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IN THE DISTRICT COURT FOR THE 		 JUDICIAL DISTRICT
FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF 				

						,
		Petitioner,
	vs.

						,
		Respondent.
	
Case No. 					

AFFIDAVIT VERIFYING INCOME

I hereby state under oath that the following information is true:

A.	GROSS INCOME							FATHER	MOTHER

1.	Wages, salary, commissions, bonuses, etc.			                	________
2.	Rent, royalties, trade, or business income, etc.		                	________
	(net of ordinary & necessary expenses)
3.	Interest, dividends, pensions, annuities, etc.			                	________
4.	Social security, worker's compensation, unemployment
	benefits, disability, veterans' benefits, etc.			                	________
5.	Public assistance, welfare for self (not children)		                	________
6.	Alimony							                	________
7.	Grants, distributions from trusts, etc.				                	________
8.	Other								                	________
9.	SUBTOTAL							                	________

B.	DEDUCTIONS FROM GROSS INCOME 			FATHER 	MOTHER	
	(I.C.S.G. Sections 6 and 7)
1.	Straight line depreciation on assets				                	________
2.	One-half of self-employment Social Security taxes		                	________
3.	Child support & alimony from another relationship		                	________
4.	Support for child of another relationship living
	in the home							                	________
5.	DEDUCTIONS SUBTOTAL 					                	________
C.	GROSS INCOME, AS ADJUSTED				                	________
(line B5 subtracted from line A9)

D. 	IN-KIND BENEFITS (I.C.S.G. Section 6(b))			                	________
(housing, food, transportation, recreation)	 

E.	POTENTIAL INCOME (I.C.S.G. Section 6(c))			                	________
Potential earned income + Potential unearned income

F.	GUIDELINES INCOME (C + D + E)				                	________

G.	MONTHLY I.C.S.G. INCOME (F12 months)			               _	________

                

CERTIFICATION UNDER PENALTY OF PERJURY

I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct.

Date: 				

													
Typed/printed 		 				 	Signature