IN RE: ADMINISTRATIVE ORDER NUMBER 10:
ARKANSAS CHILD SUPPORT GUIDELINES

___ S.W.3d ___

Supreme Court of Arkansas
Opinion delivered January 31, 2002

Per Curiam. On February 5, 1990, this Court first adopted guidelines for child support in response to P.L. 100-485 and Ark. Code Ann. 9-12-312(a). Effective October, 1989, P.L. 100-485 required the following: that all states adopt guidelines for setting child support; that it be a rebuttable presumption that the amount of support calculated from the child-support chart is correct; and that each state's guidelines be reviewed and revised, as necessary, at least every four years. In response to the federal law, the Arkansas General Assembly enacted Ark. Code Ann. 9-12-312, which included the federal provisions and authorized the Arkansas Supreme Court to develop guidelines based on recommendations submitted to the Court by a committee appointed by the Chief Justice.

The Committee on Child Support initially made recommendations to the Court which formed the substance of the 1990 Per Curiam Order. On May 13, 1991, pursuant to the Committee's recommendations, the Court issued a new Per Curiam Order which supplemented the original. Then, in compliance with the four-year requirement of P.L. 100-485, the Committee submitted recommendations to the Court in October, 1993, and the Court issued a Per Curiam Order on October 23, 1993, adopting the guidelines which subsequently were published in the Court Rules volume of the Arkansas Code Annotated.

On September 25, 1997, again pursuant to the four-year requirement of P.L. 100-485, the Court issued a Per Curiam Order, adopting recommendations of the Child Support Committee. In addition, the Court adopted and published Administrative Order Number 10 Arkansas Child Support Guidelines, effective October 1, 1997. The Administrative Order incorporated by reference the weekly and monthly family-support charts and the Affidavit of Financial Means. The Court republished Administrative Order Number 10 with a Per Curiam Order of January 22, 1998, making minor corrections to the child-support charts and to the Affidavit of Financial Means.

In the ensuing four years, the Committee has continued to study the existing guidelines, pursuant to federal and state law, and once again has submitted its recommendations to the Court. Having carefully considered these most recent recommendations, the Court adopts and publishes Administrative Order Number 10 Arkansas Child Support Guidelines, effective February 11, 2002. This Administrative Order includes and incorporates by reference the revised weekly and monthly family-support charts and the revised Affidavit of Financial Means which are attached to Administrative Order No. 10.

The Court thanks the Committee for its service, and as it has done in the past, directs the Committee and the Chief Justice, as its liaison, to continue its charge pursuant to law and the rules of this Court.

Glaze and Corbin, JJ., dissent.

ADMINISTRATIVE ORDER NUMBER 10 CHILD SUPPORT GUIDELINES

Section I. Authority and scope.

Pursuant to Act 948 of 1989, as amended, codified at Ark. Code Ann. 9-12-312(a) and the Family Support Act of 1988, Pub. L. No. 100-485 (1988), the Court adopts and publishes Administrative Order Number 10 Child Support Guidelines. This Administrative Order includes and incorporates by reference the attached weekly and monthly family support charts and the attached Affidavit of Financial Means.

It is a rebuttable presumption that the amount of child support calculated pursuant to the most recent revision of the Family Support Chart is the amount of child support to be awarded in any judicial proceeding for divorce, separation, paternity, or child support. The court may grant less or more support if the evidence shows that the needs of the dependents require a different level of support.

All orders granting or modifying child support (including agreed orders) shall contain the court's determination of the payor's income, recite the amount of support required under the guidelines, and recite whether the court deviated from the Family Support Chart. If the order varies from the guidelines, it shall include a justification of why the order varies as may be permitted under Section V hereinafter. It shall be sufficient in a particular case to rebut the presumption that the amount of child support calculated pursuant to the Family Support Chart is correct, if the court enters in the case a specific written finding within the Order that the amount so calculated, after consideration of all relevant factors, including the best interests of the child, is unjust or inappropriate.

