IN RE: ADMINISTRATIVE ORDER NUMBER 10: ARKANSAS CHILD SUPPORT GUIDELINES ___ S.W.3d ___ Supreme Court of Arkansas Opinion delivered January 31, 2002 PER CURIAM. On February 5, 1990, this Court first adopted guidelines for child support in response to P.L. 100-485 and Ark. Code Ann. §9-12-312(a). Effective October, 1989, P.L. 100-485 required the following: that all states adopt guidelines for setting child support; that it be a rebuttable presumption that the amount of support calculated from the child-support chart is correct; and that each state’s guidelines be reviewed and revised, as necessary, at least every four years. In response to the federal law, the Arkansas General Assembly enacted Ark. Code Ann. §9-12-312, which included the federal provisions and authorized the Arkansas Supreme Court to develop guidelines based on recommendations submitted to the Court by a committee appointed by the Chief Justice. The Committee on Child Support initially made recommendations to the Court which formed the substance of the 1990 Per Curiam Order. On May 13, 1991, pursuant to the Committee’s recommendations, the Court issued a new Per Curiam Order which supplemented the original. requirement of P.L. Then, in compliance with the four-year 100-485, the Committee submitted recommendations to the Court in October, 1993, and the Court issued a Per Curiam Order on October 23, 1993, adopting the guidelines which subsequently were published in the Court Rules volume of the Arkansas Code Annotated. American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) On September 25, 1997, again pursuant Page 2 to the four-year requirement of P.L. 100-485, the Court issued a Per Curiam Order, adopting recommendations of the Child Support Committee. In addition, the Court adopted and published Administrative Order Number 10 -- Arkansas Child Support Guidelines, effective October 1, 1997. The Administrative Order incorporated by reference the weekly and monthly family-support charts and the Affidavit of Financial Means. The Court republished Administrative Order Number 10 with a Per Curiam Order of January 22, 1998, making minor corrections to the child-support charts and to the Affidavit of Financial Means. In the ensuing four years, the Committee has continued to study the existing guidelines, pursuant to federal and state law, and once again has submitted its recommendations to the Court. Having carefully considered these most recent recommendations, the Court adopts and publishes Administrative Order Number 10 -Arkansas Child Support Guidelines, effective February 11, 2002. This Administrative Order includes and incorporates by reference the revised weekly and monthly family-support charts and the revised Affidavit of Financial Means which are attached to Administrative Order No. 10. The Court thanks the Committee for its service, and as it has done in the past, directs the Committee and the Chief Justice, as its liaison, to continue its charge pursuant to law and the rules of this Court. American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 3 GLAZE and CORBIN, JJ., dissent. *** ADMINISTRATIVE ORDER NUMBER 10 -- CHILD SUPPORT GUIDELINES SECTION I. AUTHORITY AND SCOPE. Pursuant to Act 948 of 1989, as amended, codified at Ark. Code Ann. § 9-12-312(a) and the Family Support Act of 1988, Pub. L. No. 100-485 (1988), the Court adopts and publishes Administrative Order Number 10 -- Child Support Guidelines. This Administrative Order includes and incorporates by reference the attached weekly and monthly familysupport charts and the attached Affidavit of Financial Means. It is a rebuttable presumption that the amount of child support calculated pursuant to the most recent revision of the Family Support Chart is the amount of child support to be awarded in any judicial proceeding for divorce, separation, paternity, or child support. The court may grant less or more support if the evidence shows that the needs of the dependents require a different level of support. All orders granting or modifying child support (including agreed orders) shall contain -3- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 4 the court’s determination of the payor’s income, recite the amount of support required under the guidelines, and recite whether the court deviated from the Family