I solemnly affirm under the penalties of perjury that the contents of this document, monthly expense list,
income statement, and assets and liabilities statement are true to the best of my knowledge, information, and
belief.
NOTE: If you are not filing this statement with a pleading or your response to the other party’s claim,
mail (postage prepaid) or hand deliver this statement to the other party and file a Certificate of Service
(CC-DR-058) with the court.
CC-DR-031 (Rev. 08/2024) Page 7 of 7 FISTA