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Household Resource Worksheet - Fairfield County Probate Court
Guardianship Of
Case Number
Parent or Custodian 1 Name
Parent or Custodian 1 Occupation
Parent or Custodian 1 Employer
Parent or Custodian 1 Age
Parent or Custodian 1 Monthly Gross Income
Parent or Custodian 2 Name
Parent or Custodian 2 Occupation
Parent or Custodian 2 Employer
Parent or Custodian 2 Age
Parent or Custodian 2 Monthly Gross Income
Other Dependents One
Other Dependents Two
Other Dependents Three
Other Dependents Four
Monthly Rent or Mortgage
Monthly Natural Gas
Monthly Electric
Monthly Water
Monthly Telephone
Monthly Cable
Monthly Groceries
Monthly Insurance
Monthly Automobile
Monthly Out of Pocket Medical
Monthly Other Expenses
Total Monthly Expenses