IN RE: GUIDELINES FOR CHILD SUPPORT

863 S.W.2d 291Supreme Court of Arkansas
Delivered October 25, 1993

PER CURIAM.

The Arkansas General Assembly enacted Act 948 of 1989, amending Ark. Code Ann. 9-12-312(a) (Supp. 1991), and providing in part for guidelines for child support enforcement.

9-12-312(a)(1) When a decree is entered, the court shall make such orders concerning the alimony of the wife or the husband and care of the children, if there are any, as are reasonable from the circumstances of the parties and the nature of the case.

(2) In determining a reasonable amount of support initially or upon review to be paid by the non-custodial parent, the court shall refer to the most recent revision of the family support chart. It shall be a rebuttable presumption for the award of child support, that the amount contained in the family support chart is the

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correct amount of child support to be awarded. Only upon a written finding or specific finding on the record that the application of the support chart would be unjust or inappropriate as determined under established criteria set forth in the support chart, shall the presumption be rebutted.

(3) The family support chart shall be revised at least once every four (4) years by a committee to be appointed by the Chief Justice of the Arkansas Supreme Court to ensure that the support amounts are appropriate for child support awards. The committee shall also establish the criteria for deviation from use of the chart amount.

(4) The Arkansas Supreme Court shall approve the family support chart and criteria upon revision by the committee for use in this state and shall publish same through per curiam order of the court.

Subsequent to the enactment of this legislation the Chief Justice appointed a committee to examine and revise the family support chart previously utilized by the trial court as prescribed by Section 9-12-312(a)(2). In addition, the committee was charged with the responsibility to establish the criteria for deviation from the use of the chart.

The following persons were appointed to the committee: Hon. Ellen Brantley, Larry Carpenter, Esq.; Hon. Fred D. Davis; Hon. Jim Gunter; Don Hollingsworth, Esq.; Hon. Warren Kimbrough; Rep. Jodie Mahony; Harry Truman Moore, Esq.; Hon. Andre McNeil; Jeff Pence, Esq.; Hon. Judith Rogers; and Ben Rowland, Esq. Debby Nye, Chief Counsel for the Department of Human Services, was later added to the Committee.

The Committee members met and filed a formal report establishing child support guidelines and deviation criteria.

In accordance with this Court’s rule making authority, Act 948 of 1989 and Family Support Act of 1988, Pub.L. No. 100-485 (1988), this Court adopted the formal report of the Committee on February 5, 1990, and as a result, provisionally adopted the Family Support Chart, which was established by a Family Law section committee of the Arkansas Bar Association effective July 1, 1987, pursuant to Section 9-12-312(a)(2). A copy of that chart was attached to that per curiam and made a part thereof.

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On May 13, 1991, the court also provisionally adopted additions to the guidelines including the attached extended child support chart to be used when the payor’s income exceeds the original chart. When the payor’s income exceeds that shown on the extended chart, the trial court was advised to disregard the chart and use these percentages of the payor’s weekly or monthly income as defined hereinafter to set and establish the dollar amount of support:

One dependent: 13%

Two dependents: 22%

Three dependents: 32%

Four dependents: 42%

Five dependents: 52%

Pursuant to Act 948 of 1989 and the Family Support Act of 1988, Pub.L. No. 100-485 (1988), requiring that the guidelines be reviewed and revised as necessary every four years, the Committee, having considered all relevant data as required by 45 CFR 302.56(h), has submitted its recommendations for revision of the guidelines. After careful deliberation, the Court once more provisionally adopts the following guidelines in their entirety as proposed by the Committee, including the support charts and extended percentages referred to above.

Income refers to the definition in the federal income tax laws, less proper deductions for:

1. Federal and state income tax;

2. Social security (FICA) or railroad retirement equivalent;

3. Medical insurance paid for dependent children; and

4. Presently paid support for other dependents by Court order.

For Social Security Disability recipients, the court should consider the amount of any separate awards made to the disability recipient’s spouse and/or children.

For Veteran’s Administration disability recipients, support shall be calculated based on those benefits.

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For Workers Compensation disability recipients, support shall be calculated based on those benefits.

