Motion For Support Pendente Lite With Affidavit And Notice

DR0706123 Motion for Support Pendente Lite with Affidavit & Notice.doc COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CUYAHOGA COUNTY, OHIO _________________________________________ Plaintiff _________________________________________ Social Security Number Date of Birth _________________________________________ Address _________________________________________ City, State, Zip Code Yes No Marital Residence: vs ________________________________________ Defendant _________________________________________ Social Security Number Date of Birth _________________________________________ Address _________________________________________ City, State, Zip Code Yes No Marital Residence: : : : : : : : Filed by:__________________________ (Your Name) Case Number: ___________________________________ Judge: ___________________________________ MOTION FOR SUPPORT PENDENTE LITE WITH AFFIDAVIT AND NOTICE : : : WIFE HUSBAND Date of Marriage:____________________________ Date of Separation: __________________________ Plaintiff Defendant moves the Court for an order for support during the pendency of this action and for cause refers to the affidavit attached hereto. CERTIFICATE OF SERVICE The Motion for Support Pendente Lite with Affidavit and Notice has been sent by _____________ mail to: _____________________ (Name of Attorney or Party) located at ______________________________, ___________________________________ on ______________________________ (Address) ____________________________________________ Signature of Plaintiff Defendant, if unrepresented (City/State/Zip) (Date) ________________________________________________ Signature of Attorney for Plaintiff Defendant _______________ _________________________________ Attorney's Name and Registration Number ________________________________________________ Address ________________________________________________ City/State/Zip ________________________________________________ Telephone Number Plaintiff Defendant herein ___________________________, having been duly sworn states that he/she has been advised that this affidavit may be used for the following purposes: (1) to disclose completely affiant's income and expenses; (2) to assist in determining orders of child support and spousal support when applicable or any changes thereto; and (3) to provide for the issuance of an appropriate support withholding and deduction notice or other order. NOTICE OF MOTION Plaintiff Defendant is hereby notified of the filing of this Motion for Support Pendente Lite with Affidavit and Notice. Plaintiff Defendant is hereby directed to complete an Answer with Affidavit and, within 14 days after receiving this notice, file the Answer with Affidavit with the Clerk of Courts of Cuyahoga County, 1200 Ontario Street, Cleveland, Ohio 44113. If he/she fails to do so, the Affidavit supporting this motion will be taken as true. A form affidavit is available at www.domestic.cuyahogacounty.us and in the Court's Legal Department located in the Basement Center South or in Journal Department in Room 306 of Old Courthouse, One Lakeside Avenue, Cleveland, Ohio I. Information Required for Support Calculation: Initial: ________ Page 1 of 5 American LegalNet, Inc. www.FormsWorkflow.com A. Minor or Dependent Children of this Marriage (Include adopted children and any child of the parties who is over 18 and still attending high school or is mentally or physically disabled) Child's Name Date of Birth Age Residing with ARE THERE ANY OTHER SUPPORT ORDERS ESTABLISHED FOR THESE CHILDREN? YES NO IF YES, ATTACH COPY OF ORDER AND PROVIDE THE FOLLOWING INFORMATION: DATE OF ORDER:_________ AMOUNT: $____________ CASE NUMBER: ________________ SETS NUMBER: ___________________ COURT (or agency) NAME: ______________________________ B. Other Minor Children Living in My Household. Child's Name Relationship to You Date of Birth Age $ $ $ Court Ordered Support Received C. Other Minor Children of Mine, NOT Living in My Household. Child's Name Residing with Date of Birth Age $ $ $ Court Ordered Support Paid II. Child Support Guideline Adjustment: Husband/Father (all figures per year) Wife/Mother (all figures per year) $ $ Total court ordered child support you pay for other children Total court ordered spousal support you pay to former spouse(s) Number of your other dependent children living with you from another marriage or relationship Court ordered child support you receive for the dependent child(ren) you indicated on line above Childcare expenses you pay for child(ren) of this marriage (employment or educational related) Local income taxes paid or rate of tax where you live or work Self-employment tax (5.6% of A.G.I.) Health insurance premium for children (family plan cost minus individual plan cost) A. $ $ $ $ $ $ $ % $ $ $ $ $ % III. Annual Income [as defined in Ohio Revised Code §3119.01(B)(5)]: Gross Annual Income from Employment (If not known, please estimate and write "EST" after each estimated figure.) Husband/Father Wife/Mother Gross Annual Employment Income $ Salary Wages $ Salary Wages Name(s) of Employer(s) Payroll Address(es) City, State, Zip Check the number of 12 24 26 52 12 24 26 52 paychecks per year Through date of: Through date of: Year-to-date Gross Income $ $ Prior Year's Tax Refund $ $ Benefits from Employment (Company Car, Club Memberships, Stock Options, etc.) 1. 2. 3. $ $ $ $ $ $ Total Annual Value of Benefits: $ $ B. Annual Overtime, Commissions and Bonuses (If not known, please estimate and write "EST" after each estimated figure.) Initial: ________ Page 2 of 5 American LegalNet, Inc. www.FormsWorkflow.com Husband/Father Base Income LAST YEAR: 2 YEARS AGO: 3 YEARS AGO: Overtime, Commissions & Bonuses Base Income Wife/Mother Overtime, Commissions & Bonuses $ $ $ Month Day Year $ $ $ $ $ $ $ $ $ $ $ $ $ THIS YEAR THROUGH C. Gross Annual Self-Employment Income (If not known, please estimate and write "EST" after each estimated figure.) Use gross annual figures for most recent full year. See Ohio Revised Code §3119.01(C)(13) Gross Annual Business Receipts Ordinary & Necessary Business Expenses Net Annual Business Income D. $ -$ =$ Company Name Company Address Nature of Business: Other Annual Income: Other income includes commissions (other than from employment), royalties, tips, rents, dividends, severance pay, interest, trust income, annuities, social security benefits (including retirement, disability and survivor benefits that are not need based), workers' compensation, unempl