NOTICE OF INFORMATION REQUIRED IN CHILD/SPOUSAL SUPPORT PROCEEDINGS Commonwealth of Virginia Va. Code § 20-60.3 To help you prepare for your hearing, you should complete this form and bring it, along with supporting documentation, with you to your hearing. At your hearing, you will be required to give the Judge the following information about yourself: 1. Your gross income. Gross income "shall mean all income from all sources, and shall include, but not be limited to, income from salaries, wages, commissions, royalties, bonuses, dividends, severance pay, pensions, interest, trust income, annuities, capital gains, social security benefits except as listed below, worker's compensation benefits, unemployment insurance benefits, disability insurance benefits, veterans' benefits, spousal support, rental income, gifts, prizes or awards. If a parent's gross income includes disability insurance benefits, it shall also include any amounts paid to or for the child who is the subject of the order and derived by the child from the parent's entitlement to disability insurance benefits." Gross income "shall not include benefits from public assistance programs as defined in Virginia Code § 63.2-100 [Temporary Assistance to Needy Families (TANF), auxiliary grants to the aged, blind and disabled, medical assistance, food stamps, energy assistance, employment services, child care and general relief]; federal supplemental security income benefits or child support received; or income received by the payor from secondary employment income not previously included in "gross income," where the payor obtained the income to discharge a child support arrearage established by a court or administrative order and the payor is paying the arrearage pursuant to the order." The judge may require that you submit documentation, your most recent pay stub or other statement of your gross monthly income, prior to your hearing. .............................................................................................................................................................................. 2. Your name, address and telephone number. .............................................................................................................................................................................. 3. Your Social Security number and date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Whether you have a driver's license and, if so, the driver's license number and state of issuance. [ ] none .............................................................................................................................................................................. 5. Place of employment, address and telephone number of your employer .............................................................................................................................................................................. 6. Information regarding any license, certificate, registration or other authorization to engage in a profession, trade, business, occupation, or recreational activity issued by the Commonwealth of Virginia. .............................................................................................................................................................................. 7. 8. 9. Whether you or your spouse can provide health care coverage for your children and, if so, who is the health care provider. .............................................................................................................................................................................. How much the health care coverage will cost to cover your children only. .............................................................................................................................................................................. The cost of day care for your children and the name(s) of the day care provider. The judge may require that you provide documentation of this cost. .............................................................................................................................................................................. 10. Whether you pay support to another custodian for another child or children. Please have information about the amount and names and ages of other children and the name and address of the custodian available. .............................................................................................................................................................................. 11. Whether you are providing actual support to other persons. If you are, bring proof of this support to the hearing. .............................................................................................................................................................................. 12. Other: .............................................................................................................................................................................. FORM DC-603 MASTER 10/12 American LegalNet, Inc. www.FormsWorkFlow.com