FINANCIAL STATEMENT
(Child Support Guidelines)
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I, |
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state that: |
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My name |
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I am the |
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State Relationship (for example, mother, father, aunt, grandfather, guardian, etc.) |
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of the minor child(ren), including children who have not attained the age of 19 years, are not married or self-supporting, and are enrolled in secondary school: |
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___________________ |
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___________________ |
___________________ |
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Name |
Date of Birth |
Name |
Date of Birth |
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___________________ |
___________________ |
___________________ |
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Name |
Date of Birth |
Name |
Date of Birth |
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___________________ |
___________________ |
___________________ |
___________________ |
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Name |
Date of Birth |
Name |
Date of Birth |
The following is a list of my income and expenses (see below*):
See definitions on other side before filling out.
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Total monthly income (before taxes) |
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Child support I am paying for my other child(ren) each month |
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Alimony I am paying each month to |
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(Name of Person(s)) |
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Alimony I am receiving each month from |
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(Name of Person(s)) |
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For the child or children listed above: |
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The monthly health insurance premium |
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Work-related monthly child care expenses |
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Extraordinary monthly medical expenses |
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School and transportation expenses |
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* To figure the monthly amount of expenses, weekly expenses should be multiplied by 4.3 and yearly expenses should be divided by 12. If you do not pay the same amount each month for any of the categories listed, figure what your average monthly expense is. |
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I solemnly affirm under the penalties of perjury that the contents of the foregoing paper are true to the best of my knowledge, information, and belief. |
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Date |
Signature |
Total Monthly Income: Include income from all sources including self-employment, rent, royalties, business income, salaries, wages, commissions, bonuses, dividends, pensions, interest, trusts, annuities, social security benefits, workers compensation, unemployment benefits, disability benefits, alimony or maintenance received, tips, income from side jobs, severance pay, capital gains, gifts, prizes, lottery winnings, etc. Do not report benefits from means-tested public assistance programs, such as food stamps or AFDC.
Extraordinary Medical Expenses: Uninsured expenses in excess of $250 in a calendar year for medical treatment, including orthodontia, dental treatment, vision care, asthma treatment, physical therapy, treatment for any chronic health problems, and professional counseling or psychiatric therapy for diagnosed mental disorders.
Child Care Expenses: Actual child care expenses incurred on behalf of a child due to employment or job search of either parent with amount to be determined by actual experience or the level required to provide quality care from a licensed source.
School and Transportation Expenses: Any expenses for attending a special or private elementary or secondary school to meet the particular needs of the child and expenses for transportation of the child between the homes of the parents.
Except as provided in this section, inspection of a financial statement filed pursuant to the Rules in this Chapter is governed by Code, General Provisions Article, $ 4-328 and $ 4-336. A financial statement is open to inspection if it is an exhibit (1) attached to a motion that has been ruled upon by the court or (2) marked for identification at trial, whether or not offered in evidence, and if offered, whether or not admitted. A party who does not want the financial statement open to public inspection pursuant to this section may make a motion at any time to have it sealed.
Md. Fam. Law. Actions. 9-203
This Rule is new.
HISTORICAL NOTES
2002 Orders
The October 31, 2002, order made changes to conform to Acts 2002, c. 180, relating to dependent children.
2007 Orders
The May 8, 2007, order amended section (d) and added the cross reference following section (d). Previously section (d) read:
“(d) Inspection of Financial Statements. Inspection of a financial statement filed pursuant to the Rules in this Chapter is governed by Code, State Government Article, § 10-617(a) and (f).
Prior Rules:
Rule 9-203, adopted as Maryland Rule of Procedure S72, Sept. 15, 1961, eff. Jan. 1, 1962, amended March 28, 1966, eff. June 1, 1996; Feb. 2, 1970, eff. Feb. 2, 1970; June 30, 1973, eff. July 1, 1973; June 16, 1975, eff. July 1, 1975; Dec. 17, 1975, eff. Jan. 1, 1976; Oct. 1, 1980, eff. Jan. 1, 1981; April 6, 1984, eff. July 1, 1984; Jan. 10, 1995, eff. Feb. 1, 1995, transferred to Rule 9-203, June 5, 1996, eff. Jan. 1, 1997, amended June 5, 1996, eff. Jan. 1, 1997, related to pleading, rescinded March 5, 2001, eff. July 1, 2001. See Md. Rule 9-202.
2015 Orders
The March 2, 2015 order amended the Rule to conform an internal reference to revised Code provisions.
2016 Orders
The June 6, 2016, order revised internal references in the Rule.
2017 Orders
The June 20, 2017 order, revised an internal reference.
Cross reference: See Rule 16-904(c) and Rule 16-918.