DISCLOSURE STATEMENT FOR TEMPORARY CHILD SUPPORT (1) My Name: (2) This Disclosure Statement is about the Motion for Temporary Orders filed on: Witnesses: I plan to call these witnesses at the temporary orders hearing: (3) Name: Address: What They Will Say: Phone Number: Name: Address: What They Will Say: Phone Number: Name: Address: What They Will Say: Phone Number: Name: Address: What They Will Say: Phone Number: Expert Witnesses: I plan to call these expert witnesses at the temporary orders hearing: (4) Name: Address: What They Will Say: Their Grounds for What They Will Say: Their Qualifications: Name of Person with Copies of Their Reports: Address of Person with Copies of Their Reports: Name: Address: What They Will Say: Their Grounds for What They Will Say: Their Qualifications: Name of Person with Copies of Their Reports: Address of Person with Copies of Their Reports: Affidavit of Financial Information: I am attaching this form. Page 1 of 2 Revised September 2007 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Proof of Income: I am attaching proof of my income from all sources, including tax returns, W2 forms, and K-1 forms from the past two years and year-to-date information for the current calendar year, including pay stubs, salaries, wages, commissions, bonuses, dividends, severance pay, pensions, interest, trust income, annuities, capital gains, social security benefits, worker’s compensation benefits, unemployment insurance benefits, disability insurance benefits, recurring gifts, prizes, and spousal maintenance. (5) [ ] Support Payments for Other Cases: I am attaching proof of court-ordered child support and/or spousal maintenance I pay in another case. (6) [ ] Children’s Health Insurance: I am attaching proof of medical, dental, and/or vision insurance premiums I pay for the children on the Petition. (7) [ ] Childcare: I am attaching proof of childcare expenses I pay for the children on the Petition. (8) [ ] Children’s Education: I am attaching proof of expenses I pay for private or special schools or other particular education needs of the children on the Petition. (9) [ ] Extraordinary Child: I am attaching proof of expenses I pay for the special needs of a gifted or handicapped child listed on the Petition. (10) Certificate of Delivery: I will mail or hand-deliver this document to the other party on: . Page 2 of 2 Revised September 2007 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com