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Get IN Form 402 B

Dent. HUSBAND: Name: Address: WIFE: Name: Address: Employer: Attorney: Address: Employer: Attorney: Address: Telephone: Telephone: VERIFIED FINANCIAL DECLARATION OF GROSS WEEKLY INCOME-Attach last 3 paycheck stubs 1 SALARY AND WAGES 2 PENSIONS/RETIREMENT/SOCIAL SECURITY/DISABILITY/UNEMPLOYMENT/WORKER'S COMP 3 CHILD SUPPORT received from prior marriage 4 DIVIDENDS AND INTEREST 5 RENTS/ROYALTIES less ordinary/necessary expenses 6 BUSINESS/SELF-EMPLOYMENT INCOME-not after expenses 7 COMMISSIO.

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