Proposed Paternity Resolution Page 2
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3Case No._____________________________
3.
Child Support: The financial factors necessary to calculate child support under the Arizona Child
Support Guidelines are as follows (complete in full):
Father’s gross monthly income:
$________________
Mother’s gross monthly income:
$________________
Father has ________ other child(ren) not listed above who live(s) in his household.
Father has ________ other child(ren) not listed above for whom he pays court-ordered child support
in the amount of $________________ per month.
Mother has _______ other child(ren) not listed above who live(s) in her household.
Mother has _______ other child(ren) not listed above for whom she pays court-ordered child
support in the amount of $ ________________ per month.
Medical Insurance should be paid by:
Mother
Father. Monthly cost for the child(ren) is
$ ________________.
Dental insurance should be paid by:
Mother
Father. Monthly cost for the child(ren) is
$ ________________.
Vision insurance should be paid by:
Mother
Father. Monthly cost for the child(ren) is
$ ________________.
Monthly child care costs for _______ child[ren] is $ ________________.
Extra education expenses or extraordinary child adjustments: I believe the court should add the
following to the child support calculation (leave blank if none claimed):
Description of expense
Monthly Amount
_____________________________________________________________
$________________
_____________________________________________________________
$________________
_____________________________________________________________
$________________
Uninsured medical/dental/vision expenses should be paid:
Pro rata based upon each party’s income as provided in the guidelines; or
Other: _______% paid by Father and _______% paid by Mother.
Tax Exemptions for the child(ren) should be divided (check one):
Pro rata based upon each party’s income as provided in the guidelines; or
Other: ___________________________________________________________________
Past support should be paid by
Mother
Father for the period of _______________ through
_______________ in the amount of $ ________________.
Direct payments for support have been
received by me
paid by me for the period of
_______________ through _______________ in the amount of $ ________________.
Past medical expenses have been incurred by me (and not reimbursed by insurance) for the period
of ___________________ through ___________________ in the amount of $ ________________
and the other parent should be ordered to reimburse me for _________% of those expenses.
Expenses for pregnancy, childbirth, and genetic testing have been incurred by me (and not reim-
bursed by insurance) in the amount of $________________ and the other parent should be ordered
to reimburse me for _________% of those expenses.
4.
Attorneys’ Fees: If the case is settled today, I want the Court to order (choose one):
Each party to pay his or her own attorneys’ fees and costs.
Mother to pay $________________ of my attorneys’ fees and costs within _________ days.
Father to pay $________________ to other party for attorneys’ fees and costs within _________
days.
Page 2 of 3
3/29/10
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