Form CS-41

Form CS-41 CHILD SUPPORT OBLIGATION, INCOME STATEMENT/AFFIDAVIT

I need Form CS-41 for the Plaintiff Defendant
1.CASE INFORMATION
ALA CSES Case #:
County:
Court of Jurisdiction:
2.PARENT INFORMATION
	FIRST, MIDDLE, LAST, SUFFIX
Plaintiff
Defendant
Social Security No. of Affiant:	- -
Is the Plaintiff/Defendant currently employed? Yes No *If no, skip to section 5

3. CURRENT EMPLOYMENT
Place of employment
Employer Street/Suite No.:
City:	State: Zip:

4. PREVIOUS EMPLOYMENT
Previous place of employment
Employer Street/Suite No.:
City:	State: Zip:

Last position title:
Average monthly salary last year of employment:	$
5. INCOME, HEALTH AND DAY CARE EXPENSES
If employed, enter amounts for gross monthly income.
Employment income	$
Self-employment income	$
Employment-related income	$
Non-employment related income	$
Cost of day-care	$ *If none, write "NONE"
Children are Not covered by health insurance Are covered by health insurance
Health Insurance Costs	$ *If none, write "NONE"