Support Chart. If the order varies from the guidelines, it shall include a justification of why the order varies as may be permitted under Section V hereinafter. It shall be sufficient in a particular case to rebut the presumption that the amount of child support calculated pursuant to the Family Support Chart is correct, if the court enters in the case a specific written finding within the Order that the amount so calculated, after consideration of all relevant factors, including the best interests of the child, is unjust or inappropriate. SECTION II. DEFINITION OF INCOME. Income means any form of payment, periodic or otherwise, due to an individual, regardless of source, including wages, salaries, commissions, bonuses, workers’ compensation, disability, payments pursuant to a pension or retirement program, and interest less proper deductions for: 1. Federal and state income tax; 2. Withholding for Social Security (FICA), Medicare, and railroad retirement; 3. Medical insurance paid for dependent children; and 4. Presently paid support for other dependents by court order. SECTION III. CALCULATION OF SUPPORT. -4- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 5 a. Basic Considerations. The most recent revision of the family support charts is based on the weekly and monthly income of the payor parent as defined in Section II. For purposes of computing child support payments, a month consists of 4.334 weeks. Biweekly means a payor is paid once every two weeks or 26 times during a calendar year. Bimonthly means a payor is paid twice a month or 24 times during a calendar year. Use the lower figure on the chart for income to determine support. Do not interpolate (i.e., use the $200.00 amount for all income pay between $200.00 and $210.00 per week.) The amount paid to the Clerk of the Court or to the Arkansas Clearinghouse for administrative costs pursuant to Ark. Code Ann. § 9-12-312(e)(1)(A), § 9-10-109(b)(1)(A), and § 9-14-804(b) is not to be included as support. b. Income Which Exceeds Chart. When the payor's income exceeds that shown on the chart, use the following percentages of the payor's weekly or monthly income as defined in SECTION II to set and establish a sum certain dollar amount of support: One dependent: 15% Two dependents: 21% Three dependents: 25% Four dependents: 28% -5- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 6 Five dependents: 30% Six dependents: 32% c. Nonsalaried Payors. For Social Security Disability recipients, the court should consider the amount of any separate awards made to the disability recipient's spouse and children on account of the payor's disability. SSI benefits shall not be considered as income. For Veteran's Administration disability recipients, Workers' Compensation disability recipients, and Unemployment Compensation recipients, the court shall consider those benefits as income. For military personnel, see the latest military pay allocation chart and benefits. BAQ (quarters allowance) should be added to other income to reach total income. Military personnel are entitled to draw BAQ at a "with dependents" rate if they are providing support pursuant to a court order. However, there may be circumstances in which the payor is unable to draw BAQ or may draw BAQ only at the "without dependents" rate. Use the BAQ for which the payor is actually eligible. In some areas, military personnel receive a variable allowance. It may not be appropriate to include this allowance in calculation of income since it is awarded to offset living expenses which exceed those normally incurred. For commission workers, support shall be calculated based on minimum draw plus additional commissions. -6- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 7 For self-employed payors, support shall be calculated based on the last two years’ federal and state income tax returns and the quarterly estimates for the current year. A selfemployed payor’s income should include contributions made to retirement plans, alimony paid, and self-employed health insurance paid; this figure appears on line 22 of the current federal income tax form. Depreciation should be allowed as a deduction only to the extent that it reflects actual decrease in value of an asset. Also, the court shall consider the amount the payor is capable of earning or