Confidential — Retained Clients Only

Child & Spousal Support Questionnaire

Child Support · Spousal Support · Modification · Termination · NewLeaf Document Services

LDA #23-003 · Placer County · Registered & Bonded

Please complete before your appointment.
This questionnaire collects the income, deduction, and support details needed to calculate guideline child and/or spousal support and to set the terms of your order. Please complete every section that applies to your situation. If you are unsure of an exact amount, your best estimate is fine — you can enter "unknown" or leave a field blank where it does not apply.

Please enter monthly amounts unless a field says otherwise, and "gross" means before taxes and deductions. Even when both parties agree to set support at zero, the court still asks to see the guideline calculation, so these figures are used either way.

This questionnaire is confidential and for retained clients only.

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Case Information

Your full legal name *

Other party's full legal name *

Existing case number (if any)

County

Who is (or will be) the Petitioner?

# of minor children of this relationship

What type of support is this? *

Child support only Spousal support only Both

Is this new, a modification, or a termination? *

New — no existing order Modification of existing order Termination of existing order

⚠️ Please upload a copy of the existing support order using the upload field at the end of this form. JoHanna will need to review it before preparing the modification.

Income — Both Parties

Income is the starting point for the guideline calculation in Cal Support Pro. Enter gross monthly amounts (before taxes). Leave a line blank if it does not apply. Provide the other party's figures if you know them — your best estimate is fine, or enter "unknown."

Your Income

Employment status *

Employer name (if employed)

Gross monthly wages / salary * (incl. bonus, commissions, overtime)

Self-employment income (after business expenses)

Rental income (after expenses)

Interest, dividends & investment income

Retirement / pension income

Social Security income (retirement or disability)

Other tax-free income (military allowance, VA, etc.)

Spousal support you receive from a different relationship

Capital gains (note short-term / long-term, if any)

Other Party's Income (if known)

Employment status

Employer name (if known)

Gross monthly wages / salary (if known)

Self-employment income (after expenses)

Rental income (after expenses)

Interest, dividends & investment income

Retirement / pension income

Social Security income (retirement or disability)

Other tax-free income

Capital gains (if known)

Deductions From Income — Both Parties

These monthly amounts are subtracted before support is calculated. Enter monthly amounts; leave blank if none. The first group is applied automatically by law; the second group counts only if both parties agree or the judge orders it.

Your Deductions

Applied by law

Health insurance premium you pay (self + children)

Mandatory union dues

Mandatory retirement contributions (required by your job)

Child support you pay for children of another relationship

Spousal support you pay to a former spouse (by court order)

Only if agreed or ordered

Necessary job-related expenses

Extraordinary uninsured health expenses you must pay

# of other minor children living in your home (from another relationship)

Other Party's Deductions (if known)

Applied by law

Health insurance premium they pay (self + children)

Mandatory union dues

Mandatory retirement contributions

Child support they pay for children of another relationship

Spousal support they pay to a former spouse (by court order)

Only if agreed or ordered

Necessary job-related expenses

# of other minor children living in their home

Child Support — Children, Timeshare & Add-Ons

Number of minor children *

Your custody timeshare percentage

Other party's custody timeshare percentage

💡 Timeshare is the share of time each parent has the children. The two percentages should add up to 100%. If you are not sure, give your best estimate.

Who provides health insurance for the children?

Monthly cost of children's health insurance

Add-On Costs (Shared by Parents)

How are add-on costs (childcare, uninsured medical) shared?

50/50 Prorated by each parent's net income Other (note below)

Monthly childcare costs (work- or education-related)

Monthly uninsured medical / dental / vision costs

Children's special or educational needs costs (if any)

Travel costs for visitation (if any)

Child Support Terms

Child support arrangement

Agreed monthly amount (if agreed)

Paid by

First payment due date

How are uninsured medical costs shared?

Tax exemptions — who claims which child?

Spousal Support

What needs to happen with spousal support? *

Monthly support amount

Paid by

Start date

Duration or end date

Step-down schedule?

Yes No — fixed amount

Automatic termination events

Support terminates upon recipient's remarriage

Support terminates upon death of either party

Support terminates upon recipient's cohabitation in a marriage-like relationship

💡 Reserving the right means neither party receives support now, but either may request it in the future through the court. JoHanna will include appropriate reservation language.

Reason for modification or termination (if applicable)

Tax Information — Both Parties

The guideline calculation is based on after-tax income, so a few tax details are needed. Most people select the standard deduction. Answer as if you are not married to the other party. If a field does not apply, leave it blank or note "none."

Your Tax Info

Tax filing status

# of dependents / exemptions you will claim

If filing jointly with a new spouse, their gross monthly income

Deduction method

Standard deduction (most common) Itemized

Voluntary retirement contributions (401k, IRA, SEP — not required by job)

Are you blind or over 65?

Yes No

Tax credits that may apply

Child Tax Credit

Child / Dependent Care Credit

Earned Income Credit

Renter's Credit

Other Party's Tax Info (if known)

Tax filing status

# of dependents / exemptions they will claim

Deduction method (if known)

Are they blind or over 65?

Special Circumstances

These items affect the calculation only if both parties agree or a judge orders it. Leave blank if none apply.

Do you have a new spouse or live-in partner?

Yes No

Does the other party have a new spouse or live-in partner?

Yes No Unknown

Has the sale of the family home been deferred for the benefit of the children?

Yes No

Anything else that affects income or support? (optional)

Upload Documents & Submit

Upload any relevant documents (optional)

💡 Helpful to upload: existing support orders, recent pay stubs, last year's tax return, or proof of the costs above. Multiple files accepted.

Questions or anything you'd like to discuss (optional)

Something went wrong. Please try again or contact JoHanna at (916) 751-6498.

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🌿 Thank You — Questionnaire Received!

JoHanna will review your information before your appointment.

(916) 751-6498 — Call or text
newleafoffice.us@gmail.com

NewLeaf Document Services · LDA #23-003 · Not a Law Firm · Not an Attorney

NewLeaf Document Services · JoHanna C. Cody, LDA #23-003 · Placer County · Registered & Bonded
(916) 751-6498 · newleafoffice.us@gmail.com · NewleafDocumentServices.com
This questionnaire is confidential. Not a Law Firm. Not an Attorney.

Child & Spousal Support Questionnaire

Your Income

Other Party's Income (if known)

Your Deductions

Other Party's Deductions (if known)

Your Tax Info

Other Party's Tax Info (if known)

🌿 Thank You — Questionnaire Received!

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