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Get AER 57R 2011

TEM AMOUNT Fed Income Tax Social Security (FICA) Medicare State Income Tax Insurance (SGLI/TSGLI/Navy Home/FSGLI) Dental Plan Child Support TSP Garnishment Other Other Allotment 1 Other Allotment 2 Other Allotment 3 Other Allotment 4 TOTAL DEDUCTIONS TOTAL MONTHLY EXPENDITURES TOTAL MONTHLY INCOME BALANCE (+ OR ) SIGNATURE OF APPLICANT AER Form 57R (Dec 11) (Local Reproduction Authorized). Previous editions of this form are obsolete DATE SIGNED AMOUNT .

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