Section II. Definition of income.

Income means any form of payment, periodic or otherwise, due to an individual, regardless of source, including wages, salaries, commissions, bonuses, workers' compensation, disability, payments pursuant to a pension or retirement program, and interest less proper deductions for:

1. Federal and state income tax;

2. Withholding for Social Security (FICA), Medicare, and railroad retirement;

3. Medical insurance paid for dependent children; and

4. Presently paid support for other dependents by court order.

Section III. Calculation of support.

a. Basic Considerations.

The most recent revision of the family support charts is based on the weekly and monthly income of the payor parent as defined in Section II.

For purposes of computing child support payments, a month consists of 4.334 weeks. Biweekly means a payor is paid once every two weeks or 26 times during a calendar year. Bimonthly means a payor is paid twice a month or 24 times during a calendar year.

Use the lower figure on the chart for income to determine support. Do not interpolate (i.e., use the $200.00 amount for all income pay between $200.00 and $210.00 per week.)

The amount paid to the Clerk of the Court or to the Arkansas Clearinghouse for administrative costs pursuant to Ark. Code Ann. 9-12-312(e)(1)(A), 9-10-109(b)(1)(A), and

9-14-804(b) is not to be included as support.

b. Income Which Exceeds Chart.

When the payor's income exceeds that shown on the chart, use the following percentages of the payor's weekly or monthly income as defined in SECTION II to set and establish a sum certain dollar amount of support:

One dependent: 15%

Two dependents: 21%

Three dependents: 25%

Four dependents: 28%

Five dependents: 30%

Six dependents: 32%

c. Nonsalaried Payors.

For Social Security Disability recipients, the court should consider the amount of any separate awards made to the disability recipient's spouse and children on account of the payor's disability. SSI benefits shall not be considered as income.

For Veteran's Administration disability recipients, Workers' Compensation disability recipients, and Unemployment Compensation recipients, the court shall consider those benefits as income.

For military personnel, see the latest military pay allocation chart and benefits. BAQ (quarters allowance) should be added to other income to reach total income. Military personnel are entitled to draw BAQ at a "with dependents" rate if they are providing support pursuant to a court order. However, there may be circumstances in which the payor is unable to draw BAQ or may draw BAQ only at the "without dependents" rate. Use the BAQ for which the payor is actually eligible. In some areas, military personnel receive a variable allowance. It may not be appropriate to include this allowance in calculation of income since it is awarded to offset living expenses which exceed those normally incurred.

For commission workers, support shall be calculated based on minimum draw plus additional commissions.

For self-employed payors, support shall be calculated based on the last two years' federal and state income tax returns and the quarterly estimates for the current year. A self-employed payor's income should include contributions made to retirement plans, alimony paid, and self-employed health insurance paid; this figure appears on line 22 of the current federal income tax form. Depreciation should be allowed as a deduction only to the extent that it reflects actual decrease in value of an asset. Also, the court shall consider the amount the payor is capable of earning or a net worth approach based on property, life-style, etc.

d. Imputed Income.

If a payor is unemployed or working below full earning capacity, the court may consider the reasons therefor. If earnings are reduced as a matter of choice and not for reasonable cause, the court may attribute income to a payor up to his or her earning capacity, including consideration of the payor's life-style. Income of at least minimum wage shall be attributed to a payor ordered to pay child support.

e. Spousal Support.

The chart assumes that the custodian of dependent children is employed and is not a dependent. For the purposes of calculating temporary support only, a dependent custodian may be awarded 20% of the net take-home pay for his or her support in addition to any child support awarded. For final hearings, the court should consider all relevant factors, including the chart, in determining the amount of any spousal support to be paid.

f. Allocation of Dependents for Tax Purposes.

Allocation of dependents for tax purposes belongs to the custodial parent pursuant to the Internal Revenue Code. However, the Court shall have the discretion to grant dependency allocation, or any part of it, to the noncustodial parent if the benefit of the allocation to the noncustodial parent substantially outweighs the benefit to the custodial parent.

g. Health Insurance.