a net worth approach based on property, life-style, etc. d. Imputed Income. If a payor is unemployed or working below full earning capacity, the court may consider the reasons therefor. If earnings are reduced as a matter of choice and not for reasonable cause, the court may attribute income to a payor up to his or her earning capacity, including consideration of the payor's life-style. Income of at least minimum wage shall be attributed to a payor ordered to pay child support. e. Spousal Support. The chart assumes that the custodian of dependent children is employed and is not a dependent. For the purposes of calculating temporary support only, a dependent custodian may be awarded 20% of the net take-home pay for his or her support in addition to any child support awarded. For final hearings, the court should consider all relevant factors, including the chart, in determining the amount of any spousal support to be paid. -7- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 8 f. Allocation of Dependents for Tax Purposes. Allocation of dependents for tax purposes belongs to the custodial parent pursuant to the Internal Revenue Code. However, the Court shall have the discretion to grant dependency allocation, or any part of it, to the noncustodial parent if the benefit of the allocation to the noncustodial parent substantially outweighs the benefit to the custodial parent. g. Health Insurance. In addition to the award of child support, the court order shall provide for the child's health care needs, which normally would include health insurance if available to either parent at a reasonable cost. SECTION IV. AFFIDAVIT OF FINANCIAL MEANS. The Affidavit of Financial Means shall be used in all family support matters. The trial court shall require each party to complete and exchange the Affidavit of Financial Means prior to a hearing to establish or modify a support order. SECTION V. DEVIATION CONSIDERATIONS. a. Relevant Factors. Relevant factors to be considered by the court in determining appropriate amounts of child support shall include: 1. Food; -8- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 9 2. Shelter and utilities; 3. Clothing; 4. Medical expenses; 5. Educational expenses; 6. Dental expenses; 7. Child care (includes nursery, baby sitting, daycare or other expenses for supervision of children necessary for the custodial parent to work); 8. Accustomed standard of living; 9. Recreation; 10. Insurance; 11. Transportation expenses; and 12. Other income or assets available to support the child from whatever source. b. Additional Factors. Additional factors may warrant adjustments to the child support obligations and shall include: 1. The procurement and maintenance of life insurance, health insurance, dental insurance for the children's benefit; 2. The provision or payment of necessary medical, dental, optical, psychological or counseling expenses of the children (e.g., orthopedic shoes, glasses, braces, etc.); -9- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 10 3. The creation or maintenance of a trust fund for the children; 4. The provision or payment of special education needs or expenses of the child; 5. The provision or payment of day care for a child; 6. The extraordinary time spent with the noncustodial parent, or shared or joint custody arrangements; 7. The support required and given by a payor for dependent children, even in the absence of a court order; and 8. Where the amount of child support indicated by the chart is less than the normal costs of child care, the court shall consider whether a deviation is appropriate. SECTION VI. ABATEMENT OF SUPPORT DURING EXTENDED VISITATION. The guidelines assume that the noncustodial parent will have visitation every other weekend and for several weeks during the summer. Excluding weekend visitation with the custodial parent, in those situations in which a child spends in excess of 14 consecutive days with the noncustodial parent, the court should consider whether an adjustment in child support is appropriate, giving consideration to the fixed obligations of the custodial parent which are attributable to the child, to the increased costs of the noncustodial parent associated with the child's visit, and to the relative incomes of both parents. Any partial abatement or reduction