Financial Affidavit For Child Support Page 2

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Choose one:
[ ] There is no existing order for support for the minor childr(en) born to
me and my spouse.
OR
[ ] There is currently an order for the support of the minor child(ren) of
me and my spouse through:
_____________________________________________
(name of court)
_____________________________________________
(case number)
_____________________________________________
(amount of support)
_____________________________________________
(number of children)
2. I am employed at _____________________________________________.
(name of employer)
My current gross monthly income is $_____________________. My income
(amount of income from all sources)
is based on (choose one):
[ ] $ _________ per hour for ___________ hours per week.
(amount per hour)
(number of hours)
OR
[ ] $___________salary per month plus monthly bonuses of
(amount per month)
$_____________.
(average amount per month)
3. My spouse is employed at _______________________________________.
(name of employer)
Continued on next page …
Financial Affidavit for Child Support, DC 6:5(2), PSC Nebraska.
2

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