In Re Amendments to Administrative Order No. 10

2022 Ark. 185

• Court: Supreme Court of Arkansas
• Decided: October 6, 2022
• Status: Published

Opinion

Cite as 2022 Ark. 185 SUPREME COURT OF ARKANSAS Opinion Delivered: October 6, 2022

IN RE AMENDMENTS TO ADMINISTRATIVE ORDER NO. 10

PER CURIAM

The court herby adopts and implements the amendments to Administrative Order No. 10

and the Affidavit of Financial Means as set out below. Effectively immediately, the amended

guidelines may be used as an alternative to the previous version of Administrative Order No. 10.

The new guidelines shall be used for all support orders entered after October 6, 2022.

The Court extends its sincere gratitude to the following members of the Child Support

Committee for their work to implement the newly adopted Administrative Order No. 10.

Hon. Douglas Schrantz (Chairman), Circuit Judge of Bentonville, Hon. Brandon J.

Harrison, Arkansas Court of Appeals, Hon. Andrew Bailey, Circuit Judge of Mountain Home,

Hon. David Clark, Circuit Judge of Conway, Allison Allred, Esq., of North Little Rock, Hon.

Johnnie A. Copeland, Circuit Judge of Harrison, Traci LaCerra, Esq., of Little Rock, Michael

Shone, Esq., of the Arkansas Office of Child Support Enforcement, and Brooke F. Steen, Director

Juvenile Division, Arkansas Administrative Office of the Courts. Administrative Order No. 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 adopted and published Administrative Order Number 10, titled “Child Support Guidelines” (“Guidelines”). Pursuant to Act 907 of 2019, codified at Ark. Code Ann. § 9-12-312(a)(4), the attached revised monthly “Family Support Chart” (“Chart”) is based on an Income Shares Model. The attached Chart therefore supersedes any prior payor-income-based family support chart. (Section II.1 discusses when this Administrative Order’s incorporation of the Income Shares Model affects existing child- support orders.) This Administrative Order includes and incorporates by reference the “Forms” Addendum: Sample Calculation, Sample Language for Child-Support Orders, Family Support Chart, Child Support Worksheet (“Worksheet”), and the revised Affidavit of Financial Means.

These Guidelines are based on the Income Shares Model, developed by the Child Support Guidelines Project of the National Center for State Courts. The Income Shares Model is based on the concept that children should receive the same proportion of parental income that they would have received had the parents lived together and shared financial resources. The best available economic data on child-rearing expenditures was used to develop the model. A more detailed explanation of the Income Shares Model and the underlying economic evidence used to support it is contained in Development of Guidelines for Child Support Orders, Report to the Federal Office of Child Support Enforcement, September 1987 (National Center for State Courts, Denver, Colorado). The September 2019 Review of the Arkansas Child Support Guidelines, an Analysis of Economic Data, Development of Income Shares Charts, and Other Considerations, prepared by Jane Venohr, Ph.D., is available at www.arcourts.gov/forms-and-publications/arkansas-child- support-guidelines.

Under the revised Family Support Chart, each parent’s share is that parent’s prorated share of the two parents’ combined income. The Chart reflects the average amount of money that families in the United States spend on their children. Differences between Arkansas prices and prices across the United States more generally have been accounted for using an index that the U.S. Bureau of Economic Analysis (BEA) developed. The Chart also considers and accounts for:

• federal and state income taxes and FICA; • average child-rearing expenditures using current measurements developed by Professor David Betson using the Rothbarth methodology to separate the children’s share of expenditures from total expenditures; • out-of-pocket medical expenses of $250.00 per child per year.

The Chart excludes parental expenditures for work-related childcare, the child’s share of health insurance premiums, and out-of-pocket medical expenses over $250.00 per child per year.

These Guidelines and the accompanying Worksheet assume that the parent to whom support is owed (payee parent) is spending his or her calculated share directly on the child. For the parent with the obligation to pay support (payor parent), the pro-rata charted amount establishes the base level of child support to be given to the payee parent. The base amount may, however, 2 be adjusted to account for work-related childcare expenditures, the child’s share of the health insurance premium, out-of-pocket medical expenses exceeding $250.00 per child per year, the self- support reserve, or other factors a court determines to be in the best interest of a child or children.

Section II. Use of the Guidelines

There is a rebuttable presumption that the amount of child support calculated pursuant to the most recent revision of the Family Support Chart and these Guidelines is the amount to be awarded in any judicial proceeding for divorce, separation, paternity, guardianship, or child support.

In addition to an initial award for child support or the modification of an existing obligation, these Guidelines should be used to assess the adequacy of agreements for child support and to encourage parties to settle support-related disputes in a comprehensive manner.

These Guidelines provide calculated amounts of child support for a combined parental gross income of up to $30,000.00 per month, or $360,000.00 per year. The child-support obligation for incomes above $30,000.00 per month shall be determined by using the highest amount in these Guidelines. The court may then use its discretion in setting an amount above that to meet the needs of the child and the parent’s ability to provide support.

These Guidelines assume that the payor parent has the minor child(ren) overnight in his or her residence less than 141 overnights per calendar year.1

1. Modification of Existing Child-Support Obligation:

Pursuant to Act 904 of 2019, codified at Arkansas Code Annotated § 9-14-107(c)(2), “an inconsistency between the existing child-support award and the amount of child support that results from application of the Family Support Chart shall constitute a material change of circumstances sufficient to petition the court for modification of child support according to the Family Support Chart after appropriate deductions unless:

a. The inconsistency does not meet a reasonable quantitative standard established by the State of Arkansas in accordance with subsection (a) of this section; b. The inconsistency is due to the fact that the amount of the current child support award resulted from a rebuttal of the guideline amount and there has not been a change of circumstances that resulted in the rebuttal of the guidelines amount; or c. The inconsistency is due solely to a promulgation to a revision of the Family Support Chart.” 2