of child support should not exceed 50% of the child-support obligation during the extended visitation period of more than 14 consecutive days. -10- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 11 In situations in which the noncustodial parent has been granted annual visitation in excess of 14 consecutive days, the court may prorate annually the reduction in order to maintain the same amount of monthly child-support payments. However, if the noncustodial parent does not exercise said extended visitations during a particular year, the noncustodial parent shall be required to pay the abated amount of child support to the custodial parent. SECTION VII. PROVISIONS FOR PAYMENT. All orders of child support shall fix the dates on which payments shall be made. All support orders issued shall include a provision for immediate implementation of income withholding, absent a finding of good cause not to require immediate income withholding or a written agreement of the parties incorporated in the order setting forth an alternative agreement as required by Ark. Code Ann. § 9-14-218(a). Payment shall be made through the Arkansas Clearinghouse pursuant to Ark. Code Ann. § 9-14-805. Times for payment should ordinarily coincide with the payor's receipt of salary, wages, or other income. *** ARKANSAS Weekly Family Support Chart -11- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) PAYOR NET WEEKLY INCOME ONE CHILD TWO THREE Page 12 FOUR FIVE CHILDRE CHILDREN CHILDREN CHILDREN N 100 24 35 42 46 50 110 27 39 46 51 55 120 29 42 50 55 60 130 31 46 54 60 65 140 34 49 58 64 69 150 36 52 62 69 74 160 38 56 66 73 79 170 41 59 70 77 84 180 43 63 74 82 88 190 45 66 78 86 93 200 47 69 81 90 97 210 50 72 85 94 102 220 52 75 89 98 106 230 54 79 93 102 111 240 56 82 96 107 115 250 59 85 100 111 120 260 61 89 104 115 125 270 63 92 108 120 130 280 66 95 112 124 134 290 68 99 116 128 139 300 70 102 120 133 144 310 72 104 123 136 147 320 73 106 125 138 149 330 74 108 127 140 152 340 76 109 129 142 154 350 77 111 131 144 156 360 78 113 132 146 159 370 79 114 134 148 161 -12- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 13 380 80 116 136 150 163 390 81 117 138 152 165 400 82 119 140 154 167 410 83 120 141 156 169 420 84 122 143 158 171 430 86 123 145 160 173 440 87 125 147 162 176 450 88 127 149 165 178 460 90 129 152 167 182 470 91 132 154 170 185 480 93 134 157 173 188 490 94 136 159 176 191 500 96 138 162 179 194 510 98 140 164 182 197 520 99 143 167 184 200 530 100 145 169 187 203 540 102 147 172 190 206 550 103 149 174 193 209 560 105 151 177 195 212 570 106 153 179 198 215 580 108 155 182 201 218 590 109 157 184 203 220 600 111 159 186 206 223 610 112 161 189 208 226 620 113 163 191 211 229 630 115 165 193 214 232 640 116 167 196 216 234 650 118 169 198 219 237 660 119 171 200 221 240 670 120 173 203 224 243 680 122 175 205 227 246 690 123 177 207 229 248 700 124 179 210 232 251 710 126 181 212 234 254 720 127 183 214 237 257 730 129 185 217 240 260 740 130 187 219 242 263 -13- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 14 750 131 189 221 245 265 760 132 190 223 247 267 770 133 192 225 249 270 780 134 193 227 251 272 790 135 195 229 253 274 800 136 196 230 255 276 810 137 198 232 257 278 820 138 199 234 259 280 830 139 201 236 261 283 840 140 202 238 263 285 850 141 204 240 265 287 860 142 205 241 267 289 870 143 207 243 269 291 880 144 208 245 271 294 890 145 210 247 273 296 900 147 212 249 275 299 910 148 214 251 278 301 920 149 215 253 280 304 930 150 217 256 282 306 940 151 219 258 285 309 950 153 221 260 287 311 960 154 222 262 289 314 970 155 224 264 292 316 980 156 226 266 294 319 990 157 228 268 296 321 1000 159 229 270 298 324 *** ARKANSAS -14- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 15 Monthly Family Support Chart PAYOR NET ONE TWO THREE FOUR FIVE CHILD CHILDREN CHILDREN CHILDREN CHILDREN MONTHLY INCOME 500 121 176 209 230 250 550 133 193 229 253 274 600 145 211 249 275 298 650 156 228 269 297 322 700 168 245 289 320 347 750 180 262 309 342 370 800 191 278 328 362 393 850 202 294 347 383 415 900 214 310 366 404 438 950 225 326 384 425 460 1000 236 342 403 445 483 1050 247 359 422 467 506 1100 259 375 442 488 529 1150 271 392 462 510 553 1200 282 409 481 532 576 1250 294 425 501 553 600 1300 305 442 520 575 623 1350 314 454 534 