Page 1 of 3 DR-305 (4/18)(cs) CHILD SUPPORT GUIDELINES AFFIDAVIT Civil Rule 90.3 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) (Plaintiff)(Petitioner) ) ) ) CASE NO. (Defendant)(Petitioner) ) ) CHILD SUPPORT GUIDELINES AFFIDAVIT [Civil Rule 90.3] I swear or affirm under penalty of perjury that the information on this affidavit is true to the best of my knowledge and belief. I attached a copy of my most recent federal tax return and pay stubs to verify this information. [Note: delete social security numbers and account numbers from any documents you attach.] I did not attach supporting documents because: . The following income and deductions are MONTHLY YEARLY (you must check one box for the math on this form to work). NAME OF PARENT A: NAME OF PARENT B: PARENT A PARENT B A. Gross Income (Do not list ATAP or SSI below.) Gross wages Value of employer-provided housing, food, etc. 1 Unemployment compensation Permanent Fund Dividend (PFD) Other: TOTAL INCOME B. Deductions Allowable under Civil Rule 90.3 Federal, state and local income tax Social security tax or self-employment tax Medicare tax Employment security tax (SUI) Mandatory union dues Mandatory retirement contributions Voluntary retirement contributions if plan earnings are tax free or deferred, up to 7.5% of gross wages & self-employment income when combined with mandatory contributions Other mandatory deductions (specify): Alimony ordered in other cases and currently paid 2 Child support ordered for prior children 3 In-kind support for prior children 4 Work-related child care for children in this case Health insurance for parent (up to 10% of wages) 5 TOTAL DEDUCTIONS 1 This also includes COLA, military BAH, and BAS. 2 Includes spousal support ordered in other cases and currently paid. 3 ifferent relationship born or adopted before the children in this case. 4 For more information, see Prior Child Deduction Chart and Civil Rule 90.3(a)(1)(D). 5 This deduction cannot be more than 10% of gross wages and self-employment income, under 90.3(a)(1)(F). American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 PARENT A: DR-305 (4/18)(cs) PARENT B: CHILD SUPPORT GUIDELINES AFFIDAVIT Civil Rule 90.3 PARENT A PARENT B C. Net Income TOTAL INCOME from section A TOTAL DEDUCTIONS from section B Subtract deductions from income to get NET INCOME D. Adjusted Annual Income 1.If Net Income in section C is monthly,multiply by 12 to get adjusted annual income 2.If Net Income in section C is yearly, repeatNet Income here to get adjusted annual income 3.If line 1 or 2 above is more than $126,000, write$126,000 here. Otherwise, repeat line 1 or 2 to getADJUSTED ANNUAL INCOME E. Multiply Adjusted Annual Income from line D.3 by: .20 for one child .27 for two children x x .33 for three children, and .03 for each additional child TOTAL ANNUAL CHILD SUPPORT (Amount from TOTAL line in paragraph E or $600, whichever is larger.) F. Monthly Child Support Payment (Types of custody are defined in Civ.R.90.3(f).) 1.Primary Custody. One parent has primary physical custody. Divide Annual ChildSupport amount from section E for the non-custodial parent by 12 = $ to be paid each month by Parent A Parent B. 2.Shared Custody. Attach form DR-306. The children will reside with each parent for a period specified in writing of atleast 30% of the year. Child support payment (from line 10 of DR-306) to bepaid each month except = $ to be paid by Parent A Parent B. 3.Divided Custody. Attach form DR-307. Each parent will have primary custody of one or more of the children and theparents will not share custody of any of the children.Monthly child support payment (from line 7 of DR-307) = $ to be paid by Parent A Parent B. 4.Hybrid Custody. Attach form DR-308. Monthly child support payment (from line 8 of DR-308)= $ to be paid by Parent A Parent B. G. Health Care Coverage for the Children. 1.Health Insurance.a.Does Parent A have health insurance available for the child(ren) at areasonable cost through Parent employer, union, or otherwise? Yes No I do not know b.Does Parent B have health insurance available for the child(ren) at areasonable cost through Parent employer, union or otherwise? Yes No I do not know American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 PARENT A: DR-305 (4/18)(cs) PARENT B: CHILD SUPPORT GUIDELINES AFFIDAVIT Civil Rule 90.3 c.Are the children eligible for services through the Indian Health Service? Yes No d.Do the children have other health insurance or care available? Yes No Describe: Health insurance for the child(ren) is being will be purchased by: Parent A at a monthly cost to Parent A of $ * Parent B at a monthly cost to Parent B of $ * employer union whose name and address are The cost is will be divided between the parents equally Explain reason for unequal division: * List only the cost to insure the children involved in this case. If there is no extra cost to the parent to include the children in coverage, none of the cost can be allocated to the children. For more information, see Calculating the Cost of chart and Civil Rule 90.3(d). 2.Health Care Expenses Not Covered By Insurance.Should uninsured health care expenses of the children (up to $5,000 per calendar year) be shared equally by the parents? Yes NoIf no, explain how the costs should be divided and why: H. Monthly Child Support Payment (after adding or deducting health insurance costs). 1.Monthly Child Support Payment from paragraph F above$ 2.If obligor is buying health insurance for the child(ren), subtract 50% (or %) of the monthly insurance payment.- $ (child support.)3.If obligee is buying health insurance for the child(ren), add 50% (or %) of the monthly insurance payment.+ $ O) 4.NET MONTHLY CHILD SUPPORT PAYMENT$ I. Seasonal Income. . Yes No (Note: If income is seasonal, you can ask the court to order unequal monthly payments as described in Civil Rule 90.3(c)(5).) Print or Type Name Signature Subscribed and sworn to or affirmed before me at , Alaska on . Clerk of Court, Notary Public or other I certify that on person authorized to administer oaths. a copy of this affidavit was mailed to My Commission Expires: the other parent in this case (list name): (SEAL) Signature American LegalNet, Inc. www.FormsWorkFlow.com