2. Deviation from the Chart:

1This Administrative Order presumes that a traditional visitation schedule will be less than 141 nights while a liberal visitation schedule is usually more than 141 nights. 2 The Section titled “Modification of Existing Child-Support Obligation” recites verbatim Arkansas Code Annotated 9-14-107(c)(2). 3 All orders granting or modifying child support shall contain the court’s determination of the payor’s income, payee’s income, recite the amount of support required under these Guidelines, and state whether the court deviated from the presumptive child-support calculation set by the Worksheet and these Guidelines. If an order deviates from the Guidelines amount, then the order must explain the reason(s) for the deviation. When deciding whether the Worksheet-based amount is unjust or inappropriate, the court must consider all the relevant factors, including what is in the child’s or children’s best interest. A deviation from these Guidelines should be the exception rather than the rule. If a court chooses to deviate from the Guidelines amount, then it must make written findings and explain the deviation. It shall be sufficient in a particular case to rebut the presumption that the amount of child support calculated pursuant to the Worksheet is correct if the court provides in the order a specific written finding that the Worksheet-based amount is unjust or inappropriate. When determining whether to deviate from the Guidelines’ amount, a court should consider the following:

a. Educational expenses for the child(ren) (i.e., those incurred for private or parochial schools, or other schools where there are tuition or related costs) and/or the provision or payment of special education needs or expenses for the child(ren); b. The procurement and/or maintenance of life insurance, dental insurance, and/or other insurance for the children’s benefit (for health insurance premiums, see Section II.2 infra); c. Extraordinary travel expenses for court-ordered visitation; d. Significant available income of the child(ren); e. The creation or maintenance of a trust fund for the children; f. The support given by a parent for minor children in the absence of a court order; g. Extraordinary time spent with the payor parent; h. Additional expenses incurred because of natural or adopted children living in the home, including stepchildren if the court finds there is a court-ordered responsibility to a stepchild; i. The provision for payment of work-related childcare, extraordinary medical expenses for the child in excess of $250.00 per year per child, and/or health insurance premiums. Ordinarily, these expenses will be divided pro rata between the parents and added to the base child support of the payor parent on the Worksheet. In that scenario, it shall not support a deviation. However, if the court chooses not to add them in the total child-support obligation, they could support a deviation; and j. Any other factors that warrant a deviation.

3. Self-Support Reserve, Minimum Order, and Deviation from the Minimum Order:

In cases where the payor parent’s monthly gross income is less than $900.00, the Chart applies a self-support reserve (SSR). The SSR considers the basic subsistence needs of the payor parent and is based on the Federal Poverty Guidelines multiplied by Arkansas’s price parity. Arkansas’s price parity is the index used to adjust the Chart to reflect Arkansas prices. If the payor parent’s child-support amount pursuant to the chart is based solely on the payor parent’s gross income and corresponding number of children falls within the shaded area of the Chart, then the basic child-support obligation and the payor parent’s total child-support obligation are computed using only the payor parent’s income. In these cases, health insurance premiums, extraordinary medical expenses, and childcare expenses shall not be used to calculate the total child-support 4 obligation. However, payment of these costs by either parent may be used as a reason to deviate from these Guidelines.

When the payor parent’s monthly gross income is less than $900.00, a presumptive minimum award of $125.00 per month must issue unless a party can rebut the presumptive amount by a preponderance of the evidence. Some factors that a court may consider when deciding whether a party has rebutted the minimum order amount include but are not limited to the following:

a. There is a large adjustment due to parenting time; b. The payor is incarcerated (see Section II.4 below); c. The payor is institutionalized due to a mental illness or other impairment; d. The payor has a verified physical disability that precludes work; e. The payor’s only income is Supplemental Security Income (SSI); f. The payor’s ability or inability to work; or g. Any other deviation factor listed above in Subsection II.2 or any income imputation factor listed below in Section III.7.

4. Incarcerated Individuals

Pursuant to Act 904 of 2019, codified at Arkansas Code Annotated § 9-12-312(a), § 9-14- 106(a), and § 9-14-107(a), the incarceration of a parent shall be treated as involuntary unemployment for the purpose of establishing or modifying an award of child support. “Incarceration” means a conviction that results in a sentence of confinement to a local jail, state or federal correctional facility, or state psychiatric hospital for at least 180 days and excludes credit for time served before sentencing.

Section III. Gross Income

1. Definitions:

“Income” means the actual gross income of the parent, if employed to full capacity, or potential income if unemployed or underemployed as allowed under Section III.7. Gross income is used to avoid disputes over issues of deductibility that would arise if a net income was used.

These Guidelines presume that the parent with the legal obligation to pay support will file federal taxes as a single individual and have only one state exemption. Adjustments have been made in the Chart for federal and state income taxes, FICA, and average child-rearing expenditures (for example, out-of-pocket medical expenses of $250.00 per child per year).

The monthly child-support amount shall be converted to coincide with the payor’s receipt of salary, wages, or other income. For purposes of computing gross monthly income, a month is 4.334 weeks. Bi-weekly means a party is paid once every two weeks, or 26 times during a calendar year. Semi-monthly means a person is paid twice a month, or 24 times per calendar year.

“Child Support Gross Income” means gross income—minus amounts for preexisting child- support obligations paid to another who is not a party to the proceedings and on behalf of a child who is not the subject of the action of the court. Child support arrearage payments shall not be considered in determining a payor’s gross income.

5 “Combined Gross Income” means the combined gross income of both parties.

2. Gross Income Inclusions:

“Income” is “intentionally broad and designed to encompass the widest range of sources consistent with the State’s policy to interpret ‘income’ broadly for the benefit of the child.” Evans v. Tillery, 361 Ark. 63, 204 S.W.3d 547 (2005); Ford v. Ford, 347 Ark. 485, 65 S.W.3d 432 (2002); McWhorter v. McWhorter, 346 Ark. 475, 58 S.W.3d 840 (2001); Davis v. Office of Child Support Enforcement, 341 Ark. 349, 20 S.W. 3d 273 (2000).

Gross income includes, but is not limited to, the following: i. Wages, overtime pay, commissions, regularly-received bonuses, or other monies from all employers or as a result of any employment (as usually reported in the Medicare, wages, and tips section of the parent’s W-2). ii. Earnings generated from a business, partnership, contract, self-employment, or other similar arrangement, or from rentals. (a) Income (or losses) from a corporation should be carefully examined to determine the extent to which they were historically passed on to the parent or used merely as a tax strategy. iii. Distributed profits or payments from profit-sharing, a pension or retirement, an insurance contract, an annuity, trust fund, deferred compensation, retirement account, social security disability payments, social security retirement payments, unemployment compensation, supplemental unemployment benefits, disability insurance or benefits, or worker’s compensation. (a) Consider insurance or other similar payments received as compensation for lost earnings, but do not include payments that compensate for actual medical bills or for property loss or damage. (b) If a parent receives payments from an IRA, defined contribution, or deferred compensation plan, income does not include contributions to that account that were previously considered as the parent’s income used to calculate an earlier child-support obligation for a child in this case. To the extent that the funds received are equivalent to the amount of the funds contributed by the parent while paying child support, that amount should be excluded from the computation of gross income. (c) Social Security auxiliary benefits paid to children because of a parent’s disability shall be income to the disabled parent. If either parent receives auxiliary benefits because of a spouse or children unrelated to the case before the court, that payment shall not be included as income. iv. Military specialty pay, allowance for quarters and rations, housing, veterans’ administration benefits, G.I. benefits (other than education allotment), or drill pay. (a) If the servicemember receives housing pay and supports another home (i.e. second residence), housing pay is not considered income to the individual. v. Tips, gratuities, royalties, interest, dividends, fees, or gambling or lottery winnings. vi. Capital gains to the extent that they result from recurring transactions. vii. The standard (basic needs) portion of adoption subsidies for children in the case under consideration (do not consider the medical needs and intensive rate portion of the subsidy, nor the family support subsidy as income). viii. Any money or income due or owed by another individual, source of income, government, or other legal entity. 6 ix. Income also includes the market value of perquisites (perks) received as goods, services, or other noncash benefit for which the parent did not pay, if they reduce personal expenses, and have significant value or are received regularly. (a) Common forms of perquisites (perks) or goods and services received in-kind include, but are not limited to, the following: housing, meals, or room and board, personal use of a company business vehicle or mileage reimbursement, including use between home and primary worksite, and other goods or services. (b) Perquisites (perks) do not include money paid by an employer for benefits like tuition reimbursement, educational cost reimbursement, uniforms, and health savings account (HSA) contributions. x. The court may consider assets available to generate income for child support. For example, the court may determine the reasonable earning potential of any asset at its market value and assess against it the current Treasury bill interest rate or some other similar appropriate method of computing income.

