FL450 {TORE OR PARTY WHTHOUT ATTORNEY Pa, SB abo anon FOR COURT OBERT | MICHAEL A. GOSS 84109 GOSS & GOSS - A Professional Law Corporation 1119 Twelfth Street Modesto, CA 95354 | reiemonena: (209) 576-1871 (209) 577-8676 cam rooress omy: mike@goss-law.com artonscrror nes GREGORY BOWERMAN SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS smrecrsooress' 800 Eleventh Street nanosooness Post Office Box 1098 cmmozrcoe Modesto, CA 95353 | _PETITIONERPLANTIFE: GREGORY BOWERMAN | RESPONDENTDEFENDANTKAREN BOWERMAN OTHER PARENT/OLAIMANT: INCOME AND EXPENSE DECLARATION ae 1. Employment (Give information on your current job or, if you're unemployed, your most recent job.) Fitach copies] 2 Employer: California Emergency Physicians ofyourpay | b. Employersaddress: 2100 Powell St., #920, Emeryville, CA 94608 stubs forlast | _c Employer's phone number: (888) 267-3880 two months | d. Occupation: physician (lack out ©. Date job started: 9/1/89 social tf unemployed, date job ended: n/a security 9. Iwotk about 35 hours per week numbers) hI get paid $ 22,766 gross (before taxes) [EI per month CQ perweek (2) per hour ((fyou have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other Jobs. Write “Question 1 - Other Jobs" at the top.) 2, Age and education a. My age is (specify: 60 . Ihave completed high school or the equivalontZA Yes CL} No_ifne, highest arade completed (spect): ¢. Number of years of college completed specify): 3 (Degree(s) obtained (specify): BS 4. Number of years of graduate schoo! completed specify): 4 [) Degree(s) obtained (specify): MD fe. Ihave: (X) professionalioccupationalicense(e)(speciy): physician 1 vocational training (speci 3. Tax information a, EX) 1 tast fies taxes for tax year (specify year: 2011 b. Mytaxtfing statusis Ca single CA) head of household CX) manied, fling separately CO marred, ing joint with (specity name): c. [file state tax retumsin (California) other (specity state): 4. I claim the fotowing number of exemptions (including myself) on my taxes(speciy)- 4 4. Other party's income. | estimate the gross monthly income (before taxes) of the other partyin this case at (speoiy): Sunknown This estimate is based on explain): Respondent. has submitted to a vocational examination/assessment {Ifyou need more space to answer any questions on this form, attach an 8 1/2-by-1 ‘question number before your answer.) Number of pages attached: inch sheet of paper and write the | deciare under penaity of perjury under the laws of the State of Califomia that the information contained on all pages ofthis form and any attachments is true and correct. Date: February 15, 2012 GREGORY BOWERMAN > TPE OR PANT mE oe TT Pre tote eu INCOME AND EXPENSE DECLARATION Tere i Ese Fama ‘em acs 30 Bowerman, GregPETITIONERPLANTIFE: GREGORY BOWERMAN ase BER |_RESPONDENTIDEFENOANT:XAREN BOWERMAN. 455 922 [other PARENTICLAIMANT: Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax return to the court hearing. (Black out your social security number on the pay stub and tax return.) 5. Income (For average monthly, add up all the Income you received in each category in the last 12 months ‘Average ‘and divide the total by 12) Last month monthly a, Salary or wages (gross, before taxes) ig ee sete Cae b. Overtime (9085, Bef 1X88) ener i aes SaSiaastnaan enantaaatnaan . Commissions or bonuses... a igang ee 4, Public assistance (or example: TANF, SSI, GAIGR) [) currently receiving — EEC ESE EEC ©. Spousal support LL] from this mariage] trom a aiferont mariage mma Bg toeseee eee eoEEE EE {. Partner support (from this domestic partnership) from a different domestic partnership — . @. Pensionietirementfund payments 1, Social security retirement (not SS) iia Disabity: LL) Social security (not SSI) CL) State Unemployment compensation _. Workers’ compensation ther (itary BAQ, royally payments, tc) (specty) 6. Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property) @, Dividendsfinterest ncnunnnnnen nen b. Rental property income Bloxhan.is.listed,.but not currently..rented. 