In addition to the award of child support, the court order shall provide for the child's health care needs, which normally would include health insurance if available to either parent at a reasonable cost.

Section IV. Affidavit of financial means.

The Affidavit of Financial Means shall be used in all family support matters. The trial court shall require each party to complete and exchange the Affidavit of Financial Means prior to a hearing to establish or modify a support order.

Section V. Deviation considerations.

a. Relevant Factors.

Relevant factors to be considered by the court in determining appropriate amounts of child support shall include:

1. Food;

2. Shelter and utilities;

3. Clothing;

4. Medical expenses;

5. Educational expenses;

6. Dental expenses;

7. Child care (includes nursery, baby sitting, daycare or other expenses for supervision of children necessary for the custodial parent to work);

8. Accustomed standard of living;

9. Recreation;

10. Insurance;

11. Transportation expenses; and

12. Other income or assets available to support the child from whatever source.

b. Additional Factors.

Additional factors may warrant adjustments to the child support obligations and shall include:

3. The creation or maintenance of a trust fund for the children;

4. The provision or payment of special education needs or expenses of the child;

5. The provision or payment of day care for a child;

6. The extraordinary time spent with the noncustodial parent, or shared or joint custody arrangements;

7. The support required and given by a payor for dependent children, even in the absence of a court order; and

8. Where the amount of child support indicated by the chart is less than the normal costs of child care, the court shall consider whether a deviation is appropriate.

Section VI. Abatement of support during extended visitation.

The guidelines assume that the noncustodial parent will have visitation every other weekend and for several weeks during the summer. Excluding weekend visitation with the custodial parent, in those situations in which a child spends in excess of 14 consecutive days with the noncustodial parent, the court should consider whether an adjustment in child support is appropriate, giving consideration to the fixed obligations of the custodial parent which are attributable to the child, to the increased costs of the noncustodial parent associated with the child's visit, and to the relative incomes of both parents. Any partial abatement or reduction of child support should not exceed 50% of the child support obligation during the extended visitation period of more than 14 consecutive days.

In situations in which the noncustodial parent has been granted annual visitation in excess of 14 consecutive days, the court may prorate annually the reduction in order to maintain the same amount of monthly child support payments. However, if the noncustodial parent does not exercise said extended visitations during a particular year, the noncustodial parent shall be required to pay the abated amount of child support to the custodial parent.

Section VII. Provisions for payment.

All orders of child support shall fix the dates on which payments shall be made. All support orders issued shall include a provision for immediate implementation of income withholding, absent a finding of good cause not to require immediate income withholding or a written agreement of the parties incorporated in the order setting forth an alternative agreement as required by Ark. Code Ann. 9-14-218(a). Payment shall be made through the Arkansas Clearinghouse pursuant to Ark. Code Ann. 9-14-805. Times for payment should ordinarily coincide with the payor's receipt of salary, wages, or other income.

***

ARKANSAS

Weekly Family Support Chart

           

PAYOR NET WEEKLY INCOME

ONE
CHILD

TWO CHILDREN

THREE CHILDREN

FOUR CHILDREN

FIVE CHILDREN

           

