SDSC FLF-014 (New 2/11) DECLARATION REGARDING CHILD SUPPORT FACTORS

Cal. Form FLF-014

California Superior Local Rules

SHORT TITLE CASE NUMBER DECLARATION REGARDING CHILD SUPPORT FACTORS I, , declare under penalty of perjury under the laws of the State of California as follows: 1. Party Information: I am the custodial non-custodial parent in this case. 2. Number of Children: I have minor child(ren) with the other party. 3. Timeshare: My timeshare with my child(ren) is %. The other parent's timeshare is %. 4. Filing Status: My tax filing status is: S- HH- MFJ- MFS- 5. Wages and Salary: My average gross monthly income is $ . I earn $ per hour and I work an average of hours per week. 6.

Self-Employment Income: I am self-employed and I earn an average of $ adjusted gross per month. 7. Other Taxable Income: Disability - $ per month. Unemployment - $ per month. Other (specify) - $ per month. 8. New Spouse Income: $ gross per month. Not applicable. 9. Health Insurance: $ per month. Union Dues: $ per month. 10. Other Child Support Paid: I pay $ per month child support for children of another relationship that do not live with me. (Supporting evidence attached.) 11. Hardship Deduction(

s) Requested: I request a hardship deduction for minor children not of this relationship that live with me and whom I support. (Supporting evidence attached.) 12. Other Parent's Income: The other parent works and based upon information and belief earns $ gross per month. His/her tax filing status is . OR The other parent does not work but has the ability to work and earn $ gross per month. I request that the court impute income to him/her. 13. Other Parent's New Spouse's Income: $ gross per month. Not applicable. 14.

Child Support Add-Ons: Child Care - I request 50% of the total monthly child care expenses be paid by the other party. I request $ per month child care expenses be paid by the other party. Unreimbursed Health Care Expenses - I request 50% of the total expenses be paid by the other party. 15. Other Facts: Date: Signature

Document details

Collection	California Superior Local Rules
Citation	Cal. Form FLF-014
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	1d8d1e9165c670f25a93e849dfadd79baeef49e9

Source file is stored in the law ingest library (pdf).