For Unemployment Compensation recipients, support shall be calculated based on those benefits.

For military personnel, see latest military pay allocation chart and benefits. BAQ (quarters allowance) should be added to other income to reach total income. Military personnel are entitled to draw BAQ at a “with dependents” rate if they are providing support pursuant to a court order. However, there may be circumstances in which the payor is unable to draw BAQ or may draw BAQ only at the “without dependents” rate. Use the BAQ for which the payor is actually eligible. In some areas, military personnel receive a variable allowance. It may not be appropriate to include this allowance in calculation of income since it is awarded to offset living expenses which exceed those normally incurred.

For commission workers, support shall be calculated based on minimum draw plus additional commissions.

For self-employed payors, support shall be calculated based on last year’s federal and state income tax returns and the quarterly estimates for the current year. Also the court shall consider the amount the payor is capable of earning or a net-worth approach based on property, life-style, etc.

Use the lower figure on the chart for take-home pay to determine support. Do not interpolate (i.e., use the $200.00 amount for all take-home pay between $200.00 and $210.00 per week.)

The amount paid to the clerk for administrative costs pursuant to Ark. Code Ann. 9-12-312(e)(3) is not to be included as support. presumption that the amount of child support calculated pursuant to the most recent revision of the Family Support Chart is the amount of child support to be awarded in any judicial proceeding for divorce, separation, paternity, or child support. The court may grant less or more support if the evidence shows that the needs of the dependents require a different level of support.

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It shall be sufficient in a particular case to rebut the presumption that the amount of child support calculated pursuant to the Family Support Chart is correct, if the court enters in the case a written finding or specific finding on the record that the amount so calculated, after consideration of all relevant factors, including the best interests of the child, is unjust or inappropriate. Findings that rebut the guidelines shall state the amount of support that would have been required under the guidelines and include a justification of why the order varies from the guidelines.

The chart assumes that the custodian of dependent children is employed and is not a dependent. For the purposes of calculating temporary support, a dependent custodian should be counted as two dependents as a guide in determining support. For final hearings, the court should consider all relevant factors, including the chart, in determining the amount of any spousal support to be paid.

Relevant factors to be considered by the court in determining appropriate amounts of child support shall include:

1. Food;

2. Shelter and utilities;

3. Clothing;

4. Medical expenses;

5. Educational expenses;

6. Dental expenses;

7. Child care;

8. Accustomed standard of living;

9. Recreation;

10. Insurance;

11. Transportation expenses; and

12. Other income or assets available to support the child from whatever source.

Additional factors may warrant adjustments to the child support obligations and shall include:

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1. The procurement and/or maintenance of life insurance, health insurance, dental insurance for the children’s benefit;
2. The provision or payment of necessary medical, dental, optical, psychological or counseling expenses of the children (e.g. orthopedic shoes, glasses, braces, etc.);

3. The creation or maintenance of a trust fund for the children;

4. The provision or payment of special education needs or expenses of the child;

5. The provision or payment of day care for a child;

6. The extraordinary time spent with the non-custodial parent, or shared or joint custody arrangements; and
7. The support required and given by a payor for dependent children, even in the absence of a court order.

The child support chart assumes that the non-custodial parent will have visitation every other weekend and for several weeks during the summer. Excluding weekend visitation with the custodial parent, in those situations where a child spends in excess of 14 consecutive days with the non-custodial parent, the court should consider whether an adjustment in child support is appropriate, giving consideration to the fixed obligations of the custodial parent which are attributable to the child, to the increased costs of the non-custodial parent associated with the child’s visit, and to the relative incomes of both parents. Any partial abatement or reduction of child support should not exceed 50% of the child support obligation during the extended visitation period of more than 14 consecutive days.

In situations in which the non-custodial parent has been granted annual visitation in excess of 14 consecutive days, the court may prorate annually the reduction in order to maintain the same amount of monthly child support payments. However, if the non-custodial parent does not exercise said extended visitations during a particular year, the non-custodial parent shall be required to pay the abated amount of child support to the custodial parent.