6. Trust income enone 4. Other (specify) 7. Income from self-employment, after business oxpenses for all businesses Lamthe C2 ownertsole proprietor (XJ business partner [) other (speci): per Feb. 2013 check paid [Number of year inthis business (specify): for January 2013 hours Name of business (specify): CEP America ‘Type of business (speci): medical; K-1 issued ‘Attach a profit and loss statement forthe last two years ora Schedule C trom your last fedoral tax return. Black out your social security number. Ifyou have more than one business, provide the information above for each of your businesses. 8. (C2 Additional income, | received one-time money (lottery winnings, inheritance, et. in the last 12 months (specity source and ‘emount) 8. EE Change in income. My financial situation has changed signifcantly over the last 12 months because (specly) No longer received $1200 admin stipend from Loa Banos nor $50/hour bonus for working 40, DedubHengancs; shifts being decreased from 20 to 18 per month which is reflected on Last month a. Required union dues 1ast_sovers1.checks; cre. contract. forbids.work-st-haspitais-outside $0 b. Required retirement payments (not social security, FICA, 401), or IRA)... ‘&. Medical, hospital, dental, and other health insurance premiums((otal monthly amount). $2,050. ‘4. Child suppor that | pay for children from other relationships eee! ‘e. Spousal support that | pay by court order from a diferent marriage siesiseeaanay‘SassiaaEnaS {Partner support that | pay by court order irom a diferent domestic partnership so 9. Necessary job-related expenses not relmbursed by my employer (attach explanation labeled "Question 109°) $0 11. Assots Total Cash and checking accounts, savings, credit union, money market, and other deposit accounts $minima . Stocks, bonds, and other assets | could easily sel! Oy. the contents of storage unite gunknown c, Allother property, [&) real and [E] personal (estimate fair market value minus the debis you owe) Snegative Venicles-§5,200) both Carclys and Sloyhan properties are upside dow} $1.3 million in retirenent(?) $586,700 current/back taxes; $45,000 loan from retiranent) unforgiven 196,000 Zad on Carolyn Foes taney aT INCOME AND EXPENSE DECLARATION Poon Bota Bowerman, GregFLA80 |, PEIMIONERPLARTF. GREGORY SOWERRAN Grae RARE RESPONDENTIDEFENOANTXAREN BOWERMAN 455 922 [OTHER PARENTICLAIMANT: 12, The following people live with m Fame ‘Age | Howthe person's | Thal person's gross | Pays some ofthe dee related to me? (ex: son) | monthly income household expenses? ‘a William 18] son 0/ CI Yes ‘No b. Olivia 14 daughter 0] CQ Yes [Ky No |e Elizabeth 10 =| daughter 0} LD Yes [KJ No a. Gres Dino e Thves Ei No _| 13. Average monthly expenses: (K] Estimated expenses (X] Actual expenses (X]) Proposed needs a. Home: Bee ae (1) Gd Rentor (OQ mortgage hh Laundry and cleaning i eesseebesetaetteannaseeeine® YE mortgage: ee (@) average principal: Peete j. Education Lessons,,..lunches. a teeeaeaeaaseomamee 1 5 average inlerest qcereeeOr : ©) avenge interest: k. Entertainment, gits, and vacation s____s00. f $__aaa (@) Real property taxes for. carolyn, |. Auto expenses and transportation. (@) Homeowner's or renters insurance (surance, gas, repairs, bus, etc) ....§ 550. i See ame la Uelieeeemrneite rm. lneuranes (Ife, acldent, etc; do not (@) Maintenance and repat —..& 320 ide auto, home, or heath insurance) §______550. . . Sav reqs By. CE. 500 Le FeaRRRbe BEBREKESET insurance 200% Savings and investments ses. by. cae ©. Charitable contributions ig teeteeeesees 5 6 Child care $_____600 p. Monthly payments listed in tem 14 {temize below in 14 and inser (ote! here) §____9, 169. 4. Grocers and household s 1,000 f cee 4. Other (spent nia avant 0 eas cae eae eeae ee og personal grooming, etc. |r. TOTAL EXPENSES (a- (donot addin $__18,372| £. Uilties (gas, electic, water, trash) ....