Opinion
Opinion delivered September 25, 1997
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 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 again submitted recommendations to the Court in October, 1993, and the Court issued the most recent Per Curiam Order on October 23, 1993, adopting the guidelines which are published in the Court Rules Volume of the Arkansas Code Annotated.
In the ensuing four years, the Committee continued to study the existing guidelines pursuant to federal and state law and has once again submitted its recommendations.
Having carefully considered these most recent recommendations, the Court adopts and publishes Administrative Order Number 10 — Arkansas Child Support Guidelines, effective October 1, 1997. This Administrative Order includes and incorporates by reference the weekly and monthly family support charts and the Affidavit of Financial Means which are attached to Administrative Order Number 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.
I dissent for the reasons stated in the dissenting opinion of Hickman, J., when the per curiam order adopting the guidelines was issued. In re: Guidelines for Child Support Enforcement, 301 Ark. 627, 784 S.W.2d 589 (1990).
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.
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. Findings that rebut the guidelines shall state the payor's income, recite the amount of support required under the guidelines, recite whether or not the Court deviated from the Family Support Chart and include a justification of why the order varies from the guidelines as may be permitted under SECTION V. hereinafter.
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, worker's 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 dependant 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/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)(3); § 9-10-109(b)(1); and § 9-14-804 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/or children on account of the payor's disability.
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 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 last year's federal and state income tax returns and the quarterly estimates for the current year. 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, a dependent custodian should be counted as two dependents as a guide in determining support. 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 would normally 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;
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:
1. The procurement and/or maintenance of life insurance, health insurance, dental insurance for the children's benefit;
2. The provision or payment of necessary medical, dental, optical, psychological or counseling expenses of the children (e.g. orthopedic shoes, glasses, braces, etc.);
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; and
7. The support required and given by a payor for dependent children, even in the absence of a court order.
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 where 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. PROVISION FOR PAYMENT.
All orders of child support should fix the dates on which payments should 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)(3)(A). Payment should be made through the Clerk of the Court or 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 ONE TWO THREE FOUR FIVE INCOME CHILD CHILDREN CHILDREN CHILDREN CHILDREN ----------------------------------------------------------------- 100 24 35 42 46 50 110 26 39 46 50 55 120 29 42 50 55 59 130 31 45 54 59 64 140 34 49 58 64 69 150 36 52 61 68 74 160 38 55 65 72 78 170 40 58 69 76 83 180 43 62 73 80 87 190 45 65 77 85 92 200 47 68 80 89 96 210 49 72 84 93 101 220 52 75 88 97 106 230 54 78 92 102 110 240 56 82 96 106 115 250 59 85 100 110 120 260 60 87 102 113 123 270 61 89 104 115 125 280 62 90 106 117 127 290 64 92 108 120 130 300 65 94 110 122 132 310 66 95 112 124 134 320 67 97 114 126 136 330 68 98 115 128 138 340 69 100 117 129 140 350 70 101 119 131 142 360 71 103 121 133 144 370 73 105 123 136 147 380 74 107 125 138 150 390 76 109 128 141 153 400 77 111 130 144 156 410 79 114 133 147 159 420 80 116 136 150 162 430 82 118 138 153 165 440 83 120 141 155 168 450 85 122 143 158 171 460 86 124 146 161 174 470 88 126 148 164 177 480 89 128 150 