Cite as 2016 Ark. 315
SUPREME COURT OF ARKANSAS
Opinion Delivered September 15, 2016
IN RE SUPREME COURT
COMMITTEE ON CHILD
SUPPORT—AFFIDAVIT OF
FINANCIAL MEANS
PER CURIAM
The Supreme Court Committee on Child Support proposed a new Affidavit of
Financial Means to the court, revised and updated to provide more pertinent information
to the parties and the courts in matters involving family support than the current affidavit
provides. By per curiam dated April 14, 2016, the court published the proposed affidavit
for written comments due to the court by May 20, 2016.
The court requested that the committee review the comments submitted and, taking
those into consideration, to make a final recommendation to the court. The committee’s
final recommendation is to adopt the proposed affidavit with one change suggested in the
comments, to add lines at the bottom of each page for the litigants and, if represented, their
attorneys, to initial.
The court accepts the committee’s recommendation and adopts the new affidavit,
with that one change, effective October 10, 2016. The new Affidavit is attached.
RECOMMENDATION TO THE SUPREME COURT OF ARKANSAS
FROM THE SUPRE,ME COURT COMMITTEE ON CHILD SUPPORT
IN RE: ADMINISTRATIVE ORDER NO. IO--AFFIDAVIT OF FINANCIAL MEANS
TNTRODUCTION
The Supreme Court Committee on Child Support proposed a new Affidavit of Financial
Means to the Court, revised and updated to provide more pertinent information to the parties and
the courts in matters involving family support than the current affidavit provides. By per curiam
order dated April 14, 2076,the Court published the proposed affidavit for comment, with written
comments due to the Clerk of the Court on May 20,2016. The Clerk received four letters in
response. The Court requested that the Committee review the comments and make a final
recommendation, taking those comments into consideration.
DISCUSSION
The Committee met on June 24,2016, to review the comments. Of the four letters
submitted, three of them supported the proposed affidavit, with one suggestion made for a
formatting issue, In the fourth letter, the writer commented positively to one change and made
seven suggestions for other changes. The Committee discussed each and every suggestion'
Some were for changes the Committee had discussed specifically in the drafting stage. Some
were for changes to things the Committee had done by design or had opted not to do. The
Committee adopted one of the suggestions: putting lines at the bottom of each page for the
litigant and the attorney, if he or she is represented, to initial, The affidavit was amended
accordingly.
I{ECOMMENDATION
AfteL consiclerìrrg the Comrnents submitteclto the Court, the Committee rcspectfully
recommerrcls that the Court approve and aclopt the attached Affidavit of llinarlcial Means, âs
amenclecl,
Tliank you.
Rcspectfr,rl ly subn'ritted,
Mackie Pielcc
Circuit Judge
Chair of Child Support Committce
D
2
IN THE CIRCUIT COURT OF COUNTY, ARKANSAS
(Domestic Relations Division)
Division
Plaintiff
V Case No. DR
Defendant
AFFIDAVIT OF FINANCIAL MEANS
Name: , being duly sworn, says under penalty of perjury,
that he/she has prepared or approved this financial statement, and that the following
information and attachments (including income verification as required by page 7)
are complete, true, and correct.
Date Signature
Subscribed and sworn to before me on this day of 20
-
Notary Public
My commission expires
MY INCOME
1 How often are you paid?
_ weekly
_ bi-weekly (every two weeks-26 times a year)
_ monthly
_ bi-monthly (twice a month-24 times a year)
_ other -Explain (attach an exhiþit if necessary)
2.* Net Pay: (Take-home after allowable deductions)
$
*Complete worksheet on next page to determine Net Pay for calculating child support
Page 1 of 7
Ini t iaf s Ini t iaf s
NET PAY WORKSHEET
(lf more than one employer, fill out and attach multiple copies of this worksheet)
EMPLOYER
Address: Telephone #:
3. Gross Wages per pay period $
ALLOWABLE DEDUCTIONS UNDER STATE LAW
A. Federal lncome Taxes Withheld $
B. State lncome Taxes Withheld $
C. F.l.C.A. (Social Security) or Railroad Retirement $
D. Medicare: $
E. Health lnsurance (only the porlion paid for children in fhis case $
as required by page 7)
F. Court-ordered child supportfor other children not $
involved in this current case. (For example, children from
a previous relationship or marriage):
G TOTAL Allowable Deductions $
3.H Subtract TOTAL Allowable Deductions from Gross Wages
= NET PAY $
THE FINAL NUMBER IN THIS BOX BELONGS ON PAGE 1 UNDER ''NET PAY"
lf you pay support for children nof involved in this case in a form other
than þavro ll deduction , then you should attach the ch¡ld support order
and proof of ment as an exh¡b¡t to this affidavit
Any other deductions from your paycheck do not figure into your net pay under Arkansas
law regarding child support. Some examples of payroll deductions that you mav not
subtract from your income for calculating child support include: pension plans, union
dues, 401(k) payments, loan repayments, charitable contributions, life insurance, and
health insurance payments that cover you or your spouse.