To further this State’s policy of interpreting “income” broadly for the benefit of children, a support order may include as its basis a percentage of a bonus to be paid in the future. The child support attributable to a bonus amount (or another one-time source of money) shall be in addition to the periodic child-support obligation. This child-support obligation shall terminate when the underlying child-support obligation terminates. Variable income such as commissions, bonuses, overtime pay, military bonuses, and dividends shall be averaged by the court over a reasonable period of time consistent with the circumstances of the case and added to a parent's fixed salary or wages to determine gross income. When income is received on an irregular, nonrecurring, or one- time basis, the court may, but is not required to, average or prorate the income over a reasonable specified period of time or require the parent to pay as a one-time support amount a percentage of his or her nonrecurring income.

One-time sources of money like an inheritance, gambling or lottery winning, or liquidating a Certificate of Deposit, for example, is income for these Guidelines purposes (as detailed in the previous paragraph). If the receipt of an asset is not sold or otherwise disposed of, however, then it has not “realized a gain” and therefore is not income under these Guidelines.

3. Income from Self-employment, Business Owners, Executives, and Others

a. Difficulty in determining income for self-employed individuals, business owners, and others occurs for several reasons including: i. These individuals often have types of income and expenses not frequently encountered when determining income for most people. ii. Taxation rules, business records, and forms associated with business ownership and self-employment differ from those that apply to individuals employed by others. Common business documents reflect policies unrelated to an obligation to support one’s child. iii. Due to the control that business owners or executives exercise over the form and manner of their compensation, a parent, or a parent with the cooperation of a business owner or executive, may arrange compensation to reduce the amount visible to others looking for common forms of income.

b. To determine monies that a parent has available for support, it may be necessary to examine business tax returns, balance sheets, accounting or banking records, and other business 7 documents to identify additional monies a parent has available for support that were not included as personal income. At a minimum, a self-employed parent shall provide their two most recent years of state and federal tax returns. The parent should provide three years of tax returns when there is a reduced, deferred, or elective income situation. Unless otherwise prohibited by law, the court may award expert witness fees when necessary to determine self-employed parent’s income.

c. For income from self-employment, proprietorship of a business, or ownership or a partnership or closely held corporation, gross income is defined as gross receipts minus ordinary and necessary expenses required for self-employment or business operation, including an employer’s share of FICA. However, the court should exclude from those expenses amounts allowed by the Internal Revenue Service for accelerated depreciation of investment tax credits for purposes of these Guidelines and add those amounts back in to determine gross income. In general, the court should carefully review income and expenses from a parent’s self-employment or operation of a business to determine actual levels of gross income available to the parent. The court’s duty is to accurately determine a child-support obligation in every case. This amount may differ from the determination of business income for tax purposes.

d. Whether organized informally, or as a corporation, a partnership, a sole proprietorship, or other arrangement or entity, these considerations apply to all forms of self- employment and business ownership, as well as to business executives and others who may receive similar forms of compensation.

e. For purposes of this subsection, income includes amounts that were not otherwise included as income elsewhere in this chapter. Special attention shall be given to the following forms of compensation: i. Distributed profits, profit sharing, officers’ fees and other compensation, management or consulting fees, commissions, and bonuses. ii. In-kind income or perquisites (perks), gifts, free admission to entertainment, or personal use of business property. The value of these items must be based on a fair-market price, that is, the price a person not affiliated with the business would pay. In-kind payments received by a parent from self-employment, or the operation of a business is income if the payments are significant and reduce personal living expenses.

f. Redirected income, or amounts treated by the business or company as if the redirected amounts were something other than the parent’s income. Amounts include, but are not limited to, the following: i. Personal loans. Presume personal loans from a business are in fact redirected income, unless all the following are true: (1) the parent signed a contract or promissory note outlining the terms of the loan, (2) the business maintains records showing the loan owed as a receivable, (3) the parent makes installment payments and the present loan is paid current, and (4) the interest earned and repayment rate appear to be a reasonable business practice. Unless the presumption is overcome by a preponderance of the evidence, then a parent’s income includes the difference between the amount the parent repays and a repayment amount for a similar commercially available unsecured personal loan. ii. Payments made to friends or relatives of the parent. If the business cannot demonstrate that the payments are equivalent to a fair market value payment for the work or services the friend or relative performs, then include any amount that exceeds the fair-market value as the parent’s income.

8 g. Reduced or deferred income. Because a parent’s compensation can be rearranged to hide income, determine whether unnecessary reductions in salaries, fees, or distributed profits have occurred by comparing amounts and rates to historical patterns. i. Unless the business can demonstrate legitimate reasons for a substantial reduction in the percentage of distributed profits, use a three-year average to determine the amount to include as a parent’s income. ii. Unless a business can demonstrate legitimate reasons for reductions (as a percentage of gross business income) in salaries, bonuses, management fees, or other amounts paid to a parent, use a three-year average to determine the amount to include as a parent’s income.

h. Business income subject to elective treatment. Income that is subject to elective status (for example, retained income) may be considered as income after the court considers the circumstances and history of the elective treatment, which includes but is not limited to the status prior to the implementation of the support order. If a change in the status was made after the original election, then a court can either choose to include the income in child-support calculations or not include it in the calculations.

i. Deductions for Tax Purposes. For a variety of historical and policy reasons, the government allows considerable deductions for business-related expenses before taxes are calculated. Those same considerations are not always relevant to monies a parent should have available for child support. Therefore, some deductions should be added back into a parent’s income for purposes of determining child support. The deductions include, but are not limited to, the following: i. Rent paid by the business to the parent, if it is not counted as income on that parent’s personal tax return. ii. Real estate depreciation shall always be added back into a parent’s income when calculating support. iii. Depreciation figured at a straight-line (not accelerated) rate on a parent’s (not a corporation’s or partnership’s) tangible personal property, other than for personal vehicles or home offices, shall be deducted from income. Any parent who uses accelerated depreciation for tangible personal property may deduct the value of the straight-line depreciation amount for property other than personal vehicles or home offices, if the parent proves what the straight-line amounts would have been. iv. Home office expenses, including rent, hazard insurance, utilities, repairs, and maintenance. v. Entertainment expenses spent by the parent. Legitimate expenses for customers’ entertainment may be treated as deductions. vi. Travel expense reimbursements, except where such expenses are inherent in the nature of the business or occupation (for example, a traveling salesperson), and do not exceed the standard rates allowed by the State of Arkansas for employee travel. vii. Personal automobile repair and maintenance expenses.