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In addition to the award of child support, the court order shall provide for the child’s health care needs, which would normally include health insurance if available to either parent at a reasonable cost.

Allocation of dependents for tax purposes belongs to the custodial parent unless the parties otherwise agree. See Sec. 152(e) of the Internal Revenue Code.

All orders of child support should fix the dates on which payments should be made and the method of such payment, such as through the Clerk of the Court or by wage assignment. Times for payment should ordinarily coincide with the payor’s receipt of salary, wages, or other income.

For purposes of computing child support payments, a month consists of 4.334 weeks. Bi-weekly means a wage earner is paid once every two weeks or 26 times during a calendar year. Bi-monthly means a wage earner is paid twice a month or 24 times during a calendar year.

The Court hereby approves and adopts the attached revised Affidavit of Financial Means for use in all family support matters. The trial court shall require each party to complete and exchange the attached Affidavit of Financial Means prior to a hearing.

Inasmuch as this is a provisional order of the Court, the Court directs the Chief Justice and the Committee on Child Support to continue its charge to study, and revise where necessary, the guidelines for child support to ensure the proper enforcement of child support awards in this state.

The Court notes that the Committee has requested that it now be reconstituted, having served for four years, and that terms be established for its members. The Court thanks the Committee and its Chair, Hon. Ellen Brantley, for their tireless and dedicated service and will, in due time, reappoint a Committee with set terms to continue the work of reviewing and revising the guidelines.

NEWBERN, J. dissents; see In re: Guidelines for Child Support Enforcement, 301 Ark. 627, 784 S.W.2d 589 (1990) (Hickman, J., dissenting).

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WEEKLY FAMILY SUPPORT CHART

DEPENDENTS

WEEKLY TAKE HOME PAY ONE TWO THREE FOUR FIVE

$ 100.00 25.00 30.00 40.00 50.00 60.00 $ 110.00 27.50 33.00 44.00 55.00 66.00 $ 120.00 30.00 36.00 48.00 60.00 72.00 $ 130.00 32.50 39.00 52.00 65.00 78.00 $ 140.00 35.00 42.00 56.00 70.00 84.00 $ 150.00 37.50 45.00 60.00 75.00 90.00 $ 160.00 40.00 48.00 64.00 80.00 96.00 $ 170.00 42.50 51.00 68.00 85.00 102.00 $ 180.00 45.00 54.00 72.00 90.00 108.00 $ 190.00 47.50 57.00 76.00 95.00 114.00 $ 200.00 50.00 60.00 80.00 100.00 120.00 $ 210.00 51.00 62.00 83.00 104.00 125.00 $ 220.00 52.00 64.00 86.00 108.00 130.00 $ 230.00 53.00 66.00 89.00 112.00 135.00 $ 240.00 54.00 68.00 92.00 116.00 140.00 $ 250.00 55.00 70.00 95.00 120.00 145.00 $ 260.00 56.00 72.00 98.00 124.00 150.00 $ 270.00 57.00 74.00 101.00 128.00 155.00 $ 280.00 58.00 76.00 104.00 132.00 160.00 $ 290.00 59.00 78.00 107.00 136.00 165.00 $ 300.00 60.00 80.00 110.00 140.00 170.00 $ 310.00 61.00 82.00 113.00 144.00 175.00 $ 320.00 62.00 84.00 116.00 148.00 180.00 $ 330.00 63.00 86.00 119.00 152.00 185.00 $ 340.00 64.00 88.00 122.00 156.00 190.00 $ 350.00 65.00 90.00 125.00 160.00 195.00 $ 360.00 66.00 92.00 128.00 164.00 200.00 $ 370.00 67.00 94.00 131.00 168.00 205.00 $ 380.00 68.00 96.00 134.00 172.00 210.00 $ 390.00 69.00 98.00 137.00 176.00 215.00 $ 400.00 70.00 100.00 140.00 180.00 220.00 $ 410.00 71.00 102.00 143.00 184.00 225.00 $ 420.00 72.00 104.00 146.00 188.00 230.00 $ 430.00 73.00 106.00 149.00 192.00 235.00 $ 440.00 74.00 108.00 152.00 196.00 240.00 $ 450.00 75.00 110.00 155.00 200.00 245.00 $ 460.00 76.00 112.00 158.00 204.00 250.00 $ 470.00 77.00 114.00 161.00 208.00 255.00 $ 480.00 78.00 116.00 164.00 212.00 260.00 $ 490.00 79.00 118.00 167.00 216.00 265.00 $ 500.00 80.00 120.00 170.00 220.00 270.00 $ 510.00 81.00 122.00 173.00 224.00 275.00 $ 520.00 82.00 124.00 176.00 228.00 280.00 $ 530.00 83.00 126.00 179.00 232.00 285.00 $ 540.00 84.00 128.00 182.00 236.00 290.00 $ 550.00 85.00 130.00 185.00 240.00 295.00

