City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email  

 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  
 

I am   [  ]  Petitioner 

[  ]  Respondent 
[  ]  Respondent’s Attorney  (Utah Bar #:__________) 

[  ]  Petitioner’s Attorney 
[  ]  Petitioner’s Licensed Paralegal Practitioner 
[  ]  Respondent’s Licensed Paralegal Practitioner   

(Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of (select one) 
 

[  ]  the Marriage of (for a divorce with or without 
children, annulment, separate maintenance, or 
temporary separation case) 

[  ]  the Children of (to establish custody, parent-

time or child support) 

[  ]  the Parentage of the Children of (for a 

paternity case) 

____________________________________ 
(name of Petitioner) 

Declaration of Other Parent's 
Earnings 
(Utah Code 78B-12-201(2) and 78B-12-203(8)) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner  

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

and  

1. 

2. 

My name is: ______________________________________________________. 

I believe: ____________________________________________________ (name 
of other party) (Choose one.): 

1004FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Declaration of Other Parent's Earnings 

Page 1 of 4 

[  ]  earns $________________ in gross income per month. 

[  ]  should be considered to make minimum wage. 

[  ]  should be considered to have zero income. They are in a non-temporary 

situation and they: 

 

children; 

skills; or 

•  cannot earn more than the reasonable costs of child care for our minor 

•  are physically or mentally unable to earn minimum wage; 

•  are engaged in career or occupational training to establish basic job 

•  care for one or more of our children whose unusual emotional or 

physical needs require them to be present in the home. 

I am relying on the following:  

3.   
 

 

Explanation 

         

         

       

         

         

The other party’s employment 
opportunities, work history, and 
occupation qualifications  

Educational attainment and 
literacy  

Age and health 

Criminal record 

Other employment barriers and 
background factors 

1004FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Declaration of Other Parent's Earnings 

Page 2 of 4 

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

         

Prevailing earnings and job 
availability for persons of similar 
backgrounds in the community 

Petitioner or Respondent  

ttorney or Licensed Paralegal Practitioner of record (if applicable) 

Signature ► 

Printed Name 

Signature ► 

Printed Name 

 

 

 

 

Date 

 

    A

 

Date 
 

1004FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Declaration of Other Parent's Earnings 

Page 3 of 4 

Certificate of Service 

I certify that I filed with the court and am serving a copy of this Declaration of Other Parent's Earnings on 
the following people. 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

 

 

 

Signature ► 

Printed Name 

 

 

 

 

 

 

 
Date 

 

1004FAJ Approved January 27, 2020 / 
Revised May 1, 2022 
 

Declaration of Other Parent's Earnings 

Page 4 of 4