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DC-606 Financial Statement - Judiciary of Virginia

Clear All Data Financial Statement Case No.. FOR assessment OF GUARDIAN AD LITEM COSTS. Commonwealth of Virginia VA. CODE [ ] I currently receive the following type(s) of public assistance: [ ] TANF $ .. [ ] Medicaid [ ] Supplemental Security Income $ .. [ ] SNAP (food stamps) $ .. [ ] Other (specify type and amount) .. Names and address of employer(s) for myself and for my spouse (if my household member): Self .. Spouse (not applicable if alleged victim) .. Self Spouse NET INCOME: Pay period (weekly, every second week, twice monthly, monthly) .. Net take home pay (salary/wages, minus deductions required by law) .. $ .. Other income sources (please specify).. $ .. COURT USE ONLY.

FOR ASSESSMENT OF GUARDIAN . AD LITEM. COSTS . Commonwealth of Virginia. VA. CODE § 19.2-159 [ ] I currently receive the following type(s) of public assistance: [ ] TANF $ ..... [ ] Medicaid [ ] Supplemental Security Income $ ...

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