4. Gross Income Exclusions:

Gross income does not include benefits received from means-tested public assistance programs, such as Temporary Assistance to Needy Families (TANF), Supplemental Security Income (SSI) received for self or any child; Food Stamps and General Assistance; income derived by other household members; child support, adoption subsidy payments, and foster care board payments received for other children not involved in the case.

9 5. Spousal Support:

If a parent paying spousal support also pays child support to the same person, then the amount of alimony a former payee spouse may be receiving shall be reduced from the payor’s gross income and added to the payee’s gross income for purposes of determining income under the child- support calculation.

6. Other Child Support Paid:

Any previous or existing court orders requiring the payment of current child support shall receive priority over any subsequent child-support obligation. A subsequent support obligation shall not constitute the sole basis for a material change of circumstances sufficient to support a petition to the court for modification of a prior child-support order.

Current child support paid for the benefit of children other than those considered in this computation, to the extent such payment or payments are required by a previous court order, shall be deducted from gross income. Child support arrearage payments shall not be considered in determining a payor’s gross income.

7. Income Verification:

The Affidavit of Financial Means and Worksheet shall be used in all family-support matters. Each party shall exchange the Affidavit of Financial Means and Worksheet at least three days before a hearing to establish or modify a support order. The Worksheet shall be filed in the court file and attached to the order that includes the child-support award. The Affidavit of Financial Means shall not be filed in the court file.

A court may rely on suitable documentation of current earnings, preferably for at least one month. Suitable documentation includes, but is not limited to, pay stubs, employer statements or verifications, and receipts and expenses if the parent is self-employed.

Verification of current earnings, whether they are reflected on the Affidavit of Financial Means or not, can be supported with copies of the most recent federal and state tax returns that a parent has filed.

Income can also be verified through the Department of Workforce Services or through the Department of Finance and Administration.

8. Income Imputation Considerations:

If imputation of income is ordered, the court must take into consideration the specific circumstances of both parents, to the extent known, including such factors as the parents’ assets, residence, employment and earnings history, job skills, educational attainment, literacy, age, health, criminal record and other employment barriers, and record of seeking work, as well as the local job market, the availability of employers willing to hire the parent, prevailing earnings level in the local community, and other relevant background factors in the case.

There is a rebuttable presumption that the payor and the payee can work full-time or earn full-time income, and the court may calculate child support based on a determination of potential income that would otherwise ordinarily be available to the parties. 10 The court may consider a disability or the presence of young children or disabled children who must be cared for by the parent as being a reason why a parent is unable to work.

Although Temporary Assistance to Needy Families (TANF) and other means-tested public assistance benefits are not included in gross income, income may be imputed to these recipients.

In addition to determining potential earnings, the court may impute income to any non- income producing assets of either parent, if significant, other than a primary residence or personal property. Examples of such assets are vacation homes (if not maintained as rental property) and idle land. The current rate determined by the court is the rate at which income may be imputed to such nonperforming assets.

Section IV. Health Insurance, Extraordinary Medical Expenses, and Childcare Costs

Three additional child-rearing expenses—health insurance premiums, extraordinary medical expenses, and childcare expenses—shall be added to the Worksheet and must be considered by the court when determining the total child-support obligation. If either or both parents carry health insurance for the child(ren), incur extraordinary medical expenses for the child(ren), or pay for childcare expenses for one or more children who receive support, the cost of these expenses shall be added to the Worksheet. The court may in turn add one or more of these expenses to the basic child-support obligation as detailed below.

1. Health insurance:

The court shall consider provisions for the children’s health care needs through health insurance coverage. Health insurance coverage is considered reasonable if the cost of dependent coverage does not exceed 5% of the gross income of the parent who is to provide coverage. The court may require coverage by one or both parents who can obtain the most comprehensive coverage through an employer or otherwise, and at the most reasonable cost.

If the employer provides some coverage, then only the amount the employee pays shall be used in the calculation of support. This amount may be determined by the difference between self- only coverage and family coverage, or the cost of medical insurance for the child. If the amounts for self-only and family coverage cannot be verified, then the total cost of the premium may be divided by the total number of persons covered by the policy and then multiplied by the number of children in the support order. If the party providing coverage does not incur an additional cost to add the child(ren), then no amount shall be added to the child-support obligation for insurance.

2. Extraordinary Medical Expenses:

Extraordinary medical expenses may be added to the basic child-support obligation and may include uninsured expenses for a single illness or condition. It may include but is not limited to reasonable and necessary costs for orthodontia, dental treatment, asthma treatment, physical therapy, uninsured chronic health problems, and professional counseling or psychiatric therapy for diagnosed mental disorders (including any reasonable treatment or diagnostic testing needed to diagnose whether there is a recognized mental disorder or disability in the first place).

11 3. Childcare Costs:

The childcare costs that a parent incurs due to employment or the search for employment is the third add-on to the Worksheet, and they may be considered in the total child-support obligation. Childcare costs must be reasonable, not to exceed the level required to provide quality care for child(ren) from a licensed provider.

Section V. Computation of Child Support

1. Calculation and Use of Worksheet:

Except as provided in Section II, paragraph 3, Self-Support Reserve, the gross income of both parents shall first be determined and combined. Each parent’s share of the combined total gross income is then determined based on their percentage of the combined income. Next, the basic child-support obligation is determined by looking at the Chart for the parties’ combined income and the number of children they have. A presumptive child-support obligation is then determined by adding the allowed additional monthly child-rearing expenses (including health insurance premiums, extraordinary medical expenses, and childcare expenses). Each parent’s share of additional child-rearing expenses is determined by multiplying the percentage of income they have available for support, which was determined in step 1. The total child-support obligation for each parent is determined by adding each parent’s share of the child-support obligation with their share of allowed additional child-rearing expenses. Lastly, the payor receives a credit for the additional child-rearing expenses that the payor is paying out of pocket, resulting in their presumed child-support order. See the “Forms” Addendum for a sample child-support calculation.

The payor parent shall owe his or her presumed child-support obligation as a money judgment of child support to payee parent.

All orders granting or modifying child support shall contain the court’s determination of both parents’ gross income and shall specify who is the payor parent and who is the payee parent. Any order shall also state the amount of health insurance premiums, extraordinary medical expenses, and childcare expenses allowed in determining the total child-support obligation. See the “Forms” Addendum for sample language that may be used.