591 640 1400 319 462 544 601 652 1450 325 470 554 612 663 1500 331 479 563 622 675 1550 337 487 573 633 686 1600 342 495 582 643 697 1650 348 503 591 653 708 1700 354 511 600 663 719 1750 359 518 609 672 729 1800 364 526 617 682 739 1850 370 533 626 692 750 1900 375 541 635 701 760 -15- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 16 1950 383 551 647 714 774 2000 391 563 659 729 790 2050 398 574 672 743 805 2100 406 585 685 757 821 2150 414 596 698 771 836 2200 422 607 711 785 851 2250 429 618 723 799 866 2300 437 628 736 813 881 2350 444 639 748 827 896 2400 451 649 761 841 911 2450 458 660 773 854 926 2500 466 671 786 868 941 2550 473 681 797 881 955 2600 480 691 809 894 969 2650 487 701 820 906 982 2700 494 711 832 919 996 2750 501 721 843 932 1010 2800 508 731 855 945 1024 2850 515 741 867 958 1038 2900 522 751 879 971 1052 2950 529 761 890 984 1067 3000 536 771 902 997 1081 3050 542 780 914 1010 1095 3100 549 790 926 1023 1109 3150 556 800 938 1036 1123 3200 563 810 950 1049 1137 3250 569 819 960 1061 1150 3300 574 827 970 1071 1161 3350 579 834 979 1081 1172 3400 584 842 988 1092 1183 3450 589 849 997 1102 1194 3500 594 857 1006 1112 1205 3550 599 864 1015 1122 1216 3600 604 872 1024 1132 1227 3650 609 879 1034 1142 1238 3700 614 887 1043 1152 1249 3750 619 895 1052 1162 1260 3800 624 902 1061 1172 1271 3850 630 910 1071 1184 1283 -16- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 17 3900 636 919 1082 1195 1295 3950 642 928 1092 1207 1308 4000 648 937 1102 1218 1321 4050 654 946 1113 1230 1333 4100 660 954 1123 1241 1346 4150 666 963 1134 1253 1358 4200 672 972 1144 1264 1371 4250 678 981 1155 1276 1383 4300 684 989 1165 1288 1396 4350 690 998 1176 1299 1408 4400 696 1007 1186 1311 1421 4450 702 1015 1195 1321 1432 4500 707 1023 1205 1331 1443 4550 713 1031 1214 1341 1454 4600 718 1039 1223 1352 1465 4650 724 1047 1232 1362 1476 4700 729 1054 1242 1372 1487 4750 735 1062 1251 1382 1498 4800 740 1070 1260 1392 1509 4850 746 1078 1269 1403 1520 4900 751 1086 1278 1413 1531 4950 757 1094 1288 1423 1542 5000 762 1102 1297 1433 1553 *** IN THE CIRCUIT COURT OF _________ COUNTY, ARKANSAS ___________ DIVISION STATE OF ARKANSAS } }ss COUNTY OF ________} AFFIDAVIT OF FINANCIAL MEANS Revised 02-02 _____________________ PLAINTIFF Vs. Case No. _____________ -17- American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 18 _____________________ DEFENDANT BOTH PARTIES MUST COMPLETE AND EXCHANGE THIS AFFIDAVIT PRIOR TO ANY HEARING. BOTH PARTIES MUST SUPPLY THE ORIGINAL NOTARIZED AFFIDAVIT TO THE COURT. THE COURT WILL PUNISH PERJURY BY APPROPRIATE ACTION. The affiant, being duly sworn, says under penalty of perjury that affiant is the [Plaintiff/Defendant/Party](circle one) to this support action herein, has prepared this financial statement, knows the contents thereof, and that it is true and correct. Attach additional pages as needed. INCOME Complete Item 29. 1. My weekly take-home pay [from Item 29(i)) is $_________. 2. I claim ____ dependents for the purpose of determining my State of Arkansas withholding. I claim ____ dependents for the purpose of determining my federal withholding. I [did/did not] (circle one) claim myself as a dependent. I [do/do not](circle one) have an additional amount withheld from my payroll checks for tax purposes and, if so, that amount is $________ per [week/pay period](circle one)and itemized below. All other deductions taken from my payroll check before I receive it total $___________ [from Item 29(j)(8)]. 3. I receive total payments, periodic, or otherwise, from the following sources: ________________________________ in the following amount(s) of $________________. 4. I have cash on hand in the amount of $_________ from the following sources:________________________________________ 5. I have on deposit in banks and savings institutions the amount of $________ from the following source(s):_________________. 6. I have stocks and bonds in the amount of $________ and their source was _________________________________________. CREDITORS Complete Items 30, 31 and 32. 