100

24

35

42

46

50

110

27

39

46

51

55

120

29

42

50

55

60

130

31

46

54

60

65

140

34

49

58

64

69

150

36

52

62

69

74

160

38

56

66

73

79

170

41

59

70

77

84

180

43

63

74

82

88

190

45

66

78

86

93

200

47

69

81

90

97

210

50

72

85

94

102

220

52

75

89

98

106

230

54

79

93

102

111

240

56

82

96

107

115

250

59

85

100

111

120

260

61

89

104

115

125

270

63

92

108

120

130

280

66

95

112

124

134

290

68

99

116

128

139

300

70

102

120

133

144

310

72

104

123

136

147

320

73

106

125

138

149

330

74

108

127

140

152

340

76

109

129

142

154

350

77

111

131

144

156

360

78

113

132

146

159

370

79

114

134

148

161

380

80

116

136

150

163

390

81

117

138

152

165

400

82

119

140

154

167

410

83

120

141

156

169

420

84

122

143

158

171

430

86

123

145

160

173

440

87

125

147

162

176

450

88

127

149

165

178

460

90

129

152

167

182

470

91

132

154

170

185

480

93

134

157

173

188

490

94

136

159

176

191

500

96

138

162

179

194

510

98

140

164

182

197

520

99

143

167

184

200

530

100

145

169

187

203

540

102

147

172

190

206

550

103

149

174

193

209

560

105

151

177

195

212

570

106

153

179

198

215

580

108

155

182

201

218

590

109

157

184

203

220

600

111

159

186

206

223

610

112

161

189

208

226

620

113

163

191

211

229

630

115

165

193

214

232

640

116

167

196

216

234

650

118

169

198

219

237

660

119

171

200

221

240

670

120

173

203

224

243

680

122

175

205

227

246

690

123

177

207

229

248

700

124

179

210

232

251

710

126

181

212

234

254

720

127

183

214

237

257

730

129

185

217

240

260

740

130

187

219

242

263

750

131

189

221

245

265

760

132

190

223

247

267

770

133

192

225

249

270

780

134

193

227

251

272

790

135

195

229

253

274

800

136

196

230

255

276

810

137

198

232

257

278

820

138

199

234

259

280

830

139

201

236

261

283

840

140

202

238

263

285

850

141

204

240

265

287

860

142

205

241

267

289

870

143

207

243

269

291

880

144

208

245

271

294

890

145

210

247

273

296

900

147

212

249

275

299

910

148

214

251

278

301

920

149

215

253

280

304

930

150

217

256

282

306

940

151

219

258

285

309

950

153

221

260

287

311

960

154

222

262

289

314

970

155

224

264

292

316

980

156

226

266

294

319

990

157

228

268

296

321

1000

159

229

270

298

324

***

ARKANSAS

Monthly Family Support Chart

 

PAYOR NET MONTHLY INCOME

ONE
CHILD

TWO CHILDREN

THREE CHILDREN

FOUR CHILDREN

FIVE CHILDREN

           

