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 American LegalNet, Inc. www.USCourtForms.com>>>> 2Form 32C-1 (Short Form) COMPLETENESS AND UNDERSTANDING I have read my answers to this affidavit and before signing it I have al lowed 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 affid avit 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 American LegalNet, Inc. www.USCourtForms.com