Form 1F-P-826 "Income and Expense Statement" - Hawaii

What Is Form 1F-P-826?

This is a legal form that was released by the Hawaii Family Court - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2011;
  • The latest edition provided by the Hawaii Family Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1F-P-826 by clicking the link below or browse more documents and templates provided by the Hawaii Family Court.

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Download Form 1F-P-826 "Income and Expense Statement" - Hawaii

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C A S E N U MB E R
STATE OF HAWAI‘I
INCOME AND EXPENSE STATEMENT
FAMILY COURT
FC-CU No.
Plaintiff
Defendant
FIRST CIRCUIT
This document is prepared by:
G
G
G
G
Plaintiff
Defendant
Atty for Plaintiff
Atty for Defendant
PLAINTIFF,
(Full Name)
Name
v.
Address
DEFENDANT.
City, State, Zip Code
(Full Name)
Telephone No.
Employer:
Occupation (Job Title):
Address:
Length of Service:
months/years. Income Tax Withholding based on:
dependents.
INCOME
G
G
G
G
G
Gross income paid:
monthly,
2 times per month,
every 2 weeks,
weekly,
or other
Gross per pay period
......................................
$
Per month
..........
$
Payroll deductions per pay period:
Fed. income tax
.....................................
$
State income tax
...................................
$
FICA (Social Security)
............................
$
Union dues
............................................
$
a) Net per pay period
...................
$
Per month
........
$
0.00
0.00
0.00
Other:
Retirement/401 K
..................................
$
Credit Union
..........................................
$
Direct Deposit
.......................................
$
Income Assignments
.............................
$
Support Payments
.................................
$
Medical Insurance
.................................
$
b) Take home per pay period
.......
$
Per month
........
$
0.00
0.00
Other regular monthly income
nd
(rental incom e, 2
job, interest, child support, welfare, food
.
stam ps, and any other source)
Gross monthly receipt
...........................
$
Taxes paid IRS and State on above
.......
$
$
c) Total other income net
..............
0.00
Total Monthly Income (Add per month from lines a and c above)
....
$
0.00
FOR COURT USE ONLY
In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable
accommodation for a disability, please contact the ADA Coordinator at the Office of the Chief Administrator at PHONE NO.954-8200, FAX
954-8212, or TTY 539-4853 at least ten (10) working days prior to your hearing or appointment date.
Please call Ho‘okele, the Self-Help Desk, at 954-8290, if you have any questions about how to fill out this form.
FC A dm 12/11
RevaComm 508 Certified
P A G E 1 O F 3 PA G E S
C U D A IN C O M E & E XP E N SE ST A T E M EN T
1F-P-826
Reprographics (12/11)1F
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Reset Form
C A S E N U MB E R
STATE OF HAWAI‘I
INCOME AND EXPENSE STATEMENT
FAMILY COURT
FC-CU No.
Plaintiff
Defendant
FIRST CIRCUIT
This document is prepared by:
G
G
G
G
Plaintiff
Defendant
Atty for Plaintiff
Atty for Defendant
PLAINTIFF,
(Full Name)
Name
v.
Address
DEFENDANT.
City, State, Zip Code
(Full Name)
Telephone No.
Employer:
Occupation (Job Title):
Address:
Length of Service:
months/years. Income Tax Withholding based on:
dependents.
INCOME
G
G
G
G
G
Gross income paid:
monthly,
2 times per month,
every 2 weeks,
weekly,
or other
Gross per pay period
......................................
$
Per month
..........
$
Payroll deductions per pay period:
Fed. income tax
.....................................
$
State income tax
...................................
$
FICA (Social Security)
............................
$
Union dues
............................................
$
a) Net per pay period
...................
$
Per month
........
$
0.00
0.00
0.00
Other:
Retirement/401 K
..................................
$
Credit Union
..........................................
$
Direct Deposit
.......................................
$
Income Assignments
.............................
