Form CS-41 at a glance
What it is: Form CS-41 is the Child-Support-Obligation Income Statement/Affidavit of the State of Alabama Unified Judicial System.
Who signs: The Affiant signs, and the form is sworn to and subscribed before the Notary/Clerk.
A filled-in Form CS-41 example: a defendant reports income and child-care
How to fill out Form CS-41, box by box
Case Number, Plaintiff and Defendant
Write the Case Number.
After IN THE, write Circuit or District; after COURT OF, write the Name of County.
Write the Plaintiff and the Defendant.
Name of Affiant and Plaintiff, Defendant or Other
After I, write the Name of Affiant.
In box 1, after I am the, mark Plaintiff, Defendant or Other (please specify); for Other, specify it before in the above matter.
Currently employed or not currently employed
If you are currently employed, mark I am currently employed and write your employer's name and address.
If you are not currently employed, mark not currently employed and write your last employer's name and address, the Last position title and the Average monthly salary in the last year of employment.
My monthly gross income includes
For examples of income that must be included, see the back of this form; if income varies by month, enter the estimated average monthly gross income.
Enter Employment income, Self-employment income, Other employment-related income, Other non-employment-related income and the Total.
Employment Income shall include, but not be limited to, salary, wages, bonuses, commissions, severance pay, worker's compensation, pension income, unemployment insurance, disability insurance, and Social Security benefits.
Self-Employment Income shall include, but not be limited to, income from self-employment, rent, royalties, proprietorship of a business, or joint ownership of a partnership or closely held corporation. Gross income means gross receipts minus ordinary and necessary expenses required to produce this income.
Other Employment-Related Income shall include, but not be limited to, the average monthly value of any expense reimbursements or in-kind payments received in the course of employment that are significant and reduce personal living expenses, such as a furnished automobile, a clothing allowance, and a housing allowance.
Other Non-Employment-Related Income shall include, but not be limited to, dividends, interest, annuities, capital gains, gifts, prizes, and preexisting periodic alimony.
Gross income includes income from any source, but does not include child support received for other children or benefits received from means-tested public-assistance programs, including Temporary Assistance for Needy Families, Supplemental Security Income, food stamps, and general assistance.
Under Rule 32, Alabama Rules of Judicial Administration, income means the actual gross income of a parent if the parent is employed to full capacity; if the parent is unemployed or underemployed, it means the actual gross income the parent has the ability to earn.
Work-related child-care
Enter the amount you incur monthly for work-related child-care; if none, write “None”.
Health-care coverage for the child(ren)
If not covered by health-care coverage from you and/or your employer, mark not covered by health-care coverage from me and/or my employer; when health-care coverage is available at a cost, mark Health-care coverage is available at a cost of and write the cost per month.
If covered by Medicaid or other public health-care coverage at no cost to you, mark covered by Medicaid or other public health-care coverage at no cost to me.
If the child(ren) are covered by health-care coverage, mark that box, write what you pay each month, or the amount paid on your behalf each month by your ____, for the family policy coverage under which the child(ren) are covered, and write the total number of persons covered under that policy.
Write the pro rata portion of the health-care coverage cost attributable to the child or children who are the subject of the support order, calculated by dividing the total health-care coverage cost actually paid by, or on behalf of, the parent ordered to provide the coverage by the total number of persons (adult and/or children) covered and then multiplying the result by the number of children who are the subject of the support order.
Write the health-care-coverage company's name and address.
Child support alimony in a prior case(s)
Write the total amount you pay for child support or alimony in a prior case(s), mark child support or alimony, and under List case number(s) and county(ies) and state(s) here, list them; if none, write “None”.
Affiant and Sworn to and subscribed before me
You will be required to maintain all income documentation used in preparing this Income Statement/Affidavit (including your most recent income-tax return), and such documentation shall be made available as directed by the court.
Any intentional falsification of the information presented in this Income Statement/Affidavit may subject you to the penalties of perjury.
The Notary/Clerk fills in Sworn to and subscribed before me this and day of.
Sources
[1] Form CS-41 (Rev. 7/2019), Child-Support-Obligation Income Statement/Affidavit, State of Alabama Unified Judicial System (the Official source link on this page).