166 180 490 91 130 153 169 183 500 92 132 155 171 186 510 93 134 157 174 188 520 95 136 160 176 191 530 96 138 162 179 194 540 98 140 164 182 197 550 99 142 167 184 200 560 100 144 169 187 202 570 102 146 171 189 205 580 103 148 174 192 208 590 104 150 176 195 211 600 106 152 178 197 214 610 107 154 181 200 217 620 108 156 186 202 219 630 109 158 185 204 222 640 110 159 187 206 224 650 111 161 189 208 226 660 112 162 190 210 228 670 113 164 192 212 230 680 115 165 194 214 232 690 116 167 196 216 235 700 117 168 198 219 237 710 118 170 200 221 239 720 119 171 201 223 241 730 120 173 203 225 243 740 121 174 205 227 246 750 122 176 207 229 248 760 123 178 209 231 251 770 124 180 212 234 253 780 126 182 214 236 256 790 127 183 216 238 258 800 128 185 218 241 261 810 129 187 220 243 263 820 130 189 222 245 266 830 132 190 224 248 268 840 133 192 226 250 271 850 134 194 228 252 273 860 135 195 230 254 275 870 136 197 232 256 275 880 137 198 234 258 280 890 138 200 235 260 282 900 139 202 237 262 284 910 140 203 239 264 286 920 142 205 241 266 289 930 143 206 243 268 291 940 144 208 245 270 293 950 145 209 247 272 295 960 146 211 248 274 297 970 147 213 250 276 300 980 148 214 252 275 302 990 149 216 254 281 304 1000 150 217 256 283 306 ARKANSAS MONTHLY FAMILY SUPPORT CHART PAYOR NET INCOME ONE TWO THREE FOUR FIVE INCOME CHILD CHILDREN CHILDREN CHILDREN CHILDREN ----------------------------------------------------------------- 500 122 177 210 232 252 550 133 193 229 253 274 600 144 210 248 274 297 650 155 226 266 294 319 700 166 242 285 315 342 750 178 258 304 336 364 800 189 274 323 357 387 850 200 290 342 377 409 900 212 307 361 399 433 950 223 323 381 421 456 1000 235 340 400 442 479 1050 246 357 420 464 503 1100 257 372 438 485 525 1150 263 381 448 495 437 1200 269 389 458 506 548 1250 275 397 467 516 460 1300 280 405 477 527 571 1350 286 413 486 537 582 1400 291 421 495 547 593 1450 297 429 503 556 603 1500 302 436 512 566 613 1550 308 444 521 575 624 1600 314 453 531 587 636 1650 322 464 544 601 651 1700 330 475 556 615 667 1750 338 486 569 629 682 1800 345 497 582 643 697 1850 353 508 595 657 712 1900 360 518 607 671 727 1950 368 529 620 685 742 2000 375 540 632 698 757 2050 382 550 645 712 772 2100 389 560 656 725 786 2150 396 570 668 738 800 2200 404 581 679 751 814 2250 411 591 691 764 828 2300 418 601 703 776 841 2350 425 611 714 789 856 2400 431 620 726 802 870 2450 438 630 738 815 884 2500 445 640 750 828 898 2550 452 650 762 842 912 2600 458 660 773 855 926 2650 465 670 785 868 940 2700 471 679 796 879 953 2750 476 686 805 889 964 2800 481 694 814 899 975 2850 483 701 823 910 986 2900 491 709 832 920 997 2950 496 716 841 930 1008 3000 501 724 851 940 1019 3050 506 731 860 950 1031 3100 511 739 869 960 1041 3150 517 746 878 970 1052 3200 522 755 888 981 1064 3250 528 764 899 993 1076 3300 534 772 909 1004 1089 3350 540 781 919 1016 1101 3400 546 790 930 1028 1114 3450 552 799 940 1039 1126 3500 558 807 951 1051 1139 3550 564 816 961 1062 1151 3600 570 825 972 1074 1164 3650 576 834 982 1085 1176 3700 582 842 991 1095 1187 3750 587 849 1000 1106 1198 3800 583 857 1010 1116 1209 3850 598 864 1019 1126 1220 3900 604 873 1028 1136 1261 3950 609 881 1037 1146 1242 4000 615 889 1046 1156 1254 4050 620 897 1056 1167 1265 4100 626 905 1065 1177 1276 4150 631 913 1074 1187 1287 4200 637 920 1083 1197 1298 4250 642 928 1092 1207 1309 4300 648 936 1102 1217 1320 4350 653 944 1111 1228 1331 4400 659 952 1120 1238 1342 4450 664 960 1129 1248 1353 4500 670 968 1138 1258 1364 4550 675 976 1148 1268 1375 4600 681 983 1157 1278 1386 4650 686 991 1166 1289 1397 4700 691 998 1174 1297 1406 4750 695 1004 1182 1306 1415 4800 699 1011 1189 1314 1425 4850 704 1017 1197 1323 1434 4900 708 1024 1205 1331 1443 4950 713 1030 1213 1340 1453 5000 717 1037 1220 1348 1462
IN THE CHANCERY COURT OF _____________________ COUNTY, ARKANSAS
_______________________ Division
STATE OF ARKANSAS ) ) SS AFFIDAVIT OF FINANCIAL MEANS COUNTY OF ) REVISED 10-97
_________________________________ Plaintiff
vs.
_________________________________ Case No. __________________ Defendant
THE AFFIANT, BEING DULY SWORN, SAYS UNDER PENALTY OF PERJURY THAT AFFIANT IS THE PLAINTIFF( ) DEFENDANT( ) PARTY( ) (CHECK ONE) TO THIS SUPPORT ACTION HEREIN, HAS PREPARED THIS FINANCIAL STATEMENT, KNOWS THE CONTENTS THEREOF, AND THAT IT IS TRUE AND CORRECT.