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$ 560.00 86.00 132.00 188.00 244.00 300.00 $ 570.00 87.00 134.00 191.00 248.00 305.00 $ 580.00 88.00 136.00 194.00 252.00 310.00 $ 590.00 89.00 138.00 197.00 256.00 315.00 $ 600.00 90.00 140.00 200.00 260.00 320.00 $ 610.00 91.00 142.00 203.00 264.00 325.00 $ 620.00 92.00 144.00 206.00 268.00 330.00 $ 630.00 93.00 146.00 209.00 272.00 335.00 $ 640.00 94.00 148.00 212.00 276.00 340.00 $ 650.00 95.00 150.00 215.00 280.00 345.00 $ 660.00 96.00 152.00 218.00 284.00 350.00 $ 670.00 97.00 154.00 221.00 288.00 355.00 $ 680.00 98.00 156.00 224.00 292.00 360.00 $ 690.00 99.00 158.00 227.00 296.00 365.00 $ 700.00 100.00 160.00 230.00 300.00 370.00 $ 710.00 101.00 162.00 233.00 304.00 375.00 $ 720.00 102.00 164.00 236.00 308.00 380.00 $ 730.00 103.00 166.00 239.00 312.00 385.00 $ 740.00 104.00 168.00 242.00 316.00 390.00 $ 750.00 105.00 170.00 245.00 320.00 395.00 $ 760.00 106.00 172.00 248.00 324.00 400.00 $ 770.00 107.00 174.00 251.00 328.00 405.00 $ 780.00 108.00 176.00 254.00 332.00 410.00 $ 790.00 109.00 178.00 257.00 336.00 415.00 $ 800.00 110.00 180.00 260.00 340.00 420.00 $ 810.00 111.00 182.00 263.00 344.00 425.00 $ 820.00 112.00 184.00 266.00 348.00 430.00 $ 830.00 113.00 186.00 269.00 352.00 435.00 $ 840.00 114.00 188.00 272.00 356.00 440.00 $ 850.00 115.00 190.00 275.00 360.00 445.00 $ 860.00 116.00 192.00 278.00 364.00 450.00 $ 870.00 117.00 194.00 281.00 368.00 455.00 $ 880.00 118.00 196.00 284.00 372.00 460.00 $ 890.00 119.00 198.00 287.00 376.00 465.00 $ 900.00 120.00 200.00 300.00 380.00 470.00 $ 910.00 121.00 202.00 303.00 384.00 475.00 $ 920.00 122.00 204.00 306.00 388.00 480.00 $ 930.00 123.00 206.00 309.00 392.00 485.00 $ 940.00 124.00 208.00 312.00 396.00 490.00 $ 950.00 125.00 210.00 315.00 400.00 495.00 $ 960.00 126.00 212.00 318.00 404.00 500.00 $ 970.00 127.00 214.00 321.00 408.00 505.00 $ 980.00 128.00 216.00 324.00 412.00 510.00 $ 990.00 129.00 218.00 327.00 416.00 515.00 $1,000.00 130.00 220.00 330.00 420.00 520.00

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MONTHLY FAMILY SUPPORT CHART

