Judgment And Decree For Marriage Dissolution With Children Page 13
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43Pension or Disability from work or military
$______________ per month
Worker's Compensation
$______________ per month
Court-ordered spousal maintenance received
$______________ per month
Other income____________________________
$______________ per month
List Source
Add all of the above. Total monthly income
$ ______________per month
Enter the amount of child support Petitioner A is court-ordered
to pay for any nonjoint child(ren)
$______________ per month
Enter the amount of spousal maintenance Petitioner A is court-ordered
to pay to a current or former spouse
$______________ per month
Enter the amount of Social Security or Veteran's Benefits received by a joint child
because of Petitioner A's retirement, disability, or other eligibility
$______________ per month
Which parent receives the payment for the child?
Petitioner A
Petitioner B
22.
Living Expenses for the Family
a. Petitioner A and Petitioner B and their child(ren) are still living together. Current
monthly living expenses for the family total $
.
OR
b. Petitioner A and Petitioner B are living separately. The monthly family living
expenses before separation totaled $
. At this time, Petitioner A's separate
monthly living expenses total $____________, and Petitioner B's monthly living
expenses total $______________.
Of the total current monthly living expenses for
Petitioner A, $_______________ amount is for expenses just for the child(ren) that
live(s) with Petitioner A. Of the total current monthly living expenses for Petitioner B,
$___________is for expenses just for the child(ren) that live(s) with Petitioner B.
23.
Expenses for Special Needs for the Children
a. Is there a joint child of the parties who has special needs and extraordinary medical
expenses?
YES
NO If Yes,
Name of child with special needs:
DIV1702
State
ENG
Rev 09/13
Page 13 of 43
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