INCOME
Complete item 27 on page 3
1. My weekly take-home pay (from line 27 (i) on page 3) ____________|_____.
2. I claim ____ dependents for the purpose of determining my State of Arkansas withholding. I claim ____ dependents for the purpose of determing my federal withholding. I did( ) or did not( ) (check one) claim myself as dependent. I do( ) or do not( ) (check one) have additional amount withheld from my payroll checks for tax purposes and, if so, that amount is _________|_____ per week of _________|_____ per pay period and itemized on reverse side. All other deductions taken from my payroll check before I receive it: total: _________|_____ (from line j8 on page 3).
3. I have income from the following other sources: ____________________________________________________
4. I have cash on hand in the amount of ___________|_____ from the following source(s): ___________________
5. I have on deposit in banks and savings institutions ________________|_______ and its source was _________ __________________________________________________________________ __________________________________________________________________
6. I have stocks and bonds in the amount of ________|_____ and their source was _________________________________________________ __________________________________________________________________ __________________________________________________________________ (Attach additional schedules as needed) CREDITORS
Complete items 28,29 and 30 on page 4
7. Debts in the name of the plaintiff only: ALL CREDITORS LISTED ON PAGE 4
TOTAL UNPAID BALANCES $ (a) ________|____ TOTAL MONTHLY PAYMENTS $ (b) ________|____
8. Debts in the name of defendant only: ALL CREDITORS LISTED ON
TOTAL UNPAID BALANCES $ (a) ________|____ TOTAL MONTHLY PAYMENTS $ (b) ________|____
9. Debts in our JOINT NAMES are: ALL CREDITORS LISTED ON PAGE 4
TOTAL UNPAID BALANCES $ (a) ________|____ TOTAL MONTHLY PAYMENTS $ (b) ________|____
MONTHLY EXPENSES
10. My present necessary monthly expenses to support myself and ________ child(ren) are:
(a) Rent or housepayment $ ______|____
(b) Gas and electricity $ ______|____
(c) Water $ ______|____
(d) Telephone $ ______|____
(e) Food $ ______|____
(f) Clothing $ ______|____
(g) Laundry $ ______|____
(i) Medical $ ______|____
(j) Drugs $ ______|____
(k) Life Insurance $ ______|____
(l) Auto Insurance $ ______|____
(m) Fire Insurance $ ______|____
(n) Transportation $ ______|____
(o) Other Expenses $ ______|____ (Attach schedules if needed)
TOTAL ...................................... $ ______|____
A check mark should be placed by all expenses which are not being paid currently. GENERAL INFORMATION
11. My full name is ____________________________________________
12. My social security number is _______________________________ Military I.D. No. (if applicable) ______________________________
13. My Arkansas Driver's License Number is _____________________
14. My date of birth is ________________________________________ My place of birth is ___________________________________________
15. My present resident address is _____________________________ ________________________________________________________________ Zip Code
16. The full name of children born (or legally adopted) of this marriage are:
(1) ________________________________ Date of Birth _____________ S.S. No. _________________________
(2) ________________________________ Date of Birth _____________ S.S. No. _________________________
(3) ________________________________ Date of Birth _____________ S.S. No. _________________________
(4) ________________________________ Date of Birth _____________ S.S. No. _________________________
(5) ________________________________ Date of Birth _____________ S.S. No. _________________________
(6) ________________________________ Date of Birth _____________ S.S. No. _________________________
17. My employer is _____________________________________________ ________________________________________________________________
18. My employer's full address is ______________________________ ________________________________________________________________ Zip Code
19. My home telehone number is _________________________________ My work telephone number is ____________________________________
INFORMATION ABOUT OPPOSING PARTY IN THIS CASE, IF KNOWN (DO NOT GUESS)
20. The opposing party's full name is __________________________ ________________________________________________________________
21. The opposing party's social security number is _____________ Military I.D. No. (if applicable) ______________________________
22. The opposing party's Arkansas Driver's License Number is _____________________________________________________________
23. The opposing party's present resident address is ___________ ________________________________________________________________ Zip Code
24. The opposing party's employer is ___________________________ ________________________________________________________________
25. The opposing party's employer's address ____________________ ________________________________________________________________ Zip Code
26. The opposing party's home telephone number _________________ work telephone _________________________________________________ INCOME
