Form 32C-1 (Short Form) CHILD SUPPORT AFFIDAVIT NO DEVIATION FROM GUIDELINES REQUESTED I am paid weekly; every other week; twice monthly; other A. I have gross monthly income from all sources as follows: (NOTE: To arrive at monthly figures, weekly income is multiplied by 4.3; every other week income is multiplied by 2.15 and twice monthly income is multiplied by 2.) Wages Overtime Commissions Bonus Interest Dividends Trust fund Social Security Pension Military Retirement Rents Child support and/or Alimony Business profits Other: TOTAL GROSS INCOME B. Monthly amount, if any, of pre-existing child support payments. $ C. Monthly amount, if any, of work related childcare costs. $ D. Monthly amount, if any, of insurance premium costs for child(ren). $ E. Monthly amount of extraordinary expenses, if any. $ F. To the best of my knowledge, information and belief, my former/estranged spouse earns a gross income of $ _____ per month. G. A copy of my latest payroll stub or voucher is attached hereto. (over) Page 1 of 2 >>>> 2Form 32C-1 (Short Form) COMPLETENESS AND UNDERSTANDING I have read my answers to this affidavit and before signing it I have allowed my attorney, if any, to read it. I have also asked my attorney to explain any parts of this affidavit that I did not understand before signing it. I understand that the Rules of Court require me to completely and honestly answer all parts of this affidavit and that it will be used in Court. I also understand that there are many sanctions, which the Court may impose for failing to complete this affidavit and I have discussed them with my attorney. __________________ AFFIANT Sworn and subscribed before me, this the day of , 20 . _______________________ Notary Public My Commission Expires Page 2 of 2