Person Submitting Proposed Order: Name: Telephone No. Address: Attorney for Pro Se (self-represented) AS 25.27.020, .062. .080 Page 1 of 9 DR-300 ()(cs)CHILD SUPPORT ORDER Civil Rule 90.3 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) CASE NO. ) ) Interim Final 1. 2.DOB: DOB: DOB: Parent A.Full Name:Mailing Address:Residence Address (if different):Most Recent Employer:Employer's Address:Parent B.Full Name:Mailing Address:Residence Address (if different):Most Recent Employer:Employer's Address:Custodian (if not a parent).Full Name:Mailing Address:Residence Address (if different): Children. Custody and support are ordered for the following minor child(ren): Full Names of Children Birth Dates American LegalNet, Inc. www.FormsWorkFlow.com AS 25.27.020, .062. .080 Page 2 of 9 DR-300 ()(cs)CHILD SUPPORT ORDER Civil Rule 90.3 3.Legal custody of the child(ren) named above is awarded to: 4.Physical Custody.Type of Custody Ordered: Primary Shared Divided Hybrid (For divided custody, fill in both a and b. For hybrid custody, fill in a, b, and c.) Primary Custody (child lives with this parent more than 70% of the year) a.Parent A,, will have primary physical custody of the following child(ren): b.Parent B,, will have primary physical custody of the following child(ren): Shared Custody (child lives with each parent at least 30% of the year) c.The parents will share physical custody of the following child(ren): The child(ren) will reside with during the following periods: which equals % of the year, and with during the following periods: which equals % of the year. Failure to take physical custody of the child(ren) at least 30% of the year is grounds for modification of this support order. However, denial of visitation by the custodial parent is not cause to increase child support. Civil Rule 90.3(b)(1)(E) 5.Child Support.The obligor, , shall pay child support as follows: (Put the current number of children on the first line. Subtract one number on eachsubsequent line and do the calculations for each line.)Except as provided below, as each child reaches the age of 18, is otherwise legally emancipated or dies, the amount of support will change to the next lower amount. Support must continue while each child is 18 years old if the child is (1) unmarried, (2) actively pursuing a high school diploma or equivalent level of technical or vocational training, and (3) living as a dependent with the obligee parent or guardian or a designee of the parent or guardian, unless the following box is checked: Child support will end when each child reaches age 18. The first payment is due no later than . Subsequent payments are due no later than the 1st day of each month thereafter. Number ofChildren Basic Monthly Amount Owed Adjustment for Health Insurance (266 9) Total Monthly Amount Owed American LegalNet, Inc. www.FormsWorkFlow.com AS 25.27.020, .062. .080 Page 3 of 9 DR-300 ((cs)CHILD SUPPORT ORDER Civil Rule 90.3 6.Extended Visitation Credit (available only in primary custody situations). Primary physical custody of the children listed in paragraph 4.a or 4.b has been given tothe non-obligor parent. However, the obligor parent shall have physical custody ofthese child(ren) for the following periods of over 27 consecutive days: If this visitation is exercised, child support is reduced for the above period(s) as follows: (This reduction may not exceed 75% of the amount owed for the period.) If this visitation is not exercised, child support is not reduced. [Civil Rule 90.3(a)(3)] 7.Seasonal Income. The court finds that obligee agrees that, as long as the total annual amount remains the same, theobligor can make higher payments during high income months and lowerpayments during low income months as set forth below, andthe burden of budgeting for periods of unequal income should be placed on theobligee rather than the obligor.The annual support amount is: $ The average monthly support amount is: $ Therefore, it is ordered that the monthly support amount in paragraph 5 will be varied as follows: High Income Months. Obligor must pay $ per month in the following months: Low Income Months. Obligor must pay $ per month in the following months: If this support order takes effect in a low income month, the obligor must pay the each month until a high income month is reached, at which time the unequal monthly payment schedule will begin. This order varying the monthly support amount applies only to the support amount for the number of children listed on the first line in paragraph 5. When support is no longer owed for the first child, the seasonal variation in monthly support amounts must be recalculated. will be as follows American LegalNet, Inc. www.FormsWorkFlow.com AS 25.27.020, .062. .080 Page 4 of 9 DR-300 ()(cs)CHILD SUPPORT ORDER Civil Rule 90.3 8.Application of Civil Rule 90.3 Formula.The amount of child support in paragraph 5 was determined pursuant to:a. b. c. The formula in Civil Rule 90.3(a) or (b). so the $600 minimum was ordered incarcerated. unable to work because other 9.Medical Support Order. AS 25.27.060(c) and Civil Rule 90.3(d)(1). This medicalsupport order concerns health insurance for the child(ren) covered by this child supportorder. It does not concern health insurance for any other children or for the parents.a.Current Coverage. The obligor obligee must purchase health insurance for the child(ren) because such insurance is available at reasonable cost through his/her employer, union or otherwise. Name and address of employer/union through which insurance will be purchased: The insurance cost (currently $ per month) will be divided between the parties equally unless a different division of the cost is ordered. The child support calculation in paragraph 5 includes: a credit of $ per month (50% of the cost to the obligor) for health insurance purchased for the child(ren) by the obligor. If the obligor fails to purchase the insurance, the monthly child support obligation will increase by this amount, without further order of the court, until the obligor purchases the insurance and provides proof of the purchase to the other parent and to the Child Support Services Division (CSSD) if CSSD is handling collections. an extra $ per month (50% of the cost to the obligee) for health insurance purchased for the child(ren) by the obligee. If the obligee fails to purchase the insurance, the monthly child support obligation will decrease by this amount, without further order of the court, until the obligee purchases the insurance and provides proof of the purchase to the other parent and to the Child Support Services Division (CSSD) if CSSD is handling collections. d. 90.3(c)(1). The court finds good cause upon proof by clear and convincing evidence that manifest injustice would result if the support award were not varied. Reason(s) for the variation: The amount of support that would have been required but for this 90.3(c)(1) variation is $ for children per month to be paid by Parent A Parent B. The estimated value of any property conveyed instead of support calculated under 90.3 is $ . American LegalNet, Inc. www.FormsWorkFlow.com AS 25.27.020, .062. .080 Page 5 of 9 DR-300 ()(cs)CHILD SUPPORT ORDER Civil Rule 90.3 If the cost of the insurance changes, the amount of the child support obligation will be adjusted accordingly, without further order of the court. The parent purchasing the insurance shall provide documentation of the change to the other parent and to the Child Support Services Division (CSSD) if CSSD is handling collections. If either parent believes the cost of the insurance has become unreasonable, that parent may file a motion asking the court to suspend the requirement that insurance be purchased. The children are eligible for services through the Indian Health Service military medical benefits but these services are not available in the area where the children live. Therefore, insurance must be purchased as stated above until these services become available. The children are eligible for services through the Indian Health Service military medical benefits and these services are available to the children. Therefore, no additio