DEPENDENTS

WEEKLY TAKE HOME PAY ONE TWO THREE FOUR FIVE

$ 500.00 125.00 150.00 200.00 250.00 300.00 $ 550.00 137.50 165.00 220.00 275.00 330.00 $ 600.00 150.00 180.00 240.00 300.00 360.00 $ 650.00 162.50 195.00 260.00 325.00 390.00 $ 700.00 175.00 210.00 280.00 350.00 420.00 $ 750.00 187.50 225.00 300.00 375.00 450.00 $ 800.00 200.00 240.00 320.00 400.00 480.00 $ 850.00 210.00 255.00 340.00 425.00 510.00 $ 900.00 220.00 265.00 355.00 445.00 535.00 $ 950.00 225.00 275.00 370.00 465.00 560.00 $1000.00 230.00 285.00 385.00 485.00 585.00 $1050.00 235.00 295.00 400.00 505.00 610.00 $1100.00 240.00 305.00 415.00 525.00 635.00 $1150.00 245.00 315.00 430.00 545.00 660.00 $1200.00 250.00 325.00 445.00 565.00 685.00 $1250.00 255.00 335.00 460.00 585.00 710.00 $1300.00 260.00 345.00 475.00 605.00 735.00 $1350.00 265.00 355.00 490.00 625.00 760.00 $1400.00 270.00 365.00 505.00 645.00 785.00 $1450.00 275.00 375.00 520.00 665.00 810.00 $1500.00 280.00 385.00 535.00 685.00 835.00 $1550.00 285.00 395.00 550.00 705.00 860.00 $1600.00 290.00 405.00 565.00 725.00 885.00 $1650.00 295.00 415.00 580.00 745.00 910.00 $1700.00 300.00 425.00 595.00 765.00 935.00 $1750.00 305.00 435.00 610.00 785.00 960.00 $1800.00 310.00 445.00 625.00 805.00 985.00 $1850.00 315.00 455.00 640.00 825.00 1010.00 $1900.00 320.00 465.00 655.00 845.00 1035.00 $1950.00 325.00 475.00 670.00 865.00 1060.00 $2000.00 330.00 485.00 685.00 885.00 1085.00 $2050.00 335.00 495.00 700.00 905.00 1110.00 $2100.00 340.00 505.00 715.00 925.00 1135.00 $2150.00 345.00 515.00 730.00 945.00 1160.00 $2200.00 350.00 525.00 745.00 965.00 1185.00 $2250.00 355.00 535.00 760.00 985.00 1210.00 $2300.00 360.00 545.00 775.00 1005.00 1235.00 $2350.00 365.00 555.00 790.00 1025.00 1260.00 $2400.00 370.00 565.00 805.00 1045.00 1285.00 $2450.00 375.00 575.00 820.00 1065.00 1310.00 $2500.00 380.00 585.00 835.00 1085.00 1335.00 $2550.00 385.00 595.00 850.00 1105.00 1360.00 $2600.00 390.00 605.00 865.00 1125.00 1385.00 $2650.00 395.00 615.00 880.00 1145.00 1410.00 $2700.00 400.00 625.00 895.00 1165.00 1435.00 $2750.00 405.00 635.00 910.00 1185.00 1460.00