500

121

176

209

230

250

550

133

193

229

253

274

600

145

211

249

275

298

650

156

228

269

297

322

700

168

245

289

320

347

750

180

262

309

342

370

800

191

278

328

362

393

850

202

294

347

383

415

900

214

310

366

404

438

950

225

326

384

425

460

1000

236

342

403

445

483

1050

247

359

422

467

506

1100

259

375

442

488

529

1150

271

392

462

510

553

1200

282

409

481

532

576

1250

294

425

501

553

600

1300

305

442

520

575

623

1350

314

454

534

591

640

1400

319

462

544

601

652

1450

325

470

554

612

663

1500

331

479

563

622

675

1550

337

487

573

633

686

1600

342

495

582

643

697

1650

348

503

591

653

708

1700

354

511

600

663

719

1750

359

518

609

672

729

1800

364

526

617

682

739

1850

370

533

626

692

750

1900

375

541

635

701

760

1950

383

551

647

714

774

2000

391

563

659

729

790

2050

398

574

672

743

805

2100

406

585

685

757

821

2150

414

596

698

771

836

2200

422

607

711

785

851

2250

429

618

723

799

866

2300

437

628

736

813

881

2350

444

639

748

827

896

2400

451

649

761

841

911

2450

458

660

773

854

926

2500

466

671

786

868

941

2550

473

681

797

881

955

2600

480

691

809

894

969

2650

487

701

820

906

982

2700

494

711

832

919

996

2750

501

721

843

932

1010

2800

508

731

855

945

1024

2850

515

741

867

958

1038

2900

522

751

879

971

1052

2950

529

761

890

984

1067

3000

536

771

902

997

1081

3050

542

780

914

1010

1095

3100

549

790

926

1023

1109

3150

556

800

938

1036

1123

3200

563

810

950

1049

1137

3250

569

819

960

1061

1150

3300

574

827

970

1071

1161

3350

579

834

979

1081

1172

3400

584

842

988

1092

1183

3450

589

849

997

1102

1194

3500

594

857

1006

1112

1205

3550

599

864

1015

1122

1216

3600

604

872

1024

1132

1227

3650

609

879

1034

1142

1238

3700

614

887

1043

1152

1249

3750

619

895

1052

1162

1260

3800

624

902

1061

1172

1271

3850

630

910

1071

1184

1283

3900

636

919

1082

1195

1295

3950

642

928

1092

1207

1308

4000

648

937

1102

1218

1321

4050

654

946

1113

1230

1333

4100

660

954

1123

1241

1346

4150

666

963

1134

1253

1358

4200

672

972

1144

1264

1371

4250

678

981

1155

1276

1383

4300

684

989

1165

1288

1396

4350

690

998

1176

1299

1408

4400

696

1007

1186

1311

1421

4450

702

1015

1195

1321

1432

4500

707

1023

1205

1331

1443

4550

713

1031

1214

1341

1454

4600

718

1039

1223

1352

1465

4650

724

1047

1232

1362

1476

4700

729

1054

1242

1372

1487

4750

735

1062

1251

1382

1498

4800

740

1070

1260

1392

1509

4850

746

1078

1269

1403

1520

4900

751

1086

1278

1413

1531

4950

757

1094

1288

1423

1542

5000

762

1102

1297

1433

1553

***

IN THE CIRCUIT COURT OF _________ COUNTY, ARKANSAS

____________ DIVISION

STATE OF ARKANSAS    }

}ss  

AFFIDAVIT OF FINANCIAL MEANS

COUNTY OF                       

Revised 02-02

_____________________

PLAINTIFF      

Vs.   Case No. _____________
_____________________

DEFENDANT

BOTH PARTIES MUST COMPLETE AND EXCHANGE THIS AFFIDAVIT PRIOR TO ANY HEARING. BOTH PARTIES MUST SUPPLY THE ORIGINAL NOTARIZED AFFIDAVIT TO THE COURT. THE COURT WILL PUNISH PERJURY BY APPROPRIATE ACTION.

    The affiant, being duly sworn, says under penalty of perjury that affiant is the [Plaintiff/Defendant/Party] (circle one) to this support action herein, has prepared this financial statement, knows the contents thereof, and that it is true and correct.

Attach additional pages as needed.

INCOME
Complete Item 29.

1. My weekly take-home pay [from Item 29(i)] is $_________.

2. I claim ____ dependents for the purpose of determining my State of Arkansas withholding. I claim ____ dependents for the purpose of determining my federal withholding. I [did/did not] (circle one) claim myself as a dependent. I [do/do not] (circle one) have an additional amount withheld from my payroll checks for tax purposes and, if so, that amount is $________ per [week/pay period] (circle one) and itemized below. All other deductions taken from my payroll check before I receive it total $___________ [from Item 29(j)(8)].

3. I receive total payments, periodic, or otherwise, from the following sources: ________________________________ in the following amount(s) of $________________.

4. I have cash on hand in the amount of $_________ from the following sources:________________________________________

5. I have on deposit in banks and savings institutions the amount of $________ from the following source(s):_________________.

6. I have stocks and bonds in the amount of $________ and their source was _________________________________________.

CREDITORS
Complete Items 30, 31 and 32.