2. Shared Custody Adjustment:

In cases where the parties share approximately an equal amount of time, the parties shall complete the Worksheet and Affidavit of Financial Means. The court shall then determine the basic child-support obligation by deducting the smaller obligation from the larger obligation as determined in “Part II: Basic Obligation” of the Child Support Worksheet. Once the basic child- support obligation has been determined, if the court determines there are Additional Monthly Child-Rearing Expenses that must be accounted for in Part III of the Child Support Worksheet, the court shall refer to “Line 10: Share of additional child-rearing expenses” to determine what adjustment, if any, should be made to the basic child-support obligation.

In cases where the parties share less than an approximately equal amount of time, but each parent has responsibility of the child(ren) for at least 141 overnights per calendar year, the parties shall complete the Worksheet and Affidavit of Financial Means. The court may then consider the time spent by the child(ren) with the payor parent as a basis for adjusting the child-support amount 12 from the amount determined on the Worksheet.3 In particular, in deciding whether to apply an additional credit, the court should consider the presence and amount of disparity between the income of the parties, giving more weight to those disparities in the parties’ income of less than 20% and considering which parent is responsible for the majority of the non-duplicated fixed expenditures, such as routine clothing costs, costs for extracurricular activities, school supplies, and any other similar non-duplicated fixed expenditures.

This discretionary adjustment is based on the number of overnights, or overnight equivalents, that a parent spends with a child pursuant to a court order. For purposes of this section, overnight equivalents are calculated using a method other than overnights if the parent has significant time periods on separate days when the child is in the parent’s physical custody, under the direct care of the parent, but does not stay overnight.

If the court determines that the Worksheet-based offset amount is inappropriate, the court may deviate after having considered the deviation factors set forth in Section II, Paragraph 2 above, including what is in the child’s or children’s best interest.

3. Split Custody:

When each of the parents have sole custody of one or more of the children, a support obligation for each parent shall be determined based on the number of children in the other household and offsetting the smaller obligation against the larger obligation. The parent with the larger obligation shall pay to the other parent the difference between the two obligations. To accomplish this calculation, a Worksheet must be completed for each custody arrangement. There must be separate worksheets for the child(ren) who do not live primarily with the other(s).

4. Third-party Custody:

When one or more children are not in the care of either biological parent, a child-support order can issue against each parent. The support amount is calculated by using the Worksheet and computing the obligation of each parent by multiplying each parent’s share of income by the total child-support obligation. Both parties shall owe his or her total child-support obligation as a money judgment of child support to the third-party caretaker or guardian. If only one parent is available, that parent’s sole income shall be used to determine the total gross income and one hundred percent of the basic child-support obligation shall be given to that parent. If the third-party caretaker or guardian incurs costs for health insurance premiums, extraordinary medical expenses, and childcare expenses, those expenses may be apportioned pro rata between the parents, or apportioned by the court if only one parent is available, as a deviation from these Guidelines.

5. Social Security Benefit Payment:

a. When a monthly auxiliary Social Security payment is paid directly to a payee parent on behalf of a child(ren), that payment shall be treated as child support paid by the payor when: (1) The monthly auxiliary benefit is paid based on the payor parent’s qualification for disability or retirement benefits as determined by the Social Security Administration; and

3 The Guidelines intend for the court to deviate (in an amount to be determined) on a case-by-case basis when the payor parent has more than 141 overnights with a child(ren).

13 (2) The payor and the payee are parties to the same child support case and the monthly auxiliary payment will benefit those same child(ren).

b. If the monthly auxiliary benefit paid to the payee parent exceeds the amount of child support the court has ordered to be paid, then the excess benefit shall be treated as a gift that should not be credited against future child support or past due child support unless otherwise ordered by the court. If the monthly auxiliary payment does not satisfy the monthly child support for which the payor is responsible, then the payor is responsible for the difference unless the court finds that a deviation is warranted as set forth in Section II, Paragraph 2 herein.

c. Any lump sum payment of Social Security Disability benefits received directly by a payee parent on behalf of the child(ren), and on account of the payor parent’s disability which constitutes payment for the time period the payor parent was disabled or a disability claim was pending, shall be credited against unpaid support owed during the time period for which the lump sum was paid. If the lump sum payment exceeds the unpaid support owed for that time period, the excess payment shall be treated as a gift and shall not be credited against support owed during a prior or future period unless otherwise ordered by the court.

d. When the auxiliary benefit is paid directly to the payor parent, then the payor parent shall use those funds to pay his or her child support obligation to the payee parent.

SECTION VI. Miscellaneous Provisions

1. Allocation of Dependents for Tax Purposes:

Allocation of dependents for tax purposes belongs to the payee parent pursuant to the Internal Revenue Code. However, if allowed by state or federal law, the court shall have the discretion to grant dependency allocation, or any part of it, to the payor parent if the benefit of the allocation to the payor parent substantially outweighs the benefit to the payee parent.

2. Administrative Costs:

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) shall not be included as support.

3. Provisions for payment

All child-support orders shall fix the beginning date of the child-support obligation and the interval (weekly, bi-weekly, semimonthly, or monthly) on which payments shall be made.

Child-support obligations shall be rounded down to the nearest whole dollar. All other computations relating to the determination of a payor’s child-support obligation shall use mathematical rules for rounding. If the number you are rounding is followed by 5, 6, 7, 8, or 9, round the number up. For example: 37.5 will be rounded to 38. If the number you are rounding is followed by 0, 1, 2, 3, or 4, round the number down. For example, 37.4 will be rounded to 37. Each parent’s share of the basic child-support obligation on Line 5 of the Worksheet should be rounded to two decimal places.

14 All child-support orders shall include a provision for immediate implementation of income withholding or withholding from a financial institution, absent a finding of good cause not to require immediate income withholding or withholding from a financial institution. All withholding forms shall be filed in the court file and have a security level where it can only be viewed by the parties and attorneys of record. Circuit clerks shall only release the withholding order to parties, their employers, and attorneys of record.

Payment shall be made through the Arkansas Clearinghouse pursuant to Ark. Code Ann. § 9-14-805.

4. Sharing of income information

Parents shall provide proof of income for a previous calendar year whenever requested in writing by certified mail by the other parent, but not more than one (1) time a year.

15 FORMS ADDENDUM

Sample Calculation

Step 1: The gross income of both parents is determined and combined. Payor parent earns $2,000 and (payee parent earns $1,000, for a $3,000 combined gross income. Each parents’ share of income is then determined based on their percentage of the combined income. Payor earns 66.66% of the income, and payee earns 33.33% of the income.

Step 2: The basic child-support obligation is determined by looking at the Chart for the $3,000 combined income and is $469 for the parties’ one child. Each parent’s share of the basic child-support obligation is then determined: 66.66% of $469 is $312.67 (payor parent), and 33.33% of $469 is $156.33 (payee parent).

