Form 6 - Child Support Financial Affidavit COURT COUNTY . . STATE. OF. NORTH . CAROLINA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . Wayne County Lenoir County GreeneCounty : File No. In The General Court Of Justice District Court Division Index No. Family Court : Calendar No. : JUDICIAL SUBPOENA Plaintiff: Plaintiff(s) VERSUS -against- : Defendant: CHILD SUPPORT FINANCIAL AFFIDAVIT : The Undersigned Plaintiff Defendant, having been first duly sworn as to the truthfulness and completeness of this Affidavit, : deposes and says that my average gross income is as follows: Defendant(s) : 1. My. Monthly.Gross. Income .is.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... .... ...... .. 2. I have Pre-existing Child Support Payments of: 3. My Responsibility for Other Children is: THE PEOPLE OF THE STATE OF NEW YORK 4. Directions: Add lines 2 and 3 TO 5. Directions: Enter the amount on line 1 here 6. Directions: Enter the amount on line 4 here 7. Monthly Adjusted Gross Income GREETINGS: Directions: Subtract line 6 from line 5 and enter here WE COMMAND YOU, that 8. My Work Related Child Care Costs are: all business and excuses being laid aside, you and each of you attend before the Honorable at the Court 9. My Health Insurance Premium Costs for theat located Children are: County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 10. I have the following Extraordinary give evidence expenses: in this action on the part of the or adjourned date, to testify and Child-Related as a witness A. B. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a C. result of your failure to comply. Date Signature Of Affiant Witness, Honorable County, day DATE SWORN Court SUBSCRIBED BEFORE ME THISof AND in Plaintiff Defendant , one of the Justices of the , 20 Notary Public (Seal) My Commission Expires (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Eighth Judicial District Family Court Form 6 3/01 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com ,