Free DR-305 Child Support Guidelines Affidavit Civil Rule 90.3 - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) )

(Plaintiff)(Petitioner) vs. (Defendant)(Petitioner)

CASE NO. CHILD SUPPORT GUIDELINES AFFIDAVIT [Civil Rule 90.3]

I swear or affirm under penalty of perjury that the following information is true to the best of my knowledge and belief. I have attached a copy of my most recent federal tax return and pay stubs to verify this information. [Note: Delete social security numbers and account numbers from any documents you attach.] The following income and deductions are monthly yearly. FATHER A. Gross Income (Do not list ATAP or SSI below.) Gross wages Value of employer-provided housing/food/etc. Unemployment compensation Permanent fund dividend Other:
0.00
0.00

MOTHER

B.

TOTAL INCOME Deductions Allowable under Civil Rule 90.3 Federal, state and local income tax Social security tax or self-employment tax Medicare tax Employment security tax Mandatory retirement contributions Mandatory union dues Voluntary retirement contributions if plan earnings are tax-free or tax-deferred, up to 7.5% of gross wages and self-employment income when combined with mandatory contributions Other mandatory deductions (specify) Child support/alimony ordered in other cases and currently being paid Child support for children from prior relationships living with this parent, calculated under Civil Rule 90.3 Work-related child care for children of this marriage TOTAL DEDUCTIONS Net Income TOTAL INCOME from section A TOTAL DEDUCTIONS from section B Subtract deductions from income to get NET INCOME

0.00

0.00

C.

0.00 0.00

0.00 0.00
0.00
Civil Rule 90.3

0.00

Page 1 of 3 DR-305 (4/09)(cs) CHILD SUPPORT GUIDELINES AFFIDAVIT

D.

E.

FATHER Adjusted Annual Income 1. If the above figures are based on monthly information, multiply Net Income from section C by 12 to get Adjusted Annual Income 2. If the above figures are based on yearly information, repeat the Net Income amount from section C to show 0.00 Adjusted Annual Income 3. If line 1 or 2 is more than $105,000, write 105,000 here. Otherwise, repeat amount from line 1 or 2. 0.00 ADJUSTED ANNUAL INCOME Multiply Adjusted Annual Income from line D.3 by: .20 for one child .27 for two children x .00 .33 for three children, and .03 for each additional child $0.00 TOTAL
$0.00 ANNUAL CHILD SUPPORT (amount from "TOTAL" line above or $600, whichever is larger.

MOTHER

0.00 0.00

x .00
$0.00 $0.00

F.

Monthly Child Support Payment (See definitions of types of custody in Civil Rule 90.3(f).) 1. Primary Custody. One parent has primary physical custody. Divide Annual Child Support amount from section E for the non-custodial parent 0 to be paid each month by by 12 = $ mother father. 2. Shared Custody. Attach form DR-306. The children will reside with each parent for a period specified in writing of at least 30% of the year. Monthly child support payment (from line 10 of DR-306) to be paid each month except = $ to be paid by mother father. 3. Divided Custody. Attach form DR-307. Each parent will have primary custody of one or more of the children and the parents will not share custody of any of the children. Monthly child support payment (from line 7 of DR-307) = $ to be paid by mother father. 4. Hybrid Custody. Attach form DR-308. Monthly child support payment (from line 8 of DR-308) = $ to be paid by mother father. Health Care Coverage. 1. Health Insurance. a. Does father have health insurance available for the child(ren) at reasonable cost through his employer, union or otherwise? Yes No I do not know b. Does mother have health insurance available for the child(ren) at reasonable cost through her employer, union or otherwise? Yes No I do not know c. Are the children eligible for services through the Indian Health Service? Yes No Yes No d. Do the children have other health insurance or care available? Describe:
Civil Rule 90.3

G.

Page 2 of 3 DR-305 (4/09)(cs) CHILD SUPPORT GUIDELINES AFFIDAVIT

Health insurance for the child(ren) is being father at a monthly cost to father of $ mother at a monthly cost to mother of $ through the above person's employer union whose name and address are

will be * *

purchased by:

The cost is will be divided between the parties Explain reason for unequal division:

equally

*List only the cost to insure the children involved in this case. If there is no extra cost to the parent to include the children in the parent's insurance coverage, none of the cost can be allocated to the children. See Civil Rule 90.3(d) for further explanation. 2. Health Care Expenses Not Covered By Insurance. Should uninsured health care expenses of the child(ren) (up to $5,000 per calendar year) be shared equally by the parents? Yes No If not, explain how the costs should be divided and why:

H.

Monthly Child Support Payment (after adding or deducting health insurance costs). 1. Monthly Child Support Payment from paragraph F above $ 2. If obligor is buying health insurance for the child(ren), subtract 50% (or %) of the monthly insurance payment. - $ (The "obligor" is the parent paying child support.) 3. If obligee is buying health insurance for the child(ren), add 50% (or %) of the monthly insurance payment. +$ (The "obligee" is the parent receiving child support.) 4. Net Monthly Child Support Payment $

0

0

I.

Yes No Seasonal Income. Obligor's income is seasonal. (Note: If income is seasonal, you can ask the court to order unequal monthly payments as described in Civil Rule 90.3(c)(5).)

Signature
Type or Print Name

Subscribed and sworn to or affirmed before me at on .
Date

, Alaska Clerk of Court, Notary Public or other person authorized to administer oaths. My Commission Expires: (SEAL)

I certify that on a copy of this affidavit was mailed to the other party in this case (list name): Signature
Page 3 of 3 DR-305 (4/09)(cs) CHILD SUPPORT GUIDELINES AFFIDAVIT

Civil Rule 90.3