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$2800.00 410.00 645.00 925.00 1205.00 1485.00 $2850.00 415.00 655.00 940.00 1225.00 1510.00 $2900.00 420.00 665.00 955.00 1245.00 1535.00 $2950.00 425.00 675.00 970.00 1265.00 1560.00 $3000.00 430.00 685.00 985.00 1285.00 1585.00 $3,050.00 435.00 695.00 1,000.00 1,305.00 1,610.00 $3,100.00 440.00 705.00 1,015.00 1,325.00 1,635.00 $3,150.00 445.00 715.00 1,030.00 1,345.00 1,660.00 $3,200.00 450.00 725.00 1,045.00 1,365.00 1,685.00 $3,250.00 455.00 735.00 1,060.00 1,385.00 1,710.00 $3,300.00 460.00 745.00 1,075.00 1,405.00 1,735.00 $3,350.00 465.00 755.00 1,090.00 1,425.00 1,760.00 $3,400.00 470.00 765.00 1,105.00 1,445.00 1,785.00 $3,450.00 475.00 775.00 1,120.00 1,465.00 1,810.00 $3,500.00 480.00 785.00 1,135.00 1,485.00 1,835.00 $3,550.00 485.00 795.00 1,150.00 1,505.00 1,860.00 $3,600.00 490.00 805.00 1,165.00 1,525.00 1,885.00 $3,650.00 495.00 815.00 1,180.00 1,545.00 1,910.00 $3,700.00 500.00 825.00 1,195.00 1,565.00 1,935.00 $3,750.00 505.00 835.00 1,210.00 1,585.00 1,960.00 $3,800.00 510.00 845.00 1,225.00 1,605.00 1,985.00 $3,850.00 515.00 855.00 1,240.00 1,625.00 2,010.00 $3,900.00 520.00 865.00 1,255.00 1,645.00 2,035.00 $3,950.00 525.00 875.00 1,270.00 1,665.00 2,060.00 $4,000.00 530.00 885.00 1,285.00 1,685.00 2,085.00 $4,050.00 535.00 895.00 1,300.00 1,705.00 2,110.00 $4,100.00 540.00 905.00 1,315.00 1,725.00 2,135.00 $4,150.00 545.00 915.00 1,330.00 1,745.00 2,160.00 $4,200.00 550.00 925.00 1,345.00 1,765.00 2,185.00 $4,250.00 555.00 935.00 1,360.00 1,785.00 2,210.00 $4,300.00 560.00 945.00 1,375.00 1,805.00 2,235.00 $4,350.00 565.00 955.00 1,390.00 1,825.00 2,260.00 $4,400.00 570.00 965.00 1,405.00 1,845.00 2,285.00 $4,450.00 575.00 975.00 1,420.00 1,865.00 2,310.00 $4,500.00 580.00 985.00 1,435.00 1,885.00 2,335.00 $4,550.00 585.00 995.00 1,450.00 1,905.00 2,360.00 $4,600.00 590.00 1,005.00 1,465.00 1,925.00 2,385.00 $4,650.00 595.00 1,015.00 1,480.00 1,945.00 2,410.00 $4,700.00 600.00 1,025.00 1,495.00 1,965.00 2,435.00 $4,750.00 605.00 1,035.00 1,510.00 1,985.00 2,460.00 $4,800.00 610.00 1,045.00 1,525.00 2,005.00 2,485.00 $4,850.00 615.00 1,055.00 1,540.00 2,025.00 2,510.00 $4,900.00 620.00 1,065.00 1,555.00 2,045.00 2,535.00 $4,950.00 625.00 1,075.00 1,570.00 2,065.00 2,560.00 $5,000.00 630.00 1,085.00 1,585.00 2,085.00 2,585.00