$ 900 | "the amounts in fe) and (2) includes utilities at rental g Telephone, cell pone, and e-mail .....8__47. s. Amount of expenses paid by others $a. 14, Installment payments and debts not listed above Paldto For Balance Date of ast payment] See attachnent IT | 48, Attorney fees (This is required if ether party is requosting attorney foos.): ‘To date, have pald my attorney this amount for fees and costs (specify): 38,531 b. The source ofthis money was (specify): earnings cI still owe the following fees and costs to my attorney (specify total ovred): $ 6,729 through 1/30/13 4d. Myatiomey's hourly rate is (specity):$ 395 | confirm this fee arrangement Date: February \Q, 2013 vanaes a yon Sn TYPE OR PRINT EOF ATTORNEN BORNE ATER FeoiRen any 12007 INCOME AND EXPENSE DECLARATION Poae sora fe sta me) ESTA FERN Bowerman, GregFL150 PETTIONERPLANTIFE: GREGORY BOWERMAN CAEN RESPONDENTIOEFENDANTXAREN BOWERMAN 455 922 [[OTHER PARENTICLAMANT: L CHILD SUPPORT INFORMATION (NOTE: Fill out this page only if your case involves child support.) 16. Number of children ‘a. Ihave (specify number): 2 children under the age of 18 with the other parent inthis case. b. The children spend percent oftheir time with me and percent oftheir time with the other parent. (if you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.) William is with me 100%; Elizabeth with me 80%; Olivia is with Karen in violation of the actual court order 17. Childron's health-care expenses 2. GI 1do CA idonct have health insurance available to me for the children through my job. b, Name of insurance company: Anthem Blue Cross «. Address of insurance company: 1. The monthly cost for the children’s health insurance is or would be (specify): $ (0 not include the amount your employer pays.) 18. Additional expenses for the childron in this case ‘Amount per month 2. Child care so | can work or get job traning é . Children’s health care not covered by INSUrEMCE mn ©. Travel expenses for visitation... 4. Children's educational or other special needs (specty below) 19. Special hardships. | ask the court fo consider the following special nancial circumstances (atiach documentation of any item listed here, including court orders}: ianeaeapal nents For how many months? a Extraordinary health expenses not included in 186 eee », Major losses not covered by insurance (examples: fre thef, other insured loss) ne $_____o . (1) Expenses for my minor children who are from other relationships and areliving with me... eee aE (2) Names ang ages of those children fspecty) (@) Chitd suppor | receive for those children stn ‘The expenses listed in a, b and c create an extreme financial hardship because (oxplain) 20. Other information I want the court to know concerning support in my case (spect) i aa INCOME AND EXPENSE DECLARATION Paar Esa Bowerman, Greg[OTHER PARENTICLAIMAN | PETITIONERPLAINTIFF: GREGORY BOWERMAN ” | RESPONDENTIDEFENDANTXAREN BOWERMAN 455 922 INCOME AND EXPENSE DECLARATION ATTACHMENT 14 Instaliment payments end debts (continued) Tac es Paid to For Amount Balance Date of last payment OITZ0LO IR back taxes 7000 165,000] current OL FT back taxes 350 19,000 | determined Z01zZ IRS and FTB back taxés oT Tes, 251 | determined projected OTS IRA and FTE [est. 6, 400 : not yet monthly Bloxham mortgages [Ist « 2nd 1,300 139, 734 | current Dr. PenIe counseling ZOO} ongoing CuEEenE Jason Harrel tax atty varies 7300) in arrears [State Farm ‘unbrella TU] ongoing current insurance (inc. Keren) [Trent Tilby evaluation paid 7,500 | current Profit sharing loan | loan 350 45,000 in arrears [Storage units rental 1,463 | ongoing current units BOHR - tnd mortgage | unforgiven T, 330 136,000 | not yet GOSS & GOSS attomey varies 16,729 | in arrears Karen Bowerman Support oF $8,905 TOTAL FOR THIS PAGE 3,169 665,085 INCOME AND EXPENSE DECLARATION ATTACHMENT 14 a Bowerman, GregEP. ene February 12, 2013 Re: Gregory Bowerman, MD Dear