Step 3: A presumptive child-support obligation is then determined by adding the allowed additional monthly child-rearing expenses including health insurance premiums, extraordinary medical expenses, and childcare expenses. In this case, the court allows $100 that payor parent is paying for the child’s health insurance premium and $200 that payee parent is paying for childcare expenses, for a total of $300 for additional child-rearing expenses. Each parent’s share of additional child-rearing expenses is determining by multiplying the percentage of income they have available for support (see step 1) by the total expenses: 66.66% of $300 is $200 (payor parent), and 33.33% of $300 is $100 (payee parent).

Step 4: The total child-support obligation for each parent is determined by adding each parent’s share of the child-support obligation with their share of allowed additional child-rearing expenses. Payor parent ($312.67 plus $200) has a total child-support obligation of $512.67, and payee parent ($156.33 plus $100) has a total child-support obligation of $256.33.

Step 5: The payor receives a credit for the additional child-rearing expenses that he is paying out of pocket. In this example, payor is paying $100 for the child’s health insurance premium, so we deduct $100 from payor’s total child-support obligation of $512.67. Payor has a presumed child-support order of $412.67, which shall be rounded down to $412.

Sample language for a court order based on the calculation provided above:

The court has determined that Plaintiff (payor) earns a gross income of $2,000 per month and Defendant (payee) earns a gross income of $1,000 per month. Therefore, the parents’ combined gross income is $3,000 with a basic child-support obligation of $469 for their one child per the Chart. The court also finds that Plaintiff (payor) is paying for the child’s health insurance premium in the amount of $100 per month and that Defendant (payee) is paying $200 for childcare expenses, for a total of $300 for additional child-rearing expenses. Plaintiff (payor) is responsible for 66% of the total obligation ($312.67 share of basic obligation plus $200 for expenses) and has a total child- support obligation of $512.67. Defendant (payee) is responsible for 33% of the total obligation ($156.33 share of basic obligation plus $100 for expenses) and has a total child-support obligation of $256.33. Plaintiff, as the payor, shall receive a $100 credit for the additional child-rearing expenses that he is paying out of pocket. Plaintiff shall pay $412 per month to Defendant beginning on March 1, 2020, and he shall continue to cover the child’s health insurance premium.

16 Child Support Worksheet Number of children for whom support is sought__ Plaintiff is payee/payor (circle one) and Defendant is payee/payor (circle one) Payee Payor Combined PART I: Monthly Income Line 1: Child support guidelines income Line 1a: Permissible deduction from income Line 1b: Another Permissible deduction from income Line 2: Income available for support (Line 1 minus Line 1a minus Line 1b) Line 3: Each parent’s share of income available for support (Each parent’s line 2 divided by combined line 2) PART II: Basic Obligation Line 4: Basic child-support obligation from monthly chart. Line 5: Each parent’s share of the basic child-support obligation (each parent’s line 3 multiplied by combined Line 4) PART III: Additional Monthly Child-Rearing Expenses Line 6: Cost of the child’s health insurance Line 7: Cost of the child’s extraordinary medical expenses Line 8: Cost of work-related child care expenses Line 9: Total additional child-rearing expenses (sum of line 6, 7 & 8) Line 10: Each parent’s share of additional child-rearing expenses (each parent’s line 3 multiplied by combined Line 9) PART IV: Monthly Child-Support Order Line 11: Total child-support obligation (each parent’s line 5 plus line 10) Line 12: Credit for additional child-rearing expenses (obligor’s line 9 only) Line 13: Presumed child-support order (Line 11 minus line 12 for obligor only)

17 Family Support Chart of Basic Child Support Obligations (Self-Support Reserve = $900/month, Minimum Order = $125 per month) Combined Gross Monthly One Two Three Four Five Six 4 Income Child Children Children Children Children Children

1-1050 125 125 125 125 125 125 1100 140 142 144 146 148 150 1150 175 178 180 183 185 188 1200 203 213 216 219 222 225 1250 211 249 252 256 259 263 1300 218 284 288 292 296 300 1350 226 320 324 329 333 338 1400 234 343 360 365 370 375 1450 241 354 396 402 407 413 1500 249 365 432 438 444 450 1550 256 376 454 475 481 488 1600 264 387 468 511 518 525 1650 271 398 481 537 555 563 1700 279 409 494 552 592 600 1750 286 420 507 567 623 638 1800 293 431 520 581 639 675 1850 301 442 534 596 656 713 1900 308 453 547 611 672 730 1950 316 463 560 626 688 748 2000 323 474 573 640 704 765 2050 330 485 586 654 720 783 2100 338 496 599 669 736 800 2150 345 506 612 683 752 817 2200 352 517 625 698 768 834 2250 360 528 638 712 784 852 2300 367 538 651 727 799 869 2350 374 549 664 741 815 886 2400 381 560 677 756 831 904 2450 389 571 689 770 847 921 2500 396 581 702 785 863 938 2550 403 592 715 799 879 955 2600 411 603 728 814 895 973