Page 655

IN THE CHANCERY COURT OF _______________ COUNTY, ARKANSAS ________________ DIVISION
STATE OF ARKANSAS ) ) ss AFFIDAVIT OF FINANCIAL MEANS COUNTY OF ) REVISED 10-93
_________________________________ Plaintiff vs. _________________________________ Case No. ___________ Defendant
The affiant, being duly sworn, says under penalty of perjury that affiant is the plaintiff() defendant() (check one) herein, has prepared this financial statement, knows the contents thereof, and that it is true and correct.
INCOME Complete item 29 on the page 3
1. My Weekly take-home pay (from line 29 (1) on page 3) _________|__. 2. I claim ___ dependents for the purpose of determining my State of Arkansas withholding. I claim ___ dependents for the purpose of determining my federal withholding. I did() or did not() (check one) claim myself as dependent. I do() or do not() (check one) have additional amount withheld from my payroll checks for tax purposes and, if so, that amount is ________|__ per week of _________|__ per pay period and itemized on reverse side. All other deductions taken from my payroll check before I receive it total: ________|__ (from line k8 on page 3.) 3. I have income from the following other sources: ____________________ 4. I have cash on hand in the amount of ________|__ from the following sources(s): ____________ 5. I have on deposit in banks and savings institutions _______|__ and its source was ____________________________________________________ 6. I have stocks and bonds in the amount of _______|__ and their source was ________________________________________________________________ (Attach additional schedules as needed)
CREDITORS Complete items 30, 31 and 32 on page 4 7. Debts in the name of plaintiff only: ALL CREDITORS LISTED ON PAGE 4 TOTAL UNPAID BALANCES $(a)_____|__ TOTAL MONTHLY PAYMENTS $(b)_____|__ 8. Debts in the name of defendant only: ALL CREDITORS LISTED ON PAGE 4 TOTAL UNPAID BALANCES $(a)_____|__ TOTAL MONTHLY PAYMENTS $(b)_____|__ 9. Debts in our JOINT NAMES are: ALL CREDITORS LISTED ON PAGE 4 TOTAL UNPAID BALANCES $(a)_____|__ TOTAL MONTHLY PAYMENTS $(b)_____|__
MONTHLY EXPENSES 10. My present necessary monthly expenses to support myself and ____ child ____ are: (a) Rent or housepayment $ ____|__ (b) Gas and electricity $ ____|__ (c) Water $ ____|__ (d) Telephone $ ____|__ (e) Food $ ____|__ (f) Clothing $ ____|__ (g) Laundry $ ____|__ (h) Child care $ ____|__ (i) Medical $ ____|__ (j) Drugs $ ____|__ (k) Life Insurance $ ____|__ (l) Auto Insurance $ ____|__ (m) Fire insurance $ ____|__ (n) Transportation $ ____|__ (o) Other Expenses $ ____|__ (Attach schedules if needed) TOTAL ……….. $ ____|__
A check mark has been placed by all expenses which are being paid currently.

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GENERAL INFORMATION

11. My full name is ___________________________________________________ 12. My social security number is _______________ Military I.D. No. (if applicable) _____________ 13. My Arkansas Driver’s License Number is ____________________________ 14. My date of birth is ________________ My place of birth is _________ 15. My father’s full name is __________________________________________ My mother’s full name is __________________________________________ (They)(He)(She) ___________________________________________________ Zip Code 16. My present resident address is ____________________________________ Zip Code 17. The full name of children born (or legally adopted) of this marriage are:
(1) ____________________ Date of Birth: _______ S.S. No. ___________ (2) ____________________ Date of Birth: _______ S.S. No. ___________ (3) ____________________ Date of Birth: _______ S.S. No. ___________ (4) ____________________ Date of Birth: _______ S.S. No. ___________ (5) ____________________ Date of Birth: _______ S.S. No. ___________ (6) ____________________ Date of Birth: _______ S.S. No. ___________ (Attach additional schedule for additional children)
18. My employer is _____________________________________________________ 19. My employer’s full address is ______________________________________ Zip Code 20. My home telephone number is _____________ My work telephone number is __________
INFORMATION ABOUT OPPOSING PARTY IN THIS CASE, IF KNOWN (DO NOT GUESS) 21. The opposing party’s full name is __________________________________ 22. The opposing party’s social security number is _____________________ Military I.D. No. (if applicable) ___________ 23. The opposing party’s Arkansas Driver’s License Number is ___________ 24 (a) The opposing party’s father’s full name is _____________________ (b) The opposing party’s mother’s full name is _____________________ (c) (They)(He)(She) reside at ______________________________________ (F) (M) deceased (check if applicable) Zip Code 25. The opposing party’s present resident address is ___________________ Zip Code 26. The opposing party’s employer is ___________________________________ 27. The opposing party’s employer’s address ____________________________ Zip Code 28. The opposing party’s home telephone number _________ work telephone ____________
-2-

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INCOME 29. How often are you paid, and what are your gross wages, salary or commissions due each time? WEEKLY BIWEEKLY SEMI-MONTHLY 52 times a year 26 times a year 24 times a year
MONTHLY OTHER 12 times a year explain