7. Debts in the name of plaintiff only: ALL CREDITORS LISTED UNDER ITEM 30: 

(a) TOTAL UNPAID BALANCES: $_____________
(b) TOTAL MONTHLY PAYMENTS: $_____________

 8. Debts in the name of defendant only: ALL CREDITORS LISTED UNDER ITEM 31:

(a) TOTAL UNPAID BALANCES: $_____________
(b) TOTAL MONTHLY PAYMENTS: $_____________

9. Debts in our JOINT NAMES are: ALL CREDITORS LISTED UNDER ITEM 32:

(a) TOTAL UNPAID BALANCES: $_____________
(b) TOTAL MONTHLY PAYMENTS: $_____________

AVERAGE MONTHLY EXPENSES

10. My present average monthly expenses to support myself and ___children are:

HOUSEHOLD  INSURANCES
Mortgage or rent payments $______     Health  $______
Property taxes and insurance $______ Life $______
Electricity  $______ Other Insurance $______
Water, garbage & sewer $______                                          $______
Telephone (including cell)  $______                                          $______
Fuel, oil or natural gas $______ OTHER EXPENSES NOT LISTED
Repairs & Maintenance $______ Household help  $______
Lawn (and pool) care $______ Dry Cleaning  $______
Pest Control  $______ My Clothing $______
Housewares  $______ My Hair Care $______
Food & Grocery items $______ My Cosmetics $______
Meals outside home $______ Newspaper, etc $______
Other                              $______                                                                    $______
                                                                         $______                                          $______
                                         $______ PETS
                                         $______ Food  $______
AUTOMOBILE EXPENSE Grooming $______
Car/lease payment $______ Veterinarian $______
Gasoline and Oil $______ PERSONAL
Repairs $______ Membership dues $______
Auto Tag and Title $______ Professional dues $______
Insurance $______ Social Dues $______
Other                              $______ Entertainment $______
                                         $______ Vacations $______
CHILDREN'S EXPENSES Publications $______
Nursery or babysitting  $______ Church/Charity $______
School tuition $______ Miscellaneous $______
School supplies $______ Other                              $______
Lunch money $______ MEDICAL EXPENSES
Allowance  $______ Physician $______
Clothing $______ Dental  $______
Medical, Dental, Drugs $______ Medicines $______
Vitamins $______ Hospital $______
Barber/Beauty parlor $______ Glasses  $______
Cosmetics/Toiletries $______ Other                              $______
Gifts for Holidays/Birthdays $______
Other                              $______
                                         $______
                                         $______
TOTAL MONTHLY EXPENSES  $                 

    Place a check mark next to those not being paid currently.

GENERAL INFORMATION

11. My full name is ___________________.

12. My social security number is _________________.
       My military I.D. number is ___________________.

13. My Arkansas driver's license number is ________________.

14. My date of birth is _____________.
       My place of birth is ______________.

15. My father's full name is________________.
       My mother's full name is                                 .  
       [They/He/She] reside(s) at _______________.
       My [father and/or mother] [is/are] deceased. 

16. My present resident address is __________________.

17a. The full names, birth dates and social security numbers of children born
         (or legally adopted) of this marriage are:

Name   Birth Date Soc. Sec. Number
(a) __________________ _____________ _________________
(b) __________________ _____________ _________________
(c) __________________ _____________ _________________
(d) __________________ _____________ _________________
(e) __________________ _____________ _________________
(f) __________________ _____________ _________________

17b. The full names, birth dates and social security numbers of Children born out
         of  wedlock to the parties are:

Name   Birth Date Soc. Sec. Number
(a) __________________ _____________ _________________
(b) __________________ _____________ _________________
(c) __________________ _____________ _________________

        Paternity has _______ has not _______ been established for these children.

17c. I also have the obligation to support the following additional children born
         to me and ______________________:

Name   Birth Date Soc. Sec. Number
(a) __________________ _____________ _________________
(b) __________________ _____________ _________________
(c) __________________ _____________ _________________

       Please attach any court orders establishing paternity and establishing a child
       support obligation.

18. My employer is __________________.

19. My employer's full address is _____________________.

20. My home telephone number is ___________.
       My work telephone number is  ___________.

INFORMATION ABOUT OPPOSING PARTY, IF KNOWN (DO NOT GUESS)

21. The opposing party's full name is ________________.

22. The opposing party's social security number is ___________.
       The opposing party's military I.D. number is ____________.

