U.S. DOD Form dod-navmc-11082
FINANCIAL STATEMENT - REMISSION OF INDEBTEDNESS (7220)
NAVMC 11082 (Rev. 5-97) (EF)
SN: 0109-LF-065-1800
(Previous editions are obsolete and will not be used)
NAME (Last,First, MI)
SSN
GRADE
MOS (NO. and Title)
PRIVACY ACT STATEMENT
The Privacy Act Statement for information on this
form is contained on NAVMC form11000
Privacy Act Statement for Marine CorpsPersonnel
and Pay Records.
TOTAL SERVICE
(YR./MO./DA)
TOTAL DEBT IS/WAS
AMT. COLLECTED
ENLISTMENT EXPIRES
BALANCE FOR REMISSION
CONSIDERATION
DEPENDENTS
AGE
NAME
RELATIONSHIP
PERCENT OF SUPPORT
MONTHLY INCOME AND EXPRESS
(DO NOT list spouse’s exspense incident to his/her employment. Enter information
concerning spouse’s employment under the heading "SPOUSE’S INCOME", below.) MONTHLY INCOME
MONTHLY EXPENSES
BASIC PAY
FEDERAL INCOME TAX WITHHELD
BASIC ALLOWANCE FOR QUARTERS (BAQ)
STATE INCOME TAX WITHHELD
BASIC ALLOWANCE FOR SUBSISTENCE/COMRATS
FICA TAX
CLOTHING ALLOWANCE
RENT
FAMILY SEPARATION ALLOWANCE (FSA)
UTILITIES*
VARIABLE HOUSING ALLOWANCE (VHA)
OTHER (Specify)
TELEPHONE
FOOD
CLOTHING
INSURANCE*
TOTAL
MONTHLY INSTALLMENT PAYMENTS
ITEM
EXPIRES
HOUSE
AMOUNT
SCHOOL*
MEDICAL/DENTAL*
COURTS MARTIAL OR ARTICLE 15
FORFEITURES - EXPIRES:
CHILD SUPPORT, ALIMONY OR SEPARATE
MAINTENANCE (Furnish copy of court order or decree.)
OTHER (Specify)
CAR
FURNITURE
OTHER (Specify)
TOTAL
REMARKS
CAR EXPENSES (Operating)
TOTAL
*ITEMIZE/EXPLAIN AS APPROPRIATE. USE SEPARATE SHEET
NECESSARY.
IF
NAVMC 11082 (Rev. 5-97) (EF) (BACK)
RECAP OF A MARINE’S TOTAL MONTHLY INCOME
MARINE’S TOTAL MONTHLY GROSS INCOME (PAY AND ALLOWANCES)
TOTAL MONTHLY INSTALLMENT PAYMENTS
TOTAL MONTHLY EXPENSES
TOTAL MONTHLY OBLIGATIONS (INSTALLMENT PAYMENTS AND EXPENSES
MARINE’S NET INCOME (INCOME LESS TOTAL OBLIGATIONS FROM PAY AND ALLOWANCES)
SPOUSE’S INCOME
SPOUSE’S MONTHLY GROSS INCOME
SPOUSE’S OTHER MONTHLY GROSS INCOME
LESS EXPENSES INCIDENT TO EMPLOYMENT
FITW
LESS EXPENSES INCIDENT TO THE OPERATION
OF A PRIVATE BUSINESS OR OTHER OUTSIDE
INCOME.
(Itemize and/or explain as appropriate. Use
separate sheet if necessary.)
SITW
FICA
CAR MAINTENANCE & OPERATION
OTHER TRANSPORTATION EXPENSES
CAR PAYMENT
CHILD CARE
OTHER (Specify)
NET AMOUNT OF OTHER MONTHLY INCOME
RECAP OF TOTAL MONTHLY FAMILY INCOME
MARINE’S NET INCOME
SPOUSE’S NET INCOME
TOTAL EXPENSES
SPOUSE’S NET INCOME (INCOME LESS EXPENSES
OTHER NET INCOME
DIFFERENCE BETWEEN TOTAL MONTHLY
INCOME AND EXPENSES FOR FAMILY
ASSETS
SHOW PRESENT VALUE OF AND EQUITY IN ALL ASSETS OTHER THAN HOUSEHOLD GOODS AND CLOTHING, INCLUDING BUT NOT
LIMITED TO SAVINGS AND CHECKING ACCOUNTS, STOCKS AND BINDS, REAL PROPERTY, AUTOMOBILES, BOATS, TRAILER, BUSINESS,
ETC.
CERTIFICATION
I CERTIFY that the information furnished is correct and complete to the best of my knowledge and belief.
SIGNATURE OF MARINE
DATE
Designed Using FormFlow 2.15, HQMC/ARAE, Mar 98