IN THE SUPERIOR COURT FOR THE STATE OF AT ) ) ) ) CASE NO. ) ) CHILD SUPPORT ORDER ) ) Interim Final Modification 1.CHILDRENCustody and support are ordered for the following minor children: Full Names of Children Birth Dates More children and 2.PARENTS / CUSTODIANa. Date of Birth: Email: aFull Name:Daytime b. Date of Birth: Email: Full Name:Daytime Telephone:Mailing Address:Residence Address (if different):Most Recent Employer:Employers Address: c.Custodian (other than parent) Daytime Telephone:Email: Mailing Address: Residence Address (if different): American LegalNet, Inc. www.FormsWorkFlow.com 3.LEGAL CUSTODYLegal custody of the children named above is awarded to: 4.PHYSICAL CUSTODY As specified in the child custody order dated: a. Primary custody Custodian has primary custody of all children. b. Shared custody of all children (all children live with each parent at least 30% of the year) % to per schedule in the order referenced above% to per schedule in the order referenced above% to custodian per schedule in the order referenced above c. Divided custody (each parent has primary custody of at least one child and the parents do not share custody of any children) has primary custody of has primary custody ofCustodian has primary custody of d. Hybrid custody (at least one parent has primary custody of at least one child and the parents share custody of at least one child) has primary custody of has primary custody ofCustodian has primary custody of Custody of is shared as follows: % to per schedule in the order referenced above% to per schedule in the order referenced above% to custodian per schedule in the order above 5.CHILD SUPPORT CALCULATION AND EFFECTIVE DATES a.Adjusted Annual Income Determination : Gross annual income $ $ Less annual allowable deductions $ $ Equals adjusted annual income $ $ The determination of adjusted annual income is based on (check all that apply): datednes Affidavit dated(s) and/or paystub(s) dated(s) and/or paystub(s) dated Employer-reported wages of The court imputed income to Testimony on record. Date: ctrm: start time: Other American LegalNet, Inc. www.FormsWorkFlow.com b.Amount of Support Obligation N umber of Children Basic Monthly Support Owed Health Insurance Adjustment Total Monthly Child Support Owed Obl Cost to Buy Health Ins. Cost to Buy Health Ins. 50% Heal th Insurance Adjustment + ( - ) (total children today) (total minus 1 child) (total minus 2 children) (total minus 3 children) Except as provided below, as each child turns 18, otherwise legally emancipates or dies, the amount of support will change to the next lower amount. There is more than one child support obligor. See other orders in this case. This is a modification of prior child support order dated . Social Security Insurance Benefits (CIB) apply. CIB payments are a credit against child support when the obligor is the source of the entitlement. CSSD may administratively apply the CIB credit. c.Attached Documents Calculation DR-307, Divided Custody Calculation CSSD Calculator Printout DR-306, Shared Custody Calc DR-308, Hybrid Custody Calculation d.Effective Dates The child support obligation starting date is based on the parents separation date modification motion service date . The first payment is due no later than . All other payments are due by the first day day of each month. Other (including arrears, if any): The obligor parent is (full name) .1The obligor parent shall pay child support as set forth below. (Write the currentnumber of children on the first line and calculate across. Then subtract one number on each line and calculate across again. For example, if there are 3 children today, calculate support for 3 children on the first line, calculate support for 2 children on the next line, andfor 1 child on the line after that.) 1 The obligor is the parent who must pay child support, and the obligee is the parent who receives child support. 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 American LegalNet, Inc. www.FormsWorkFlow.com 6.EXTENDED VISITATION CREDIT Extended visitation applies to this case. (Primary custody cases only.) Primary physical custody of the children was awarded to one parent or custodian. The other parent (the obligor parent) was awarded visitation with the children for certain extended periods of time longer than 27 consecutive days as follows: If and when the obligor parent exercises this extended visitation, child support is reduced for the above period(s) as follows: This credit may not exceed 75% of the amount owed for the period (Civ. R. 90.3(a)(3)) and does not apply to shared, hybrid, or divided physical custody awards. If the obligor based on seasonal income, this credit is based on the average monthly support amount. If extended visitation is not exercised, child support is not reduced. 7.SEASONAL INCOME The court finds that: the ; andthe obligee agrees that, as long as the total annual amount remains the same,the obligor can make higher payments during high income months and lowerpayments during low income months as set forth below; andthe obligee should be responsible for budgeting during unequal income periods. Annual support amount is $ Average monthly support amount is $ Therefore, it is ordered that the monthly support amount in paragraph (5)(b) will be varied as follows: High Income Months. Obligor must pay $ per month in the months of: Low Income Months. Obligor must pay $ per month in the months of: If this support order takes effect in a low income month, the obligor must pay the average monthly amount 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 of the chart in paragraph (5)(b). When support is no longer owed for the first child, the seasonal variation in monthly support amounts must be recalculated will be as follows 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. This child support order is suspended for the time periods when the child is taken into State custody in a child in need of aid case or juvenile delinquency proceeding and one of the following two conditions exist: (1) the State places the child with the obligor parent; or (2) this child support order is based on shared, divided, or hybrid custody. CSSD may redirect or administratively establish child support as necessary. American LegalNet, Inc. www.FormsWorkFlow.com 8.VARIATION FROM CIVIL RULE 90.3 FORMULAThe amount of child support was determined pursuant to: a. b. c. The formula in Civil Rule 90.3(a) or (b). adjusted annual income is over $12,000.pport is less than $600 per year so $600 minimum was ordered. O obligor is: incarcerated unable to work because other 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 which would have been required but for this 90.3(c)(1) variation is $ for children per month to be paid by the . The estimated value of any property conveyed instead of support calculated under 90.3 is $ . 9.MEDICAL SUPPORT ORDERThis order concerns health insurance for the children covered by this child supportorder. It does not concern health insurance for any other children or for the parents.[AS 25.27.060(c) and Civil Rule 90.3(d)(1)] a. Indian Health Service or Military Medical Benefits The children are eligible for services through the military Indian Health Service. These services are available to the children in the area where they live. No additional insurance is required while these services are available. b. Health Insurance Available at Reasonable Cost Services through the Indian Health Service or the military are not available to the children, but health ins