7. Debts in the name of plaintiff only: UNDER ITEM 30: (a) (b) TOTAL UNPAID BALANCES: TOTAL MONTHLY PAYMENTS: -18- ALL CREDITORS LISTED $_____________ _____________ 18 American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) 8. Debts in the name of defendant only: UNDER ITEM 31: (a) (b) 9. ALL CREDITORS LISTED TOTAL UNPAID BALANCES: TOTAL MONTHLY PAYMENTS: Debts in our JOINT NAMES are: 32: (a) (b) Page 19 $_____________ _____________ ALL CREDITORS LISTED UNDER ITEM TOTAL UNPAID BALANCES: TOTAL MONTHLY PAYMENTS: $_____________ _____________ AVERAGE MONTHLY EXPENSES 10. My present average monthly expenses to support myself and ___children are: INSURANCES HOUSEHOLD Mortgage or rent payments Property taxes and insurance Electricity Water, garbage & sewer Telephone (including cell) Fuel, oil or natural gas Repairs & Maintenance Lawn (and pool) care Pest Control Housewares Food & Grocery items Meals outside home Other ____________________ ____________________ ____________________ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ Health $______ Life $______ Other Insurance$______ ______________ $______ ______________ $______ OTHER EXPENSES NOT LISTED Household help Dry Cleaning My Clothing My Hair Care My Cosmetics Newspaper, etc ______________ ______________ $______ $______ $______ $______ $______ $______ $______ $______ PETS AUTOMOBILE EXPENSE Car/lease payment Gasoline and Oil Repairs Auto Tag and Title Insurance $______ $______ $______ $______ $______ Food Grooming Veterinarian $______ $______ $______ PERSONAL Other_______________ ____________________ $______ $______ CHILDREN’S EXPENSES Nursery or babysitting $______ -19- Membership dues Professional dues Social Dues Entertainment Vacations $_____ $_____ $_____ $_____ $_____ 19 APPENDIX Cite as 347 Ark. ___ (2001) School tuition School supplies Lunch money Allowance Clothing Medical, Dental, Drugs Vitamins Barber/Beauty parlor Cosmetics/Toiletries Gifts for Holidays/Birthdays Other _________________ _______________________ _______________________ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ Page 20 Publications Church/Charity Miscellaneous Other $_____ $_____ $_____ $_____ MEDICAL EXPENSES Physician Dental Medicines Hospital Glasses Other ________ TOTAL MONTHLY EXPENSES $______ $______ $______ $______ $______ $______ $______ Place a check mark next to those not being paid currently. GENERAL INFORMATION 11. My full name is ___________________. 12. My social security number is _________________. My military I.D. number is ___________________. 13. My Arkansas driver's license number is ________________. 14. My date of birth is _____________. My place of birth is ______________. 15. My father's full name is________________. My mother's full name is _______________. [They/He/She] reside(s) at _______________. My [father and/or mother] [is/are] deceased. 16. My present resident address is 17a The full names, birth dates and social security numbers of children born (or legally adopted) of this marriage are: 17b __________________. Birth Date Soc. Sec. Number Name (a) __________________ _____________ _________________ (b) __________________ _____________ _________________ (c) __________________ _____________ _________________ (d) __________________ _____________ _________________ (e) __________________ _____________ _________________ (f) __________________ _____________ _________________ The full names, birth dates and social security numbers of Children born out of wedlock to the parties are: (a) (b) (c) Name _________________ _________________ _________________ -20- Birth Date _____________ _____________ _____________ Soc. Sec. Number _________________ _________________ _________________ 20 American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 21 Paternity has _______ has not _______ been established for these children. 17c I also have the obligation to support the following additional children born to me and ______________________: Name (a) (b) (c) Birth Date Soc. Sec. Number _________________ _________________ _________________ _____________ _____________ _____________ _________________ _________________ _________________ Please attach any court orders establishing paternity and establishing a child support obligation. 18. My employer is __________________. 19. My employer's full address is _____________________. 20. My home telephone number is ___________. My work telephone number is ___________. INFORMATION ABOUT OPPOSING PARTY, IF KNOWN (DO NOT GUESS) 21. The opposing party's full name is ________________. 