Form DC6:5(2) "Financial Affidavit for Child Support" - Nebraska

What Is Form DC6:5(2)?

This is a legal form that was released by the United States District Court for the District of Nebraska - a government authority operating within Nebraska. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the United States District Court for the District of Nebraska;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DC6:5(2) by clicking the link below or browse more documents and templates provided by the United States District Court for the District of Nebraska.

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Download Form DC6:5(2) "Financial Affidavit for Child Support" - Nebraska

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Nebraska State Court Form
FINANCIAL AFFIDAVIT FOR
CHILD SUPPORT
DC 6:5(2)
Rev. 08/17
Neb. Ct. R. §§ 4-204, 4-205
IN THE DISTRICT COURT OF _________________ COUNTY, NEBRASKA
(county where filed)
Case No. ________________________
____________________________,
(your full name or the name of the plaintiff in the original action)
(case number assigned by clerk of court)
Plaintiff,
vs.
FINANCIAL AFFIDAVIT
FOR CHILD SUPPORT
____________________________,
(other party's full name or the name of the defendant in the
original action)
Defendant.
STATE OF NEBRASKA
)
) ss:
)
COUNTY OF ____________________
(county where signed)
I, __________________________________, am under oath and I state that
(first, middle and last names)
the following information is true:
1. This is an action for __________________________________.
(type of case)
Choose one:
[ ] There is no existing order for support for the minor childr(en) born to
the other party and me.
OR
[ ] There is currently an order for the support of the minor child(ren) of
the other party and me through:
_____________________________________________
(name of court)
_____________________________________________
(case number)
_____________________________________________
(amount of support)
_____________________________________________
(number of children)
Continued on next page …
Page 1 of 6
Financial Affidavit for Child Support
DC 6:5(2) Rev. 08/17
Nebraska State Court Form
FINANCIAL AFFIDAVIT FOR
CHILD SUPPORT
DC 6:5(2)
Rev. 08/17
Neb. Ct. R. §§ 4-204, 4-205
IN THE DISTRICT COURT OF _________________ COUNTY, NEBRASKA
(county where filed)
Case No. ________________________
____________________________,
(your full name or the name of the plaintiff in the original action)
(case number assigned by clerk of court)
Plaintiff,
vs.
FINANCIAL AFFIDAVIT
FOR CHILD SUPPORT
____________________________,
(other party's full name or the name of the defendant in the
original action)
Defendant.
STATE OF NEBRASKA
)
) ss:
)
COUNTY OF ____________________
(county where signed)
I, __________________________________, am under oath and I state that
(first, middle and last names)
the following information is true:
1. This is an action for __________________________________.
(type of case)
Choose one:
[ ] There is no existing order for support for the minor childr(en) born to
the other party and me.
OR
[ ] There is currently an order for the support of the minor child(ren) of
the other party and me through:
_____________________________________________
(name of court)
_____________________________________________
(case number)
_____________________________________________
(amount of support)
_____________________________________________
(number of children)
Continued on next page …
Page 1 of 6
Financial Affidavit for Child Support
DC 6:5(2) Rev. 08/17
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. The other party is employed at _______________________________________.
(name of employer)
The other party’s current gross monthly income is $_____________________.
(amount of income from all sources)
This income 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)
4. I believe I am capable of earning more income than is currently being
earned. I base this on past employment at _______________________,
(name of employer)
where my gross income per month was $____________________, based on
(amount of income from all sources)
(choose one):
Continued on next page …
Page 2 of 6
Financial Affidavit for Child Support
DC 6:5(2) Rev. 8/17
[ ] $_________ 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 of bonus)
5. I believe the other party is capable of earning more income than is currently
being earned. I base this on past employment at ____________________,
(name of employer)
where the other party's gross income per month was $____________________,
(amount of income from all sources)
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 of bonus)
do /
6.
I
do not (mark one) have health insurance available for the child(ren)
through my employment at a cost of $_____________________ per month.
(cost of coverage for child(ren) only)
7. The other party
does /
does not (mark one) have health insurance available
for
the child(ren) through employment at a cost of $_____________________ per
(cost of coverage for child(en) only)
month.
Continued on next page …
Page 3 of 6
Financial Affidavit for Child Support
DC 6:5(2) Rev. 8/17
8. Check the box
that applies:
[ ] I contribute to a mandatory retirement plan. The minimum
amount required as a contribution is $____________.
(minimum contribution required)
OR
[ ] I do not contribute to a mandatory retirement plan.
OR
[ ] I do not have a mandatory retirement plan, but I contribute to a
voluntary retirement plan. My monthly contribution is
$____________.
(average contribution)
OR
[ ] I do not contribute to a voluntary retirement plan.
9. Check the box
that applies:
[ ] The other party contributes to a mandatory retirement plan. The
minimum amount required as a contribution is $____________.
(minimum contribution required)
OR
[ ] The other party does not contribute to a mandatory retirement plan.
OR
[ ] The other party does not have a mandatory retirement plan, but
the other party contributes to a voluntary retirement plan.
The other party's monthly contribution is $____________.
(average contribution)
OR
[ ] The other party does not contribute to a voluntary retirement plan.
Continued on next page …
Page 4 of 6
Financial Affidavit for Child Support
DC 6:5(2) Rev. 8/17
10. I have other children I am supporting.
Number of children: _____________.
(number of other children)
Child(ren)’s name(s) and year(s) of birth:
_________________________________
______________________
(name)
(year of birth)
_________________________________
______________________
(name)
(year of birth)
_________________________________
______________________
(name)
(year of birth)
For the other child(ren) I am supporting, check the box
that applies:
[ ] If support is court-ordered:
_____________________________________________
(name of court)
_____________________________________________
(case number)
_____________________________________________
(amount of support)
OR
If support is not court-ordered and the child(ren) are living with
you:
_____________________________________________
(name of other parent)
_____________________________________________
(gross monthly income of other parent)
The other party has other children to support.
11.
Number of children: _____________.
(number of other party's other children)
Continued on next page …
Page 5 of 6
Financial Affidavit for Child Support
DC 6:5(2) Rev. 8/17
Page of 6