Spouse: Have you had a bankruptcy or foreclosure in the last 7 years?
Choose One
Yes
No
Spouse: Monthly Gross Income: (Include Before Tax Values- Salary, Overtime, Commissions, Etc.)
Choose One
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
$5,500
$6,000
$6,500
$7,000
$7,500
$8,000
$8,500
$9,000
$9,500
$10,000
$10,500
$11,000
$11,500
$12,000
$12,500
$13,000
$13,500
$14,000
$14,500
$15,000
$15,500
$16,000
$16,500
$17,000
$17,500
$18,000
$18,500
$19,000
$19,500
$20,000
$20,500
$21,000
$21,500
$22,000
$22,500
$23,000
$23,500
$24,000
$24,500
$25,000
$25,500
$26,000
$26,500
$27,000
$27,500
$28,000
$28,500
$29,000
$29,500
$30,000
$30,500
$31,000
$31,500
$32,000
$32,500
$33,000
$33,500
$34,000
$34,500
$35,000
$35,500
$36,000
$36,500
$37,000
$37,500
$38,000
$38,500
$39,000
$39,500
$40,000
$40,500
$41,000
$41,500
$42,000
$42,500
$43,000
$43,500
$44,000
$44,500
$45,000
$45,500
$46,000
$46,500
$47,000
$47,500
$48,000
$48,500
$49,000
$49,500
$50,000
Spouse: Do you pay alimony and/or child support?
Choose One
Yes
No