PAYROLL DEDUCTIONS

(a) GROSS WAGES ………………………………… (a) $ _______|__ (b) Federal Income Tax Withheld ……….. (b) $ _______|__ (c) Arkansas Income Tax Withheld ………. (c) $ _______|__ (d) F.I.C.A. (Soc. Sec.) or railroad retirement equivalent ………………… (d) $ _______|__ (e) Health Insurance (children only) …… (e) $ _______|__ (f) court ordered child support for dependents of previous marriage or previously legally determined adopted or illegitimate children …… (f) $ _______|__ (g) TOTAL WITHHELD (b) thru (f) above …………….. (g) $ _______|__ (h) NET TAKE HOME PAY PER PAY PERIOD (Subtract (g) from (a) above) ………………… (h) $ _______|__ (i) CONVERT TO WEEKLY TAKE HOME PAY
CARRY TO LINE 1 on front …………………… 29(i) $ _______|__ Example (h) above $300 is received bi-weekly: 26 x 4300 = $7,800 divided by 52 = $150 per week Carry $150 on line 1 on front (j) OTHER ITEMS WITHHELD FROM MY CHECK ARE:
(1) Union Dues …………………………… (1) __________|__ (2) Credit Union thrift plans ……………… (2) __________|__ (3) Pension Benefits, stock purchase plans ….. (3) __________|__ (4) Charitable contributions ………………. (4) __________|__ (5) Debt Payments, garnishments ……………. (5) __________|__ (6) Life Insurance payments ……………….. (6) __________|__ (7) Other (identify ____________________________ (7) __________|__ Items (1) thru (7) above are not allowed in computing take home pay. (8) TOTAL WITHHELD (total (1) through (7) above)(k8) __________|__
-3-

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CREDITORS DEBTS

30. Creditors 1. _______________________________________________ 2. _______________________________________________ 3. _______________________________________________ 4. _______________________________________________ 5. _______________________________________________ Attach additional schedules as need, then TOTAL:
(Total Unpaid Balance) 1. $ __________________|__ 2. $ __________________|__ 3. $ __________________|__ 4. $ __________________|__ 5. $ __________________|__ 6. $ __________________|__ Carry to line 7a on page 1
(Monthly Payments) 1. $ __________________|__ 2. $ __________________|__ 3. $ __________________|__ 4. $ __________________|__ 5. $ __________________|__ 6. $ __________________|__ Carry to line 7b on page 1
31. Debts in the name of DEFENDANT only are: 1. _______________________________________________ 2. _______________________________________________ 3. _______________________________________________ 4. _______________________________________________ 5. _______________________________________________ Attach additional schedules as need, then TOTAL:
(Total Unpaid Balance) 1. $ __________________|__ 2. $ __________________|__ 3. $ __________________|__ 4. $ __________________|__ 5. $ __________________|__ 6. $ __________________|__ Carry to line 8a on page 1
(Monthly Payments) 1. $ __________________|__ 2. $ __________________|__ 3. $ __________________|__ 4. $ __________________|__ 5. $ __________________|__ 6. $ __________________|__ Carry to line 8b on page 1
32. Debts in our JOINT NAMES are: 1. _______________________________________________ 2. _______________________________________________ 3. _______________________________________________ 4. _______________________________________________ 5. _______________________________________________ Attach additional schedules as need, then TOTAL:
(Total Unpaid Balance) 1. $ __________________|__ 2. $ __________________|__ 3. $ __________________|__ 4. $ __________________|__ 5. $ __________________|__ 6. $ __________________|__ Carry to line 9a on page 1
(Monthly Payments) 1. $ __________________|__ 2. $ __________________|__ 3. $ __________________|__ 4. $ __________________|__ 5. $ __________________|__ 6. $ __________________|__ Carry to line 9b on page 1
33. The weekly take-home page of the opposing party is …. $ ____|__ 34 All other income of the opposing party is ………….. $ ____|__
_________________________ Signature of Affiant

Subscribed and sworn to before me on this _____ day of _________. 199_

My commission expires: __________________________ ______________________________ NOTARY PUBLIC

NOTICE

BOTH PARTIES MUST COMPLETE AND EXCHANGE THIS FOUR PAGE AFFIDAVIT PRIOR TO THE TEMPORARY HEARING. BOTH PARTIES MUST SUPPLY THE ORIGINAL NOTARIZED AFFIDAVIT TO THE COURT. THE COURT WILL PUNISH PERJURY BY APPROPRIATE ACTION.

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