23. The opposing party's Arkansas driver's license number is _________________.

24. (a) The opposing party's father's full name is _________.
       (b) The opposing party's mother's full name is ________.
       (c) [They/He/She] reside(s) at _____________________.
       (d) Opposing party's [father and/or mother] [is/are] deceased.

25. The opposing party's present residence address is __________.

26. The opposing party's employer is _____________.

27. The opposing party's employer's address is __________.

28. The opposing party's home telephone number is ___________.
      The opposing party's work telephone number is ___________.

INCOME

29. How often are you paid and what are your gross wages, salary or commission due
      each time? (Check one)

PAYROLL DEDUCTIONS

(a) GROSS WAGES   $_____________
(b) Federal income tax withheld $_____________  
(c) Arkansas income tax withheld  $_____________  

(d) FICA (social security) or railroad retirement 

$_____________  
(e) Health insurance (children only) $_____________  

(f) Court-ordered child support
    for dependents of previous
    marriage or previously
    legally determined adopted
    or illegitimate children

$_____________  
(g) TOTAL WITHHELD ((b) through (f) above)   $_____________

(h) NET TAKE-HOME PAY PER PAY PERIOD
     (Subtract (g) from (a) above)

  $_____________
(i) CONVERT TO WEEKLY TAKE-HOME PAY
    AND CARRY TO ITEM 1 ABOVE
$_____________
    Example: If (h) above is $300.00
    and is received bi-weekly,
    multiply $300.00 by 26
    (26x3OO=$7,800), divide
    $7,800 by 52 ($150.00);
    carry $150.00 to Item 1
(j) OTHER ITEMS WITHHELD FROM MY
    CHECK ARE:
   
   (1)Union dues $_____________
   (2)Credit union, thrift plans $_____________
   (3)Pension benefits, stock purchase plans $_____________
   (4)Charitable contributions $_____________
   (5)Debt payments, garnishments $_____________
   (6)Life insurance payments $_____________
   (7)other (identify)    $_____________
   Items (1) through (7) above are not
   allowed in computing take-home pay.
   (8)TOTAL WITHHELD (sum of items (1)
       through (7) above)
$_____________

If self-employed, attach copies of your past two years' state and federal income tax returns and a list of all disbursements made to you during the current calendar year.

CREDITORS AND DEBTS

30. Debts in the name of PLAINTIFF only are:

 Creditors  

Total Unpaid Balance

Monthly Payment

(a) __________________ $_____________ $ _________________
(b) __________________    _____________    _________________
(c) __________________    _____________    _________________
(d) __________________    _____________    _________________
(e) __________________    _____________     _________________
(f) Total: *$_____________ **$_________________
*Carry forward to Item 7(a) **Carry forward to Item 7(b)

31. Debts in the name of DEFENDANT only are:

Creditors  

Total Unpaid Balance

Monthly Payment

(a) __________________ $_____________ $ _________________
(b) __________________    _____________    _________________
(c) __________________    _____________    _________________
(d) __________________    _____________    _________________
(e) __________________    _____________     _________________
(f) Total: *$_____________ **$_________________
*Carry forward to Item 8(a) **Carry forward to Item 8(b)

32. Debts in JOINT names:

Creditors  

Total Unpaid Balance

Monthly Payment

(a) __________________ $_____________ $ _________________
(b) __________________    _____________    _________________
(c) __________________    _____________    _________________
(d) __________________    _____________    _________________
(e) __________________    _____________     _________________
(f) Total: *$_____________ **$_________________
*Carry forward to Item 9(a) **Carry forward to Item 9(b)

33. The weekly take-home pay of opposing party is $____________.

34. All other income of the opposing party is $______________.

 

  _____________________________
Affiant
STATE OF _______________  
COUNTY OF ______________

    Subscribed and sworn to before me, a Notary Public, on this ___ day of _____________,______.
         (month)             (year)

 

  ______________________________
Notary Public
My Commission Expires:
_____________________.
(SEAL)