for the children in this case18.
a. Childcare so I can work or get job training.................................................................... $
b. Children's health care not covered by insurance........................................................... $
c. Travel expenses for visitation........................................................................................ $
d. Children's educational or other special needs (specify below):..................................... $
Amount per month
19. Special hardships. I ask the court to consider the following special financial circumstances
(attach documentation of any item listed here, including court orders): Amount per month For how many months?
a. Extraordinary health expenses not included in 18b................................... $
b. Major losses not covered by insurance (examples: fire, theft, other 
insured loss)............................................................................................... $
c. (1) Expenses for my minor children who are from other relationships and 
are living with me.................................................................................. $
(2) Names and ages of those children (specify):
(3) Child support I receive for those children............................................... $
The expenses listed in a, b, and c create an extreme financial hardship because (explain):
20. Other information I want the court to know concerning support in my case (specify):

Retrieval chunks

• #1

  Form ID: FL-150 Title: Income and Expense Declaration Effective Date: 2024-09-01 Mandatory Form: yes Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-150 Primary Download URL: https://www.courts.ca.gov/documents/fl150.pdf Alternate Download URLs: https://www…

• #2

  jobs. Write "Question 1—Other Jobs" at the top.) 2. Age and education a. My age is (specify): b. I have completed high school or the equivalent: Yes No If no, highest grade completed (specify): c. Number of years of college completed (specify): Degree(s) obtained (specify): d. Number of years of graduate school c…

• #3

  d. Public assistance (for example: TANF, SSI, GA/GR) ..................................currently receiving $ e. Spousal support from this marriage from a different marriage federally taxable* $ f. Partner support from this domestic partnership from a different domestic par…

• #4

  a. Required union dues.................................................................................................................................................... $ b. Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................$ c…

• #5

  (if not included above).............................. $ (4) Maintenance and repair........................... $ b. Health-care costs not paid by insurance........ $ c. Child care....................................................... $ d. Groceries and household supplies................. $ e. Eating out..........…

• #6

  a. I have (specify number): children under the age of 18 with the other parent in this case. b. The children spend percent of their time with me and percent of their time with the other parent. (If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.) Additi…