FORM # 8 STATE OF NORTH CAROLINA 20A JUDICIAL DISTRICT COUNTY OF ___________________ IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION CASE NUMBER ______________________ _______________________________ , Plaintiff, VS _______________________________, Defendant, ) ) ) ) ) ) ) ) ) ) ) AFFIDAVIT OF: PLAINTIFF DEFENDANT SEEKING SUPPORT PSS / ALIMONY CHILD SUPPORT FROM WHOM SUPPORT IS SOUGHT PSS / ALIMONY CHILD SUPPORT The affiant, having been first duly sworn as to the truthfulness and completeness of this affidavit, deposes and says that the average monthly financial needs for the support of the children in this case and/or my MONTHLY income and expenses are, as follows: PART I ­ INCOME INFORMATION COMPLETE PAGE 1, SIGN & NOTARIZE PAGE 3 IN ALL CASES 1. 2. My name is: (PRINT) ______________________________________________________________. My Social Security Number is available upon request and with the understanding and agreement that it will not be made part of the court file or released or used other than for a legitimate purpose in the preparation for or trial of this cause. I am: Employed by: (first job) ________________________ (second job) __________________________. Employer's Address(es) _______________________________________________________________ ___________________________________________________________________________________ Employer's Telephone(s) ______________________________________________________________ Self-employed doing: ________________________________________________________________. I receive the following AVERAGE MONTHLY GROSS INCOME (based on 4.33 weeks or 2.165 bi-weekly periods per month) from the following sources: A. B. C. D. 5. Wages / Salary Bonuses Commissions Interest/Dividends Investments $ _______________ $ _______________ $ _______________ $ _______________ E. F. G. H. I. Rent Business Profit Social Security Pension/Retirement Other (Itemize) $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ 3. 4. ATTACHED HERETO AND MADE A PART HEREOF ARE A. COPIES OF MY PAY STUBS FOR THE PAST TWO (2) MONTHS (OR OTHER DOCUMENTATION OF MY INCOME), B. MY LATEST FEDERAL TAX RETURN (INCLUDING ALL SCHEDULES), W-2'S & 1099'S. American LegalNet, Inc. www.FormsWorkflow.com FORM # 8 6. I have the following average MONTHLY expenses in connection with my business profit and/or rental income (including only expenses [and not depreciation] that are deductible on Schedule "C" and/or "E" or my IRS Form 1040 income tax return): _______________________________________________________________ $____________________ _______________________________________________________________ $____________________ _______________________________________________________________ $____________________ Total Expenses $____________________ PART II ­ CHILD SUPPORT INFORMATION ­ GUIDELINE CASES COMPLETE IN CHILD SUPPORT CASES USING THE CHILD SUPPORT GUIDELINES 1. I have the following average MONTHLY expenses: A. Child support required by Court Order or Separation Agreement for my children $_________________________ Who are not living with me: Name (s) and date (s) of birth of children: i: _____________________________________________ _________________________ ii: ____________________________________________ _________________________ iii: ___________________________________________ _________________________ iv: ___________________________________________ _________________________ B. Responsibility for my biological or adopted children who live with me (Calculated per Guidelines): Name (s) and date (s) of birth of children: i: _____________________________________________ _________________________ ii: ____________________________________________ _________________________ iii: ___________________________________________ _________________________ iv: ___________________________________________ _________________________ C. Gross monthly income of the other parent responsible for children listed in B above. D. Monthly work-related child care costs (100%) (attach verification) E. Child (ren)'s portion of health insurance cost: (attach verification) F. Extraordinary expenses for child (ren) (itemize): (As defined on Page 4 of the Guidelines) ____________________________________________ ____________________________________________ 2. Number of nights the child (ren) spend with me each year $____________________ $____________________ $_____________ $____________________ $____________________ ____________________ American LegalNet, Inc. www.FormsWorkflow.com FORM # 8 STATE OF NORTH CAROLINA COUNTY OF ______________________ VERIFICATION Being first duly sworn, I depose and say that I have read the foregoing pages and I know the contents thereof; that the contents are true to my knowledge, except as to those matters and things stated upon information and belief, and as to those matters and things, I believe them to be true. ____________________________________ Affiant Sworn to and subscribed before me this ________ day of ________________________, ________. _______________________________________________________ A Notary Public of _______________________________________ My Commission Expires __________________________________ IN CHILD SUPPORT CASES FOLLOWING CHILD SUPPORT GUIDELINES, STOP HERE PART III COMPLETE PART III IN SPOUSAL SUPPORT CASES AND IN NON-GUIDELINES OR DEVIATION CHILD SUPPORT CASES NOTE: One month equals 4.33 weeks (or 2.165 bi-weekly periods) A. NET INCOME 1. 2. My total MONTHLY GROSS INCOME (from Part I) is I have the following average monthly deductions from my gross income: Federal income taxes $________________ Medical Insurance State income taxes $________________ Life Insurance Social Security (FICA) $________________ Retirement/401 (k) Medicare $________________ Other:_____________ TOTAL DEDUCTIONS: 3. My average MONTHLY NET INCOME: $___________________ $____________________ $____________________ $____________________ $____________________ $____________________ $____________________ B. NEEDS AND EXPENSES 1. I have the following average monthly fixed needs and expenses: Actual Expense House pmt/rent Property tax (excluded above) Homeowner's/ renter's insurance Electricity Heat (gas, etc) Water $ $ $ $ Anticipated Expense Telephone House Maintenance Yard Maintenance Car Payment Gasoline Car repairs $ $ Actual Expense $ $ Anticipated Expense $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ American LegalNet, Inc. www.FormsWorkflow.com FORM # 8 Actual Expe