INCOME

How often are you paid?  Weekly_______, Every 2 weeks_______, Twice Per Month___________, Monthly________________

Gross Income per period (Before Taxes)______________________________________________

Commissions________________________________________________________

Estimated Overtime___________________________________________________

LESS PAYROLL DEDUCTIONS

a.                   Payroll Taxes and Social Security____________________________________

b.                  Insurance___________________________________

c.                   Union dues__________________________________

d.                  Other_______________________________________

Regular Income from operation of a business_____________________________

Income from Real Property_________________________________________

Alimony or Support received_________________________________________

Social Security or other Government Assistance___________________________

(Specify)__________________________________________________________

Pension or retirement Income_____________________________________________

Other Monthly Income_______________________________________________

(Specify)__________________________________________________________

YOU MAY ALSO FAX OR EMAIL A COPY OF YOUR MOST RECENT PAYSTUB INSTEAD OF FILLING OUT THIS FORM.

FAX: 1-888-471-8612

EMAIL: dlmarler@bellsouth.net

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