- Read through the form
completely and carefully before completing.
- Fill out each area, as it
applies, as completely as possible.
- All information should be printed
- Applicant fills out
everything except Sections IX, X, and XI.
- Three months of current pay
stubs are required with report form. If pay stubs are not available,
then two years of tax returns are required. Other verification may be
- Please print or type
juvenile's name on the upper right hand corner of the form.
- The parent(s), as the
applicant(s), completes the form with his or her (their) income, expenses,
and assets information.
- A daytime phone number must
be included on the form.
- Leave court information blank
(i.e., case number, case type).
- Verification will be
required. Please provide your case number.
- Tax returns may be necessary
to verify annual income after taxes.
- Any citizen who declines to
give this information will be taken as agreeing to pay the maximum amount.
- Monthly take-home is
described as gross pay, less involuntary deductions (federal
withholding tax, FICA, L&I, mandatory pension, union dues, etc.).
- A tax return may be required
to verify information about non-wage income such as rental, interest, etc.
Affidavit and Notification:
- IRS tax returns may be
requested to verify this information.
If you have any questions or need
assistance in completing the form, please contact the
Parent Pay Department
Thurston County Juvenile Court.
- Please print and sign your
- "Place" is the city
and state where you are in when you sign the form.