27. How often are you paid, and what are your gross wages, salary or commissions due each time?
WEEKLY BIWEEKLY SEMI-MONTHLY 52 times a year 26 times a year 24 times a year
MONTHLY OTHER 12 times a year explain
PAYROLL DEDUCTIONS
(a) GROSS WAGES ................................ (a) $ _________|____
(b) Federal Income Tax Withheld ............ (b) ___________|____
(c) Arkansas Income Tax Withheld ........... (c) ___________|____
(d) Social Security (FICA), Medicare, or railroad retirement equivalent ......... (d) ___________|____
(e) Health Insurance (children only) ....... (e) ___________|____
(f) Court ordered child support for dependents of previous marriage or previously legally determined adopted or illegitimate children ............... (f) ___________|____
(g) TOTAL WITHHELD (b) thru (f) above .......... (g) $ _________|____
(h) INCOME PAY PER PAY PERIOD (Subtract (g) from (a) above .............. (h) $ _________|____
(i) CONVERT TO WEEKLY INCOME CARRY TO LINE 1 (on front) ...............27 (i) $ _________|____
Example: h above $300 is received bi-weekly, 26 X $300 = $7,800 divided by 52 = $150 per week Carry $150 to line 1 on front
(j) OTHER ITEMS WITHHELD FROM MY CHECK ARE:
(1) Union Dues ............................. (1) _________|_____
(2) Credit Union, thrift plans ............. (2) _________|_____
(3) Pension Benefits, stock purchase plans .................................. (3) _________|_____
(4) Charitable contributions ............... (4) _________|_____
(5) Debt Payments, garnishments ............ (5) _________ |_____
(6) Life Insurance payments ................ (6) _________|_____
(7) Other (identify) _______________________ ____________________________________________ (7) _________|_____
Items (1) through (7) above are not allowed in computing income.
(8) TOTAL WITHHELD (total (1) thru (7) above) ............j (8) ________|_____CREDITORS DEBTS
28. Debts in the name of PLAINTIFF/Party only are:
Creditors (Total Unpaid (Monthly Payments) Balance)
1. __________________________ 1. $ ________|____ 1. $ ________|____ 2. __________________________ 2. $ ________|____ 2. $ ________|____ 3. __________________________ 3. $ ________|____ 3. $ ________|____ 4. __________________________ 4. $ ________|____ 4. $ ________|____ 5. __________________________ 5. $ ________|____ 5. $ ________|____ 6. __________________________ 6. $ ________|____* 6. $ ________|____*
Attach additional schedules *Carry to line 7a *Carry to line 7b as needed, the TOTAL: on page 1 on page 1
29. Debts in the name of DEFENDANT only are:
Creditors (Total Unpaid (Monthly Payments) Balance)
1. __________________________ 1. $ ________|____ 1. $ ________|____ 2. __________________________ 2. $ ________|____ 2. $ ________|____ 3. __________________________ 3. $ ________|____ 3. $ ________|____ 4. __________________________ 4. $ ________|____ 4. $ ________|____ 5. __________________________ 5. $ ________|____ 5. $ ________|____ 6. __________________________ 6. $ ________|____* 6. $ ________|____*
Attach additional schedules *Carry to line 8a *Carry to line 8b as needed, the TOTAL: on page 1 on page 1
30. Debts in our JOINT NAMES are:
Creditors (Total Unpaid (Monthly Payments) Balance)
1. __________________________ 1. $ ________|____ 1. $ ________|____ 2. __________________________ 2. $ ________|____ 2. $ ________|____ 3. __________________________ 3. $ ________|____ 3. $ ________|____ 4. __________________________ 4. $ ________|____ 4. $ ________|____ 5. __________________________ 5. $ ________|____ 5. $ ________|____ 6. __________________________ 6. $ ________|____* 6. $ ________|____*
Attach additional schedules *Carry to line 9a *Carry to line 9b as needed, the TOTAL: on page 1 on page 1
31. The weekly income of the opposing party is ................................... $ ___________|____
32. All other income of the opposing party is .. $ ___________|____
______________________________ Signature of Affiant
Subscribed and sworn to before me on this _________ day of _____________________________, ______ (month) (year)
My commission expires: ___________________________________ ___________________________________
NOTICE
BOTH PARTIES MUST COMPLETE AND EXCHANGE THIS FOUR PAGE AFFIDAVIT PRIOR TO ANY HEARING TO ESTABLISH OR MODIFY A SUPPORT ORDER. BOTH PARTIES MUST SUPPLY THE ORIGINAL NOTARIZED AFFIDAVIT TO THE COURT. THE COURT WILL PUNISH PERJURY BY APPROPRIATE ACTION.