az divorce document services - tucson's worry free divorce specialists - karen kosies - 520-750-0003

HOME | INFORMATION CENTER | SERVICES & FEES | CHILD SUPPORT CALCULATOR | PIMA CO. RECORDS | CONTACT

 

PIMA COUNTY CHILD SUPPORT MODIFICATION INFORMATION INTAKE FORM

CLIENT INFORMATION

Client Name on Pleadings

Current Client Name
(if different)

Phone NumbersBest          (XXX) XXX-XXXX
Other         
(XXX) XXX-XXXX

Client Email

Address
City, State, Zip

Client isPetitioner or  Respondent (on original orders)
Petitioner isFather  or  Mother
Paying Parent isFather  or  Mother

NON-CLIENT (OTHER PARENT)  INFORMATION

Non-Client Name on Pleadings

Current Client Name
(if different)

Address
City, State, Zip

CASE  INFORMATION

Pima Co. Case No.
Atlas No.   If unknown, call court at 520-762-4250
Current Child Support$   Date of Order (MM/DD/YYYY)
Judge/Commissioner

PAYING PARENT  INFORMATION

Date of Birth

(MM/DD/YYYY)

Social Security No.

(XXX-XX-XXXX)
Employer Name
Payroll Address
City, State, Zip

CHILDREN INFORMATION

Child 1 Name    DOB MM/DD/YYYY
Child 2 Name    DOB MM/DD/YYYY
Child 3 Name    DOB MM/DD/YYYY
Child 4 Name    DOB MM/DD/YYYY
Child 5 Name    DOB MM/DD/YYYY
Child 6 Name    DOB MM/DD/YYYY

CHILD SUPPORT CALCULATION INFORMATION

Gross Income Use Either: 1) Yearly Salary 12; or
2) Hourly Wage x 40 Hours per Week x 4.33 weeks per month or
3) Hourly Wage x 40 Hours per Week x 52 Weeks per year 12 months per year.

FATHER

 

MOTHER

 

Father's Calculation:$ 
Mother's Calculation: 

$

Spousal Maintenance ~ indicate if paid (-) or received (+)$$
Other Court Ordered Child Support paid for other children$$
No. of Other Children with another relationship
Details:
No. of Children in this matter
No. of Children who are 12 or older

Medical/Dental/Vision Premiums for the children's portion only. The difference between what Employee would pay out of pocket for Employee ONLY and what Employee pays out of pocket for Employee plus children divided by members covered times number of minor children.

TOTAL OF ALL
$
TOTAL OF ALL
$

Monthly Child Care Amount (Sometimes different in summer. 36 school weeks ~ 13 summer weeks ~ 3 other weeks)
YEARLY AMOUNT 12 for MONTHLY AMOUNT.

$$
Monthly Extra Education Costs for tutoring or private school upon agreement of parents.$$

Monthly Extraordinary/Special Needs Expenses for ongoing fixed medical treatment,medicines, or special needs situations.

$$

Parenting Time Days ~ "One day" means more than 12 continuous and consecutive hours or an overnight. "One-half day" means greater than 4 and up to and including 12 continuous and consecutive hours. "One-quarter day" means up to and including 4 continuous and consecutive hours. Actual time is calculated taking into consideration either the current court order, historical practice, or unreasonable restrictions placed on parenting time by the primary custodial parent.

Count the Normal Weeks - Weeks per year = 52, Subtract Summer weeks usually 13 weeks (-), Subtract Holiday weeks (Christmas/Winter Break, Easter/Spring Break) usually 3 weeks (-), TOTAL 'Normal' weeks per year (=)

Calculate the Days Per Year 
Add every other weekend days (normal weeks divided by 2 (every other) x 2 overnights)+
Add normal weekday days (see above times normal weeks(+
Add summer days (days out of 13 week average)+
Add holiday days (days out of 3 week average)+
TOTAL days per year (=)=

Other Responsibilities & Benefits

FATHERMOTHER

Uninsured Medical/Dental/Vision Expenses (Co-pays, Deductibles, Braces or any other expenses not covered by insurance)

%%

Parenting Time Related Travel Expenses (applicable when the parents live more than 100 miles from each other)

%%

Dependent Tax Exemptions Allocation of the federal tax exemptions applicable to the minor child(ren) which as closely as possible approximates the percentages of child support being provided by each of the parents) FIVE (5) choices, CHOOSE ONLY ONE.
1) FATHER claims all every year;
2)
MOTHER claims all every year;
3)
FATHER claims all every even year AND MOTHER claims all every odd year.
4)
MOTHER claims all every even year AND FATHER claims all every odd year.
5)
FATHER claims child(ren) every year AND MOTHER claims child(ren) every year.