Sir or Madam, Effective 1/1/2013, Gregory Bowerman, MD will be working an average of twelve 10-hour shifts at Memorial Medical Center - Modesto, where the current base hourly rate is a blended §157. He will also be working an average of three 10-hour shifts at Memorial Hospital - Los Banos, where the current base hourly rate is $145. He wil also be eligible for the annual profi distribution, which will be about 20% of his annual income, with half being paid in December and the remaining half paid the folowing February. you have any questions, feel free to contact me at your earliest convenience. Sincerely, Deady Derrick Fong CEP America Payroll Dept 510-360-2703, FongD@MedAmerica.com 2100 Powell Sse, Suite 920, Emeryville, CA 96608-1803 main Hine: 510-350-2600 wrm.cepamerics.comserangs tment spay omic apparent CEP America Sno ie 8, Enc ce 68 enemy a] Tees Firebttps:/md.cep.com/porta/comp/Y TDsttAliEnt2.asp?grp=8isA. Famings Statement CEP America 2100 Powel Sts, Sit 90, Emeril, Cafe 946508 overan Gao Pot Perio 0010 ay a2 Lael Tana ro] a a = — ai oS =a ram nossa nine mien fo] mame Fac oye bn [as [i no ar a cum] Tei ucwowvepcowenwooesro pie MEETNOFEE +00 no00 G00 SEFC ist eee re WeWORA YEO COMTERNODESTO PIE _NEHTOET woes oem ene Tame vevoer mee ian oo ico toon earn sims __sirae od Sear] Ge | Sek | em Se | Se | Set [eS a Tea Tee — sae VA8/13 1 1of2‘bnps://md.cep.com/portal/comp/YTDsttAllEnt2 asp gip=BisAr... Eamings Statement CEP America 2100 Powell Stee, Sut S00, Emeryville, Caifonia 94608 ‘ower Og Pal parece 20210 eit ott (extel Tat oes on] a ao a Ya e — isons POOS aio Tae css ny son set Co rr a —— “Peon Se | {are REDRAT HOSTING oy ee rote ieee hee mam wm Saas NSS et oo 0 i ar sane MEMOROAL weD CER pi wacewt ee aaa hewn We CENTER ero wean OH "ame 1274 ooesTO pet HOURLY “ CHECKFEE 100.00 ere MEMORIAL MED COMER ee 200 tm naw SFE cass aan et ncnesro ee eA 2 tana Tams a aes cer eure tam veeco ma tamom sr omen peu esses casera werner Tiassa as Sle Le hs Terra That — 0 Lof2 18/13 11:24 AMFL-330 Tal LOPIE PART gO ATTORNEY OR GOWER GLENTA RENE wc Fy Com 7 5) "FoR Coun UsEONLY [-MICHAEL A. GOSS 84109 GOSS & GOSS - A Professional Law Corporation 1119 Twelfth Street } Modesto, CA 95354 | i reemoneno; (209) 576-1871 sano: (209) 577-8676 arronney or nana! GREGORY BOWERMAN "SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS smecracoress: 800 Eleventh Street suncazoress Post Office Box 1098 crvewoarcoeModesto, CA 95353 PETITIONERIPLAINTIFFCREGORY BOWERMAN case waa 455 922 RESPONDENTIDEFENDANTXAREN BOWERMAN (avooetle po OTHER PARENTIPARTY: Ne Oe Hea TE PROOF OF PERSONAL SERVICE err | am at least 18 years old, not a party to this action, and not a protected person listed in any of the orders. Person served (name): YASMINE S. MEHMET | served copies of the following documents (speci): PETITIONER'S INCOME AND EXPENSE DECLARATION 4. By personally delivering copies to the person served, as follows: a. Date: February 19, 2013 b. Time: 9:00 a.m. c. Address: Stanislaus County Superior Court 300 Eleventh Street Modesto, CA 95354 6. lam 2 [ER rot a registered Calfornia process server. 4. (21 exempt tom registration under Business & Profession b. CE aegistored Calta process server. ode section 223500) &. El enemployee orindependent conractorofa —¢, (Ca Galfomia ses ormarshal registered Califomia process server. 6. Myname, address, and telephone number, and, if applicable, county of registration and number (specify) MICHAEL A. GOSS 1119 Twelfth Street Modesto, CA 95354 (209) 576-1871 7. (| declare under penalty of perjury under the laws ofthe State of Calfomia that the foregcing Is rue and correct. 8. CO |ama Calforia her or marshal and | cert thatthe foregoing is tue and correct. Date: February 19, 2013 MICHAEL » (OYPE ORFRINT NAME OF PERSON WHO BERVED THE PAPERB) eowrune 0 SERVED THE PAPERS) Page tot Fer eprr Oras Use PROOF OF PERSONAL SERVICE cae On 07 LSB Re nay 0) store Bowerman, Greg sama