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  • 8/6/2019 Emancipation Income and Expense

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    CASE NUMBER:IN THE MATTER OF (NAME):

    Amount7. The average of my gross monthly earnings is:

    Salary and wages, including bonuses and overtimea. $

    Money received from parents or other adults assisting meb. $

    (name and relationship):

    Other (specify source and amount) $c.

    Value8. I have the following assets:

    Casha. $

    b. Checking account $

    Savings account $c.

    d. Stocks, bonds $

    Vehicle (year, make, model)e. $

    f. Other (specify) $

    9. My monthly expenses are: Amount

    Rent or Mortgagea. $

    Foodb. $

    Clothing $c.

    Phone and utilitiesd. $

    Vehiclee.

    (1) Loan payments $

    (2) Maintenance $

    I declare under penalty of perjury that the foregoing is true and correct.

    Date:

    (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)

    EMANCIPATION OF MINORINCOME AND EXPENSE DECLARATION

    MC-306 (Rule 1285.50E) [Rev. January 1, 1995] Page two

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    Print This Form

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