22. The opposing party's social security number is ___________. The opposing party's military I.D. number is ____________. 23. The opposing party's _________________. 24. (a) (b) (c) (d) 25. The opposing party's present residence address is __________. 26. The opposing party's employer is _____________. 27. The opposing party's employer's address is __________. 28. The opposing party's home telephone number is ___________. The opposing party's work telephone number is ___________. Arkansas driver's license number is The opposing party's father's full name is _________. The opposing party's mother's full name is ________. [They/He/She] reside(s) at _____________________. Opposing party's [father and/or mother] [is/are] deceased. INCOME 29. How often are you paid and what are your gross wages, or commission due each time? (Check one) salary _____ Weekly (52 times a year) _____ Bi-Weekly (26 times a year) -21- 21 American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 22 _____ Semi-Monthly (24 times a year) _____ Monthly (12 times a year) _____ Other (Explain) PAYROLL DEDUCTIONS (a) (b) (c) (d) (e) (f) GROSS WAGES Federal income tax withheld Arkansas income tax withheld FICA (social security) or railroad retirement Health insurance (children only) Court-ordered child support for dependents of previous marriage or previously legally determined adopted or illegitimate children $_____________ $________ $________ $________ $________ $________ (g) TOTAL WITHHELD ((b) through (f) above) $_____________ (h) NET TAKE-HOME PAY PER PAY PERIOD (Subtract (g) from (a) above) CONVERT TO WEEKLY TAKE-HOME PAY AND CARRY TO ITEM 1 ABOVE $_____________ (i) $_____________ Example: If (h) above is $300.00 and is received bi-weekly, multiply $300.00 by 26 (26x3OO=$7,800), divide $7,800 by 52 ($150.00); carry $150.00 to Item 1 (j) OTHER ITEMS WITHHELD FROM MY CHECK ARE: (1)Union dues $_____________ (2)Credit union, thrift plans $_____________ (3)Pension benefits, stock purchase plans (4)Charitable contributions $_____________ (5)Debt payments, garnishments $_____________ (6)Life insurance payments $_____________ (7)other (identify) $_____________ Items (1) through (7) above are not allowed in computing take-home pay. (8)TOTAL WITHHELD (sum of items (1) through (7) above) $____________ If self-employed, attach copies of your past two years’ state and federal income tax returns and a list of all disbursements made to you during the current calendar year. CREDITORS AND DEBTS -22- 22 American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) 30. Debts in the name of PLAINTIFF only are: Total Unpaid Balance $_____________ _____________ _____________ _____________ _____________ *$_____________ *Carry forward to Item 7(a) Creditors (a)_____________ (b)_____________ (c)_____________ (d)_____________ (e)_____________ (f)TOTAL: 31. Monthly Payment $__________ __________ __________ __________ __________ **$__________ **Carry forward to Item 7(b) Debts in the name of DEFENDANT only are: Total Unpaid Balance $_____________ _____________ _____________ _____________ _____________ *$_____________ *Carry forward to Item 8(a) Monthly Payment $__________ __________ __________ __________ __________ **$__________ **Carry forward to Item 8(b) Total Unpaid Balance $_____________ _____________ _____________ _____________ _____________ *$_____________ *Carry forward to Item 9(a) Creditors (a)_____________ (b)_____________ (c)_____________ (d)_____________ (e)_____________ (f) TOTAL: 32. Page 23 Monthly Payment $__________ __________ __________ __________ __________ **$__________ **Carry forward to Item 9(b) Debts in JOINT names: Creditors (a)_____________ (b)_____________ (c)_____________ (d)_____________ (e)_____________ (f) TOTAL: 33. The weekly take-home pay of opposing party is $____________. 34. All other income of the opposing party is $______________. _____________________________ Affiant STATE OF _______________ COUNTY OF ______________ -23- 23 American LegalNet, Inc. www.USCourtForms.com APPENDIX Cite as 347 Ark. ___ (2001) Page 24 Subscribed and sworn to before me, a Notary Public, on this ___ day of _____________,______. (month) (year) ______________________________ Notary Public My Commission Expires: _____________________. (SEAL) -24- 24 American LegalNet, Inc. www.USCourtForms.com