Legal Child Support Declaration

LEGAL CHILD SUPPORT DECLARATION

Court Name:    County:    Case No.:

Declarant Name:    Declarant Address:

Other Party Name:    Other Party Address:

RECITALS

WHEREAS, Declarant and Other Party are the biological or legal parents of the minor child(ren) listed below and dispute or seek determination of child support obligations under the laws of this jurisdiction; and

WHEREAS, there is pending before this Court the action identified above in which child support, custody, and related relief may be determined; and

WHEREAS, Declarant submits this Declaration under penalty of perjury to set forth complete and accurate information regarding income, expenses, health insurance, extraordinary costs, and proposed support to assist the Court in calculating or modifying child support.

NOW THEREFORE, Declarant declares as follows:

1. PARTIES AND JURISDICTION

1.1 Declarant is an adult resident of: . Other Party is an adult resident of: .

1.2 Declarant represents that this Court has jurisdiction to make child support orders in this matter and that the information provided herein is true and complete to the best of Declarant's knowledge.

2. CHILD(REN)

List each child for whom support is being requested or reported:

3. INCOME AND FINANCIAL INFORMATION

3.1 Declarant's Employment: Employer: Position: Length of employment:

3.2 Declarant's Gross Monthly Income: Net Monthly Income (after taxes):

3.3 Other Party's Gross Monthly Income (to the best of Declarant's knowledge): Net Monthly Income:

Pay stubs (most recent 3 months)   Tax returns (most recent year)   Employer wage statement   Bank statements  

4. CHILD-RELATED EXPENSES

4.1 Current monthly child care expenses paid by Declarant: Provider name:

4.2 Health insurance for child(ren) provided by Declarant: Insurer: Monthly premium paid by Declarant:

5. PROPOSED SUPPORT CALCULATION

5.1 Declarant's proposed base child support amount per month: Number of children covered by this amount:

5.2 Proposed allocation of additional expenses (list type and proposed monthly contribution):

6. PAYMENT, ARREARAGES, AND ENFORCEMENT

6.1 Proposed method of payment: Frequency:

6.2 Declarant states the current known arrearage amount: (if none, enter 0.00)

7. NOTICES

7.1 Any notice required under this Declaration shall be in writing and delivered to the addresses listed above or to such other address as a party may designate in writing to the other party. Notice is effective upon personal delivery or three (3) business days after deposit in the United States mail, postage prepaid.

8. AMENDMENTS, WAIVER, GOVERNING LAW

8.1 This Declaration may be amended only by a written instrument signed by both parties or by order of the Court. No waiver of any provision shall be effective unless in writing and signed by the waiving party.

8.2 Governing Law: The laws of the state or jurisdiction of the Court named above govern the interpretation and enforcement of this Declaration.

9. ENTIRE AGREEMENT; SEVERABILITY

9.1 Entire Agreement: This Declaration, together with any exhibits or attachments, constitutes the entire written statement of Declarant regarding the matters addressed herein. Any prior oral or written statements are superseded.

9.2 Severability: If any provision of this Declaration is determined by a court of competent jurisdiction to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

10. DECLARATION AND CERTIFICATION

10.1 I, the undersigned Declarant, declare under penalty of perjury under the laws of this jurisdiction that the foregoing statements and any attached documents are true and correct to the best of my knowledge, information, and belief. I understand that knowingly making a false declaration may subject me to sanctions, including contempt of court or other penalties.

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