However, the court may consider these expenses, particularly if they are significant, so
you should reflect them in the proper place in the pages to follow'
Page 2 of 7
Ini t ial- s Initials
OTHER INCOME
Other income Amount: Source Frequency
4
Bonuses or incentive pay not
4.1
reflected on page 2:
4.2 Other court-ordered income
such as alimony/child support
paid to you:
4.3 Payments from a settlement or
annuity:
4.4 Regular gifts from relatives or
friends:
4.5 lnvestment income such as rent
payments to you:
4.6 Stock dividends or bond
payments:
4.7 Regular payments to you or on
your behalf from a Trust:
4.8 Other:
4.9 TOTAL OTHER
INCOME: $
OTHER AVAILABLE FUNDS
5 ASSET AMOUNT SOURCE
Cash on hand, and in bank
5.1 accounts:
5.2 Trust fund assets held on your
behalf:
5.3 Stocks, bonds, mutual funds
5.4 Other (i.e. 401-K, retirement, etc)
5.5 TOTAL:
$
Page 3 of 7
rni t ia1 s rni t iaÌ s
MY CURRENT MONTHLY EXPENSES *
6
Expense: Amount: Expense: Amount:
a Health lnsurance
Rent/house payment $ n $
b
Gas, water, trash, & $ o Non-covered medical $
electricity (including medicine)
c.
Telephone $ p Life insurance $
d
lnternet $ q Car payment $
e
Media Services, i.e $ r Car lnsurance $
,Cable/Satellite, etc.
f
Child care $ S Car fuel and $
maintenance
g Food $ t Lawn care $
h Union dues $ u Charitable giving $
Pension plan $ V Household Expenses $
401(k) payments $ W Dry cleaning $
J
k. Garnishments $ X Other $
Cigarettes $ v Other: $
m Alcohol $ z. $
TOTAL
* Place a check mark by all expenses which you are not currently paying.
Page 4 of 7
Tni t ia1 s Ini t i-al- s
MINOR CHILDREN
7 Number of children:
a Number of minor children I have with opposing party #
b Number of other minor children I have #
c. Names of minor children involved in this case: AGE
I
2
3
4
CREDITORS & DEBTS
8 Debts in the names of BOTH PARTIES are:
Creditor: Total amount owed Monthly payment:
a $ $
b $ $
c. $ $
d $ $
e $ $
f $ $
g $ $
Totals: $ $
Page 5 of 7
Ini t iaI s lni t iaI s
L Debts only in my name:
Creditor: Total amount owed: Monthly payment
a $ $
b $ $
c $ $
d $ $
e $ $
Totals $ $
'10. Debts only in the name of the other party:
Creditor: Total amount owed Monthly payment:
a $ $
b $ $
c $ $
d $ $
e $ $
Totals $ $
11. SUMMARY OF ABOVE DEBT TABLES
Summary of Debts: Total Owed: Total Monthly Payments:
a
Joint Debts: $ $
b
My Debts: $ $
c
Other Party's Debts: $ $
Page 6 of 7
Ini t ial- s Ini t ial- s
ACKNOWLEDGEMENT OF
RESPONSIBILITIES AND CONSEQUENCES
l, understand that I must comply with the following, I
acknowledge and agree to each provision by initialinq each paraqraph below.
_Both parties must complete and exchange this seven-page affidavit by providing
to opposing counsel or pro se litigants within five days before hearing.
_Both parties must supply the original notarized affidavit to the court.
lf I am employed, I must attach copies of my last three paystubs to this affidavit.
lf I am self-employed, I must attach copies of my last two federal and state tax
returns, including all schedules, to this affidavit.
Before each court hearing where financial matters are at issue, I will review this
document and provide updated information to the other party and to the court.
Iunderstand that the cost of dependent health insurance coverage is the difference
Ue¡,veen self-only and self with dependents or family coverage or the cost of adding the
child(ren) to existing coverage.
I understand that failing to comply with these provisions, or deliberately attempting
to mislead the court or the opposing party, may result in my being held in contempt of
cou11, being fined, being ordered to pay attorney's fees, and/or being sentenced up to 6
months in fail, and that serious violations can result in prosecution for felony perjury-
punishable by 3 to '10 years in prison.
Date Signature
I certify that I have reviewed this affidavit with my client and advised him or her of the
importance of providing true, correct, complete answers and the required exhibits.