$
Support Payments
.................................
$
Medical Insurance
.................................
$
b) Take home per pay period
.......
$
Per month
........
$
0.00
0.00
Other regular monthly income
nd
(rental incom e, 2
job, interest, child support, welfare, food
.
stam ps, and any other source)
Gross monthly receipt
...........................
$
Taxes paid IRS and State on above
.......
$
$
c) Total other income net
..............
0.00
Total Monthly Income (Add per month from lines a and c above)
....
$
0.00
FOR COURT USE ONLY
In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable
accommodation for a disability, please contact the ADA Coordinator at the Office of the Chief Administrator at PHONE NO.954-8200, FAX
954-8212, or TTY 539-4853 at least ten (10) working days prior to your hearing or appointment date.
Please call Ho‘okele, the Self-Help Desk, at 954-8290, if you have any questions about how to fill out this form.
FC A dm 12/11
RevaComm 508 Certified
P A G E 1 O F 3 PA G E S
C U D A IN C O M E & E XP E N SE ST A T E M EN T
1F-P-826
Reprographics (12/11)1F
Reset Form
Reset Form
INCOME AND EXPENSE STATEMENT
CASE NUMBER
STATE OF HAWAI‘I
FAMILY COURT
Plaintiff
Defendant
FIRST CIRCUIT
FC-CU No.
Page 2 of 3 Pages
EXPENSES
Do not list expenses which are paid by payroll deduction.
Housing expenses per month:
Rent, mortgage, agreement of sale.............. $
Insurance if not included above.................... $
Real property taxes
........... $
(if paid separately)
Utilities
.. $
(gas, water, electricity, phone, etc.)....
Transportation expenses per month:
Car payment, lease, rental........................... $
Insurance on vehicle.................................... $
Maintenance
.................................... $
(repairs)
Operating
.............................. $
(gas, oil & tires)
Total Housing and Transportation Expenses........................................................................... $
0.00
Debt service
....... $
(all m onthly paym ents, e.g. credit cards, charges, finance com pany, personal loans)
Personal Expenses per month:
Self
Children No.
(
)
Food............................................................. $
$
Clothing........................................................ $
$
Medical and Dental...................................... $
$
Laundry & Cleaning...................................... $
$
Personal articles.......................................... $
$
Recreation
............................... $
$
(m ovies, etc.)
School (include food)................................... $
$
Household.................................................... $
$
Bus
................................... $
$
(on m onthly basis)
Other (
) ................... $
$
Payment to others for dependent care......... $
$
0.00
0.00
Sub-Totals........................................ $
$
0.00
Total Personal Expenses...............................................................$
Grand Total Expenses: Housing, Transportation, Debt & Personal................................ $
0.00
0.00
Savings, <Deficiency>: Income minus Expenses............................................................ $
FC A dm 12/11
RevaComm 508 Certified
P A G E 2 O F 3 P A G E S
C U D A IN C O M E & E XP E N S E S T A T E M E N T
1F-P-826
INCOME AND EXPENSE STATEMENT
STATE OF HAWAI‘I
C A S E N U MB E R
FAMILY COURT
Plaintiff
Defendant
FIRST CIRCUIT
FC-CU No.
Page 3 of 3 Pages
Explain in detail where savings are invested, or if there is a <deficiency>, who provides the funds
to maintain the level of spending indicated in this income and expense statement. (Use separate sheet
if more space is needed.)
CERTIFICATION
I hereby declare under the penalty of perjury that I have supplied the information used in this Income
and Expense Statement and have reviewed this Statement and I certify that the information is accurate,
complete, and correct.
G
G
DATE
PLANTIFF’S
DEFENDANT’S
SIGNATURE
FC A dm 12/11
RevaComm 508 Certified
P A G E 3 O F 3 P A G E S
C U D A IN C O M E & E XP E N S E S T A T E M E N T
1F-P-826
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