Child-Support-Obligation Income Statement and Affidavit

In this form, divorcing spouses are requested to disclose their respective annual income and yearly expenses. Through the information gleaned from this form, the Court will be able to determine the appropriate amount of child support to be requested from each spouse. Download

Extracted Text for Proper Search

State of Alabama  
Unified Judicial System   
Form CS-41             Rev. 1/09  	
CHILD-SUPPORT-OBLIGATION	 	
INCOME STATEMENT/AFFIDAVIT	 	
Case Number	 	
 
IN THE ____________________________  COURT OF __________________COUNTY, ALABAMA                              	 (Circuit or District)                                                               (Name of County) 	 
Plaintiff _____________________________  v.    Defendant _________________________________	 	 	
 	AFFIDAVIT 	 I, ____________________________________________,  b eing duly sworn upon my oath, state as follows : 
                  	(Name of Affiant) 	 
1.  I am the       	 Plaintiff     	Defendant     	Other (please specify):_________________ in the abo ve matter. 	   My Social Security number is:_____________________ ________________  2.  I am    	 currently employed.  My employer’s name and address are: 
    ________________________________________________ _____________________ 
                   ________________________________ _____________________________________ 
  
                
 not currently employed. 
            My last employer’s name and address are : _______________________________________ 
  
     ________________________________________________ _________________________ 
              Last position title: _____________________________ _____________________________ 
            
   Average monthly salary in the last year of employ ment: $ ___________________________ 
  
3.  My monthly gross income includes: 	
( For example of income that must be included, see bac k of this form. If income varies by month, enter the es timated average monthly gross income.) 
   
Employment income        $_____________________________ _ 
 	
 	      Self-employment income      $______________________ ________        Other employment-related income    $______________________________        Other non-employment-related income   $______________________________        Total            $_______________________________    
                      
 4.  I incur the following amount monthly for work-related 
     child-care:                                                                        $_______________ _______________ 
                                                                                               (if none, write “None”) 
5.  The child(ren) of the parties is/are   
       
        	
 not covered by health insurance from me 
       and/or my employer. 	
      	 covered by health insurance, and I pay the  
       following amount monthly for the insurance                 $______________________________ 
       coverage.                                                                     (if none, write “None”) 
  
6.   I pay the following total	
 amount for 	child support 	alimony in (a) prior  
      case(s) as follows:  
  (List case number(s) and county(ies) and state(s)  here): 
      __________________________________________         $______________________________ 
                                                                                                   (if none, write “None”) 
      __________________________________________  	
 I understand that I will be required to maintain a ll income documentation used in preparing this Inco me Statement/Affidavit (including 
my  most  recent  income-tax  return)   and  that  such  documentation  shall  be  made  availabl e  as  directed  by  the  court.  I  also  understand 
that  any  intentional  falsification  of  the  informati on  presented  in  this  Income  Statement/Affidavit  may   subject  me  to  the  penalties  of 
perjury.	
                             
                            ____________________________ __________________ 
                     Affiant 
Sworn to and subscribed before me this ______ 	
 day of _______________________, ________  ______________________________________ Notary/Clerk

Form CS-41 (Back)	 	
 
EXAMPLES OF INCOME THAT MUST BE INCLUDED IN YOUR GR OSS MONTHLY INCOME 
 
1.	
 Employment  Income  –  shall  include,  but  not  be  limit ed  to,  salary,  wages,  bonuses,  commissions,  severan ce 
pay,  worker’s  compensation,  pension  income,  unemplo yment  insurance,  disability  insurance,  and  Social 
Security benefits. 
  
2.
 Self–Employment Income – shall include, but not be  limited to, income from self-employment, rent, royalties, 
proprietorship  of  a  business,  or  joint  ownership  of   a  partnership  or  closely  held  corporation.  “Gross  income” 
means gross receipts minus ordinary and necessary e xpenses required to produce this income. 
   
3.
 Other  Employment–Related  Income  –  shall  include,  bu t  not  be  limited  to,  the  average  monthly  value  of  any 
expense  reimbursements  or  in-kind  payments  received   in  the  course  of  employment  that  are  significant  and 
reduce  personal  living  expenses,  such  as  a  furnishe d  automobile,  a  clothing  allowance,  and  a  housing 
allowance. 
  
4.
 Other  Non-Employment-Related  Income  –  shall  include ,  but  not  be  limited  to,  dividends,  interest,  annuities, 
capital gains, gifts, prizes, and pre-existing peri odic alimony. 
    	
 
 	
RULE 32, ALABAMA RULES OF JUDICIAL ADMINISTRATION,  PROVIDES THE FOLLOWING DEFINITIONS: 
  
Income.  For  purposes  of  the  guidelines  specified  in  this  rule,  “income”  means  the  actual  gross  income  of  a 
parent,  if  the  parent  is  employed  to  full  capacity,   or  if  the  parent  is  unemployed  or  underemployed,  t hen  it 
means the actual gross income the parent has the ab ility to earn. 
  
Gross Income.    
  “ Gross  income”  includes  income  from  any  source,  and  includes,  but  is  not  limited  to,  income  from  salaries, 
wages,  commissions,  bonuses,  dividends,  severance  p ay,  pensions,  interest,  trust  income,  annuities,  capital 
gains,  Social  Security  benefits,  workers’  compensat ion  benefits,  unemployment-insurance  benefits,  disa bility-
insurance benefits, gifts, prizes, and preexisting  periodic alimony. 
 
  “Gross  income”  does  not  include  child  support  rece ived  for  other  children  or  benefits  received  from  means-
tested  public-assistance  programs,  including,  but  n ot  limited  to,  Temporary  Assistance  for  Needy  Famil ies, 
Supplemental Security Income, food stamps, and gene ral assistance. 
  
Self–employment Income.    
  For  income  from  self-employment,  rent,  royalties,  proprietorship  of  business,  or  joint  ownership  of  a 
partnership  or  closely  held  corporation,  “gross  inc ome”  means  gross  receipts  minus  ordinary  and  necess ary 
expenses  required  to  produce  such  income,  as  allowe d  by  the  Internal  Revenue  Service,  with  the  exceptions 
noted in Rule 32(B)(3)(b).    
  Under  those  exceptions,  “ordinary  and  necessary  ex penses”  does  not  include  amounts  allowable  by  the 
Internal  Revenue  Service  for  the  accelerated  compon ent  of  depreciation  expenses,  investment  tax  credits,  or 
any  other  business  expenses  determined  by  the  court   to  be  inappropriate  for  determining  gross  income  for 
purposes of calculating child support.    
    Other  Income.  Expense  reimbursements  or  in-kind  payments  received   by  a  parent  in  the  course  of 
employment of self-employment or operation of a bus iness shall be counted as income if they are significant and 
reduce personal living expenses.