CHILD SUPPORT INFORMATION FORM Fill in all the blanks. Do not file this form with the court. The Attorney will use this information to complete your child support forms at your Pre-Filing Meeting. Number of children age 12 or older: Month and year of the youngest child's birthday: The number of hours per week the children will spend with Mother, according to the parenting time you're asking for: The number of hours per week the children will spend with Father: The monthly amount of court-ordered arrears the noncustodial parent pays for spousal maintenance or for child support for children of other relationships: $ The other parent and I have been living apart since this date: . Do you want the other parent to pay you past child support for the months you've been living apart? [ ] Yes [ ] No [ ] Mother [ ] Father has voluntarily paid the other parent $ to support the children since we started living apart. Mother Each parent's monthly gross income: $ $ $ Father The monthly amount of court-ordered child support each parent pays $ for children of other relationships: The monthly amount of court-ordered spousal maintenance (alimony) each parent currently pays: The monthly amount of court-ordered spousal maintenance (alimony) each parent currently receives: The monthly amount each parent pays for health insurance for the children (Do not include the amount you pay for yourself. If unsure, ask your employer for the correct amount.): The monthly amount each parent pays for work-related childcare: The monthly amount each parent pays for a child's extraordinary educational needs based on the parents' agreement or a court order: Page 1 of 2 Revised February 2012 $ $ $ $ $ $ $ $ $ $ Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com The monthly amount each parent pays for the special needs of a gifted or handicapped child: About the Parent Who Should Pay Child Support: Social Security Number: Current Employer Name: Payroll Address: City: Phone Number: Previous Employer (if known): Payroll Address: City: Phone Number: $ $ State: Fax Number: Zip: State: Fax Number: Zip: Page 2 of 2 Revised February 2012 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com