Please indicate all income received in each of the past six months from any source. Do not guess. Examine your bank records or other advice:
Category
This month
1 month ago
2 months ago
3 months ago
4 months ago
5 months ago
6 months ago
Gross Wages
Week 1
Week 2
Week 3
Week 4
Week 5
Other Commission
Other Social Security
Other
TOTAL GROSS INCOME
Deductions
Taxes: Fed, State, FICA, Med
Total Taxes
T pass
401(k)
401(k) loan
health ins
health FSA
Life/Disable
Child Support
Other
The Law Office of Elaine M. Benkoski may be defined as a “Debt Relief Agency”. Material presented on this website is intended for informational purposes only. It is NOT intended as professional advice and should not be construed as such. To see the complete Legal Disclaimer for using of information on this web site Click Here.
