Fillable SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA (The Superior Court of California, County of Santa Clara)

Fill Online, Printable, Fillable, Blank SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA (The Superior Court of California, County of Santa Clara) Form

Use Fill to complete blank online THE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA (The Superior Court of California, County of Santa Clara)

On average this form takes 35 minutes to complete

The SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA (The Superior Court of California, County of Santa Clara) form is 4 pages long and contains:

  • 0 signatures
  • 20 check-boxes
  • 131 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your The Superior Court of California, County of Santa Clara forms online.

BROWSE THE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
JV-2020 REV 01/01/16
FINANCIAL DECLARATION / SUBSEQUENT FINANCIAL DECLARATION
Page 1 of 4
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address):
TELEPHONE NUMBER: FAX NUMBER (Optional):
EMAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
COURT ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
201 North First Street, San José, CA 95113
191 North First Street
San José, CA 95113
Juvenile Dependency
CHILDREN’S NAMES:
FOR COURT USE ONLY
FINANCIAL DECLARATION
Financial Evaluation Hearing Date:
Time: Dept.
THIS SECTION FOR COURT USE ONLY
SUBSEQUENT FINANCIAL DECLARATION
I am Requesting a Hearing for Reconsideration of my Order to Repay
Attorney Fees filed on (date):
My Request is Based on:
Change of Financial Circumstances
Financial Inability to Comply with Reunification Plan Requirements
Reconsideration Hearing Date:
Time: Dept.
CASE NUMBER:
RELATED CASES:
1. Personal Information:
Name: Social Security Number:
Other Names Used: I.D. or Driver’s License:
Address:
Check here if you are In custody. Detention Center:
Release Date:
Date of Birth: Age:
City: Zip Code: Phone: Alternate Phone:
2. I receive (check all that apply):
Medi-Cal SNAP SSI SSP County/Relief/General Assistance
IHSS (In-Home Supportive Services) CalWORKS or Tribal TANF (Tribal Temporary Assistance to Needy Families )
CAPI (Case Assistance Program for Aged, Blind and Disabled)
3.
My gross monthly income (before deductions for taxes) is less than the amount listed below:
If you checked box 3, circle the Family Income section that applies to your case.
Family Size Family Income Family Size Family Income Family Size Family Income
1 $1,228.05 3 $2,092.71 5 $2,959.38
2
$1,659.38
4
$2,526.05
6
$3,392.71
If more than 6
people in family,
add $433.34 for
each extra person.
If you checked any boxes in section 2 or 3 above, skip sections 4 through 8. Go to section 9, read and fill in the section
and sign the form.
Hearing
Date→
Hearing
Date→
To keep other people from
seeing what you have
entered, please press the
Reset Form button at the end
of this form when finished.
(CONFIDENTIAL) ATTACHMENT JV-2020
CHILDREN’S NAMES:
RESPONSIBLE PARTY’S NAME:
CASE NUMBER:
RELATED NUMBERS:
JV-2020 REV 01/01/16
FINANCIAL DECLARATION / SUBSEQUENT FINANCIAL DECLARATION
Page 2 of 4
4. Family:
a. Marital Status: Single Married Divorced Separated Widowed Domestic Partner
b. Name of Spouse/Partner:
c. Number of Dependent Children Living with You Who are Under the Age of 18:
d. Dependents’ Names and Ages:
5. Employment:
Your Employment Spouse/Partner Employment
If you checked “Married” or “Domestic Partner” in 4a,
above, fill out this section.
Employer: Employer:
Address: Address:
City and Zip Code: Phone: City and Zip Code: Phone:
How Long
Employed?
Working
Now?
Monthly Salary: Take Home Pay: How Long
Employed?
Working
Now?
Monthly Salary: Take Home Pay:
If not now employed, who was your last employer?
(Name, Address and Zip Code)
If not now employed, who was your last employer?
(Name, Address and Zip Code)
Phone number of last employer: Phone number of last employer:
6. Income and Assets:
Other Income
Unemployment and Disability .................. $
Social Security/ /SSD............................... $
General Relief.......................................... $
Worker’s Compensation........................... $
Child Support Payments .......................... $
Foster Care.............................................. $
Other Income ........................................... $
Total $
What do you own?
Cash ...................................................$
Real Property/Equity ................................$