4 The Combined Gross Monthly Income does not apply in cases where the child support amount is in the blue shaded area.

18 2650 418 613 741 828 911 990 2700 425 624 754 842 927 1007 2750 433 635 767 857 943 1025 2800 440 646 780 871 958 1042 2850 447 656 793 886 974 1059 2900 454 667 806 900 990 1076 2950 462 678 819 915 1006 1094 3000 469 688 832 929 1022 1111 3050 476 699 845 944 1038 1128 3100 484 710 858 958 1054 1146 3150 491 720 871 972 1070 1163 3200 498 731 883 987 1085 1180 3250 505 742 896 1001 1101 1197 3300 512 752 909 1015 1117 1214 3350 520 763 922 1029 1132 1231 3400 527 773 934 1044 1148 1248 3450 534 784 947 1058 1164 1265 3500 541 794 960 1072 1180 1282 3550 548 805 973 1087 1195 1299 3600 556 816 986 1101 1211 1316 3650 563 826 998 1115 1227 1333 3700 570 837 1011 1129 1242 1350 3750 577 847 1024 1144 1258 1367 3800 584 858 1037 1158 1274 1385 3850 592 868 1049 1172 1289 1402 3900 599 879 1062 1186 1305 1419 3950 606 890 1075 1201 1321 1436 4000 612 899 1086 1213 1335 1451 4050 619 908 1097 1226 1348 1465 4100 625 917 1108 1238 1362 1480 4150 631 926 1119 1250 1375 1495 4200 637 935 1130 1263 1389 1510 4250 644 945 1141 1275 1402 1524 4300 650 954 1152 1287 1416 1539 4350 656 963 1163 1300 1429 1554 4400 662 972 1174 1312 1443 1569 4450 668 981 1185 1324 1457 1583 4500 675 990 1197 1337 1470 1598 4550 681 999 1208 1349 1484 1613 4600 687 1008 1219 1361 1497 1628 4650 693 1018 1230 1373 1511 1642 4700 699 1027 1241 1386 1524 1657 4750 706 1036 1252 1398 1538 1672 4800 712 1045 1263 1410 1552 1686 4850 718 1054 1274 1423 1565 1701 19 4900 724 1063 1285 1435 1579 1716 4950 731 1072 1296 1447 1592 1731 5000 737 1081 1307 1460 1606 1745 5050 743 1091 1318 1472 1619 1760 5100 749 1100 1329 1484 1633 1775 5150 755 1109 1340 1497 1646 1790 5200 762 1118 1351 1509 1660 1804 5250 768 1127 1362 1521 1674 1819 5300 774 1136 1373 1534 1687 1834 5350 780 1145 1384 1546 1701 1849 5400 785 1152 1392 1555 1710 1859 5450 788 1154 1394 1557 1712 1861 5500 790 1156 1395 1559 1715 1864 5550 793 1159 1397 1561 1717 1866 5600 795 1161 1399 1563 1719 1869 5650 798 1163 1401 1565 1721 1871 5700 800 1165 1403 1567 1724 1873 5750 802 1167 1405 1569 1726 1876 5800 805 1170 1406 1571 1728 1878 5850 807 1172 1408 1573 1730 1881 5900 810 1174 1410 1575 1733 1883 5950 812 1176 1412 1577 1735 1886 6000 815 1178 1414 1579 1737 1888 6050 817 1181 1416 1582 1740 1891 6100 821 1185 1421 1587 1746 1897 6150 824 1189 1425 1592 1751 1904 6200 827 1193 1430 1598 1757 1910 6250 830 1197 1435 1603 1763 1916 6300 834 1201 1440 1608 1769 1923 6350 837 1205 1444 1613 1775 1929 6400 840 1209 1449 1619 1781 1936 6450 843 1214 1454 1624 1787 1942 6500 847 1218 1459 1629 1792 1948 6550 850 1222 1464 1635 1798 1955 6600 853 1226 1468 1640 1804 1961 6650 856 1230 1473 1645 1810 1967 6700 860 1234 1478 1651 1816 1974 6750 865 1240 1485 1659 1825 1984 6800 870 1247 1494 1669 1835 1995 6850 875 1254 1502 1678 1846 2006 6900 880 1261 1510 1687 1856 2017 6950 886 1268 1519 1696 1866 2028 7000 891 1274 1527 1705 1876 2039 7050 896 1281 1535 1715 1886 2050 7100 901 1288 1543 1724 1896 2061 20 7150 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2103 2349 2584 2808 12850 1270 1761 2109 2355 2591 2816 12900 1273 1765 2115 2362 2598 2824 12950 1277 1770 2121 2369 2606 2832 13000 1280 1774 2127 2375 2613 2840 13050 1284 1779 2132 2382 2620 2848 13100 1288 1783 2138 2389 2627 2856 13150 1291 1787 2144 2395 2635 2864 13200 1295 1792 2150 2402 2642 2872 13250 1298 1796 2156 2409 2649 2880 13300 1302 1801 2162 2415 2657 2888 13350 1305 1805 2168 2422 2664 2896 13400 1309 1809 2174 2428 2671 2904 13450 1313 1814 2180 2435 2679 2912 13500 1316 1818 2186 2442 2686 2920 13550 1320 1823 2192 2448 2693 2928 13600 1323 1827 2198 2455 2701 2936 13650 1326 1831 2202 2460 2706 2942 13700 1329 1834 2206 2465 2711 2947 13750 1331 1838 2211 2469 2716 2952 13800 1334 1841 2215 2474 2721 2958 13850 1337 1844 2219 2478 2726 2963 23 13900 1339 1848 2223 2483 2731 2969 13950 1342 1851 2227 2487 2736 2974 14000 1345 1854 2231 2492 2741 2979 14050 1347 1858 2235 2496 2746 2985 14100 1350 1861 2238 2500 2750 2990 14150 1352 1864 2242 2504 2755 2994 14200 1354 1867 2245 2508 2759 2999 14250 1357 1870 2249 2512 2763 3004 14300 1359 1873 2253 2516 2768 3008 14350 1361 1876 2256 2520 2772 3013 14400 1363 1879 2260 2524 2776 3018 14450 1366 1882 2263 2528 2781 3023 14500 1368 1885 2267 2532 2785 3027 14550 1370 1888 2270 2536 2790 3032 14600 1373 1891 2274 2540 2794 3037 14650 1375 1894 2277 2544 2798 3042 14700 1377 1897 2281 2548 2803 3046 14750 1380 1900 2284 2552 2807 3051 14800 1382 1903 2288 2556 2811 3056 14850 1384 1906 2292 2560 2816 3061 14900 1387 1909 2295 2564 2820 3065 14950 1389 1911 2299 2568 2824 3070 15000 1391 1914 2302 2572 2829 3075 15050 1394 1917 2306 2576 2833 3080 15100 1396 1920 2309 2580 2838 3084 15150 1398 1923 2313 2584 2842 3089 15200 1401 1926 2316 2587 2846 3094 15250 1403 1929 2320 2591 2851 3099 15300 1405 1932 2324 2595 2855 3103 15350 1408 1935 2327 2599 2859 3108 15400 1410 1938 2331 2603 2864 3113 15450 1412 1941 2334 2607 2868 3118 15500 1414 1944 2338 2611 2872 3122 15550 1417 1947 2341 2615 2877 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2723 2996 3256 17000 1488 2033 2441 2727 3000 3261 17050 1491 2036 2445 2731 3004 3265 17100 1494 2038 2448 2734 3008 3269 17150 1496 2041 2451 2738 3012 3274 17200 1499 2044 2455 2742 3016 3278 17250 1501 2047 2457 2745 3019 3282 17300 1504 2050 2461 2748 3023 3286 17350 1506 2052 2464 2752 3027 3291 17400 1509 2055 2467 2756 3031 3295 17450 1512 2058 2470 2759 3035 3299 17500 1514 2061 2474 2763 3039 3304 17550 1517 2064 2477 2767 3043 3308 17600 1520 2067 2480 2770 3047 3312 17650 1522 2070 2483 2774 3051 3317 17700 1525 2072 2487 2778 3055 3321 17750 1527 2075 2490 2781 3059 3325 17800 1530 2078 2493 2784 3063 3329 17850 1532 2081 2496 2788 3067 3333 17900 1535 2083 2499 2791 3070 3338 17950 1537 2086 2502 2795 3074 3342 18000 1540 2089 2505 2798 3078 3346 18050 1542 2091 2508 2802 3082 3350 18100 1545 2094 2511 2805 3086 3354 18150 1547 2097 2514 2809 3090 3358 18200 1550 2100 2518 2812 3093 3362 18250 1552 2102 2521 2816 3097 3367 18300 1555 2105 2524 2819 3101 3371 18350 1557 2108 2527 2822 3105 3375 25 18400 1560 2110 2530 2826 3109 3379 18450 1562 2113 2533 2829 3112 3383 18500 1565 2116 2536 2833 3116 3387 18550 1567 2119 2539 2836 3120 3391 18600 1570 2121 2542 2840 3124 3396 18650 1572 2124 2545 2843 3128 3400 18700 1575 2127 2549 2847 3131 3404 18750 1577 2129 2552 2850 3135 3408 18800 1580 2132 2555 2854 3139 3412 18850 1582 2135 2558 2857 3143 3416 18900 1585 2138 2561 2861 3147 3420 18950 1587 2140 2564 2864 3150 3424 19000 1590 2143 2567 2867 3154 3429 19050 1592 2146 2570 2871 3158 3433 19100 1595 2148 2573 2874 3162 3437 19150 1597 2151 2576 2878 3166 3441 19200 1599 2154 2579 2881 3169 3445 19250 1602 2157 2583 2885 3173 3449 19300 1604 2159 2586 2888 3177 3453 19350 1607 2162 2589 2892 3181 3458 19400 1609 2165 2592 2895 3185 3462 19450 1612 2167 2595 2899 3188 3466 19500 1614 2170 2598 2902 3192 3470 19550 1617 2173 2601 2905 3196 3474 19600 1619 2176 2604 2909 3200 3478 19650 1622 2178 2607 2912 3204 3482 19700 1624 2181 2610 2916 3207 3486 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31 IN THE CIRCUIT COURT OF COUNTY, ARKANSAS