Date Attorney
Form Revised t2016
Page 7 of 7
Judge Robert Herzfelcl
.Søfine County Circuit Court Phone: 501-303- 1584
4úi (Division
Fax: 303-l5tl5
j ud gcherzf'eld @ grnail.cotn
22"'t Ju[icíaf cDistrict of ,4rfrgnsas $,,, p rì r i, i, iìT9',ilJlif
I l. i ¡il :ì fJ,'i'f ¡,¿n, 0,.,
CF
Zúlb ÁpR l9 p t, 0l
Stacey Pectol
Clerk of the Supreme Court
ii ;AC[\' F [CTOL, CLERK
FB tu ffiÐ
ATTN: Adrninistrative Order Nulnber l0
AP R 1 I 2016
625 Marsh¿ill Street, LittleRock, AR7220I
S TACEY }TE.CTOL
CLE fiK
RE: Draft Affirlavit of F'inancial Means
Dear Ms, Pectol,
I an-r writing i1 stro¡g supporl of the new draft Affidavit of Financíal Means (AFM) that is up for conrment until lvlay
20th. It was clearly clralled with pracricality, clarity, arrd ease of r.rse in rmnd, As a Circuit Juclge who hears primarily
dornestic cases, I can attest that the nerv draft addresses allof the conceltls I have had over the years. I'll list some
highlights below:
l. Moving the nolarized signature lo the lront page soryes multiple purposes. First, approximately half of the AI'Ms
submittcd to rnc are not notarizcd. Putting it on thc front makcs it morc likely to be completed. Secon- not incltrciecl in pa¡, ancl pa;'::oll dccltrctions,
*,wr",,.T'he Lanc¿rs terLarvÞ-irm.com
TrrE L ANCASTER Lnw F IRM pflc ìruw -fhèl ¡n.nîterl ^wflirnr.cñnl
l\4ovipg ahcacj to Page 3, the "L)thel lucorne" sectioit gives good exaurples ol'what rnight be
incl¡decl. The olcl fbrm clicl not have these, which caùsed people to sometjmes forget about them
or even intentíonally leave them or"rt ancl plead ignoránce, Income is different from other funds
avail¿rble to a person, so making those sections separa-te is a great slep to even more clarity.
Adclitionally, rnaking the "My Current Monthly Expenses" table on Page 4lat'ger makes it so mr"rch
easier to complete. Thc current form cranls the same table onto half a page, which makes the
numbers so small that it's difficult to conrplete the tahle where it is legibJe.
I r,vas pleased, well, to see that the informational table about the parties was removecl (fbrmerly
as
on p,rg. 4 of 7 in the olcl version). Sontetimes these panies lrave been divorced flor years, separated
for:-yea,:s, or they are parties who u,ould never havc known the int'ormation about the other party
atait.'fakingtliissectionoutjustsavesmetime,andtruly,thissectic¡nwasalmostneverusedin
nry practice
Also, ihanging thc clebt sections cln Page 7 to "rny n¿ìme" attd "ltame ol the other pafly" instead o1'
"Plaintitl" ancl "l)cfeucl¿int" clears these sec,fit)ns up quite nicerly, A lot of tirnes, even with the
parties narne s listccl on the case , the parly cornpleting the form still does not lcnow who the Plaintiff
ancl Defend¿rut arel
I.-i1ally, the last page is. in rny opinion, the best cha-nge macle to the docr-tment. Clients rarely
urnclerit¿rncl that the rJc¡cumcnt is necessary to set r:hild supporL and spottsal support. They
sometimes f'eel like the court is just being nosy, thç other party's attorney is asking intrusive
qr.re.stions by sencling an AltrM with intcu'ogatories, and that this pcrrsonal ínforrnation cannot
possibly be needecl fãr the courl to just set support. Ilaving this information on the back easily
txplain-s the reasons the AFM is r-rccdecl ancl lcts the party knor,v that the other party has to complete
onã as we.ll T'his explanation section also clearìy tells the client that three paystttbs or t\ryo tffx
retums, as applicable, ate to bc subtlittcd with thc form as well,
As a famity larv ancl plobate practítioner, I wholehearterlly suppoil the changes nrade in this ncw
version o1'the AIìM,
'Lhank you for your tinre ancl for allorving the conun¡¡nt period, If you should have any other
questions ln this regar.cì, please do not hesltate to give nrc ¿r cal1.
S it Lccrcly,
Lori D, Howalcl
Associafe AttorneY
Seln T I(eith
Keiiirh, Ndill,ero Victoria Hirsis lJltrtrr¡t
Arlcllei,v Iì iVl illcr
St.:plrerr \\r lJLrtler
lFl,r"l tl e ir', S,c[-l n e i cil e r CcIn re Sup. Ct. Comm. on Child Support
Combined Opinion