Cars and Other Vehicles ..........................$
Life Insurance...........................................$
Bank Accounts (list below) .......................$
Stocks and Bonds ....................................$
Business Interest......................................$
Other Assets.............................................$
Total $
Name and Branch of Bank:
Account Numbers:
0
0
(CONFIDENTIAL) ATTACHMENT JV-2020
CHILDREN’S NAMES:
RESPONSIBLE PARTY’S NAME:
CASE NUMBER:
RELATED NUMBERS:
JV-2020 REV 01/01/16
FINANCIAL DECLARATION / SUBSEQUENT FINANCIAL DECLARATION
Page 3 of 4
7. Expenses
List your monthly expenses
Rent or Mortgage Payment...................... $
Car Payment............................................ $
Gas and Car Insurance............................ $
Public Transportation............................... $
Utilities (Gas, Electric, Phone, Water)...... $
Food....................................................... $
Clothing and Laundry............................... $
Child Care................................................ $
Child Support Payments ........................ $
Medical Expenses.................................... $
Other Necessary Monthly Expenses........ $
Total $
Monthly cost of services required by your
reunification plan
(If you do not know the cost, please indicate “UK” )
Parenting Classes …… ......................... $
Substance Abuse Trmt .......................... $
Therapy/Counseling ………………….… $_______________
Medical Care/Medications ........................$
Domestic Violence Counseling.................$
Batterers’ Intervention ............................ $
Victim Support ..........................................$
Regional Center Programs .......................$
Transportation ........................................ $
In-Home Services.....................................$
Other ........................................................$
Other ........................................................$
Total $
8. Loan/Expense Payments
Name of lender and type of loan/expense Monthly Payment Balance Owed
$ $
$ $
$ $
0
0
(CONFIDENTIAL) ATTACHMENT JV-2020
CHILDREN’S NAMES:
RESPONSIBLE PARTY’S NAME:
CASE NUMBER:
RELATED NUMBERS:
JV-2020 REV 01/01/16
FINANCIAL DECLARATION / SUBSEQUENT FINANCIAL DECLARATION
Page 4 of 4
9. I, , understand that a hearing will be set to determine my ability to pay the
costs for legal services. If I do not appear at the hearing and do not pay in full the assessed costs for legal services, the court
may enter a judgment against me without further notice or order.
I understand that I have a right to a separate evidentiary hearing to determine my ability to pay the assessed fees, in the
event that I dispute the judicial officer’s order for repayment. I further understand that I am entitled to the following at that
evidentiary hearing:
• The opportunity to be heard in person;
• The opportunity to present witnesses and written evidence;
• The opportunity to confront and cross-examine witnesses brought against me.
• Disclosure of the evidence against me;
• A written statement of findings of the court;
• To be represented by an attorney and, if I cannot afford an attorney, to have an attorney appointed to represent me; and
I understand that at any time prior to full repayment of any fees ordered by the court that I may petition the court to modify or
vacate its previous judgment on the grounds of a change in circumstances with regard to my ability to pay the judgment.
I certify under penalty of perjury that the above information is true and correct. I understand that perjury is punishable by
imprisonment; I also consent to the release of my credit information from credit reporting agencies.
Date:
X
(TYPE OR PRINT NAME OF RESPONSIBLE PARTY/APPLICANT) (SIGNATURE OF RESPONSIBLE PARTY/APPLICANT)
Clerk’s Certificate of Service
I certify that I am not involved in this case. This notice of hearing was served on the responsible party by
personal service
mail and to counsel for the responsible party by mail pony mail at the street address listed above.
Date:
Clerk, By , Deputy
FOR COURT USE ONLY
TOTAL INCOME $
TOTAL EXPENSES $
NET DISPOSABLE INCOME $
FEES BASED ON UNIFORM COST MODEL $
TOTAL FEES ASSESSED $
PAYMENT DUE TO COURT ON
Reset Form
(CONFIDENTIAL) ATTACHMENT JV-2020
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA (The Superior Court of California, County of Santa Clara)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document