(Domestic Relations Division) _____Division

Plaintiff

v. Case No. _____DR__________________

Defendant

AFFIDAVIT OF FINANCIAL MEANS

Name:_________________________, being duly sworn, says under penalty of perjury, that he/she has prepared or approved this financial statement, and that the following information and attachments (including income verification as required by page 6) are complete, true, and correct.

__________________ _____________________________ Date Signature

Subscribed and sworn to before me on this day of 20 .

Notary Public My commission expires:

MY INCOME 1. How often are you paid?

____ weekly ____ bi-weekly (every two weeks—26 times a year) ____ monthly ____ bi-monthly (twice a month–24 times a year) ____ other –Explain (attach an exhibit if necessary):

2. Gross Pay: $__________________________

Page 1 of 6 ______ ______ Initials Initials 32 INCOME

Income: Amount: Source Frequency 3 Gross wages from employment, 3.1 contract labor, etc. 3.2 Bonuses or incentive pay not reflected on page 2: 3.3 Other court-ordered income such as alimony/child support paid to you: 3.4 Payments from a settlement or annuity: 3.5 Regular gifts from relatives or friends: 3.6 Investment income such as rent payments to you: 3.7 Stock dividends or bond payments: 3.8 Regular payments to you or on your behalf from a Trust: 3.9 Other:

3.10 TOTAL MONTHLY INCOME: $

OTHER AVAILABLE FUNDS 4 ASSET AMOUNT SOURCE Cash on hand, and in bank 4.1 accounts: 4.2 Trust fund assets held on your behalf: 4.3 Stocks, bonds, mutual funds:

4.4 Other (i.e. 401-K, retirement, etc):

4.5 TOTAL: $

Page 2 of 6 ______ ______

33 Initials Initials

MY CURRENT MONTHLY EXPENSES *

5. Expense: Amount: Expense: Amount: Health Insurance- for Health Insurance- a. child only $ n. excludes amount in “a” $ Extraordinary medical Non-covered medical b. expenses for child in this $ o. for self or child not $ case involved in this case Childcare for child in Childcare for child not c. this case $ p. involved in this case $ Rent/house payment Car payment d. $ q. $ Media Services, e.g. Car Insurance e. Cable/Satellite, Internet $ r. $ Telephone Car fuel and f. $ s. maintenance $ Gas, water, trash, & Lawn care g. electricity $ t. $

h. Union dues $ u. Charitable giving $

i. Pension plan $ v. Household Expenses $

j. 401(k) payments $ w. Dry cleaning $

k. Garnishments $ x. Life Insurance: $

l. Alcohol and Tobacco $ y. Other: $ Products

m. Food $ z. TOTAL $

* Place a check mark by all expenses which you are not currently paying.

Page 3 of 6 ______ ______ Initials Initials

34 MINOR CHILDREN

6. Number of children:

a. Number of minor children I have with opposing party: #

b. Number of other minor children I have: #

c. Names of minor children involved in this case: AGE

1.

2.

3.

4.

CREDITORS & DEBTS 7. Debts in the names of BOTH PARTIES are:

Creditor: Total amount owed: Monthly payment:

a. $ $

b. $ $

c. $ $

d. $ $

e. $ $

f. $ $

Totals: $ $

35 Page 4 of 6 ______ ______ Initials Initials 8. Debts only in my name:

9. Debts only in the name of the other party:

10. SUMMARY OF ABOVE DEBT TABLES:

Summary of Debts: Total Owed: Total Monthly Payments: Joint Debts: a. $ $ My Debts: b. $ $ Other Party’s Debts: c. $ $

36 Page 5 of 6 ______ ______ Initials Initials

37 ACKNOWLEDGEMENT OF RESPONSIBILITIES AND CONSEQUENCES I, _________________________, understand that I must comply with the following. I acknowledge and agree to each provision by initialing each paragraph below.

_____Both parties must complete and exchange this six-page affidavit at least three days before a court hearing where financial matters are at issue. The affidavit must be provided to opposing counsel, if a party is represented, or directly to a self-represented litigant.

_____Both parties must supply the original notarized affidavit to the court.

_____ If I am employed, I must attach copies of my last three paystubs to this affidavit.

_____ If I am self-employed, I must attach copies of my last two federal and state tax returns, including all schedules, to this affidavit.

_____ Before each court hearing where financial matters are at issue, I will review this document and provide updated information to the other party and to the court.

_____ I understand that the cost of dependent health insurance coverage is the difference between self-only and self with dependents or family coverage or the cost of adding the child(ren) to existing coverage.

_____ I understand that failing to comply with these provisions, or deliberately attempting to mislead the court or the opposing party, may result in my being held in contempt of court, being fined, being ordered to pay attorney’s fees, and/or being sentenced up to 6 months in jail, and that serious violations can result in prosecution for felony perjury—punishable by 3 to 10 years in prison.

______________________ ________________________________ Date Signature

I certify that I have reviewed this affidavit with my client and advised him or her of the importance of providing true, correct, complete answers and the required exhibits.

_______________________ ________________________________ Date Attorney

Page 6 of 6 ______ ______ Initials Initials

Revised 10/2022

38 39