Exceptional Circumstance Form For Child Support Guidelines
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1CASE NUMBER
STATE OF HAWAI‘I
EXCEPTIONAL CIRCUMSTANCE FORM
FAMILY COURT OF THE
for
FC-
NO.
CHILD SUPPORT GUIDELINES
____________ CIRCUIT
The Court should deviate from the Total Monthly Child Support Obligation as calculated because of the
following exceptional circumstance(s):
I hereby declare, under penalty of perjury, that I have examined the statement regarding exceptional
circumstances and to the best of my knowledge and belief it is true, correct and complete.
Dated: _______________, Hawai‘i, _______________________________.
_____________________________________
(Signature)
ATTACHMENT C
CLEAR
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