Alaska has many requirements for those who wish to file a DV-101 application. This article will provide an overview of the process, and what you'll need to complete your application. First, you must establish eligibility; this includes meeting residency and criminal history requirements. Once eligibility is established, you must gather all required documentation and submit your application. The processing time for a DV-101 can vary depending on the individual circumstances of each case, so be sure to allow plenty of time for the application to be processed. For more information on the DV-101 process, please visit our website or contact us directly. Thank you for choosing Alaska as your place of residence! If you are interested in becoming a permanent resident of Alaska, you will
| Question | Answer |
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| Form Name | Alaska Form Dv 101 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names |
IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT
PETITIONER (protected person), |
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Birthdate: |
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Petitioner is a child. Who is signing for the child?
Name:Birthdate: Relationship to child:
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RESPONDENT (restrained person), |
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Birthdate |
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Respondent is a child. Who is signing for the child?
Name:Birthdate: Relationship to child:
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) CHILD SUPPORT INFORMATION
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INSTRUCTIONS. If child support is requested in a petition for a
Provide information about yourself and, to the extent it is available, about the other party. A court clerk can notarize this document for you at no charge. The information in this form is required by Civil Rule 90.3 and the statutes listed at the bottom of this form. If you want a copy of Civil Rule 90.3, ask the clerk for a copy of the booklet about child support,
Each party must attach a copy of his or her most recent federal tax return and most recent pay stubs to verify income and deductions.
AFFIDAVIT
I swear or affirm under penalty of perjury that the following information is true to the best of my knowledge and belief.
I.Other Child Support Orders
There are no other child support orders currently in effect concerning the children involved in this case.
The following child support order(s) concerning these children is/are still in effect:
Case No. |
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Effective Date: |
Page 1 of 4 |
Civil Rule 90.3 |
AS 25.27.062(a) |
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CHILD SUPPORT INFORMATION |
AS 25.27.060(c) |
II.Income Information. The following income and deductions are
monthly
yearly.
I have attached a copy of my most recent federal tax return and pay stubs to verify this
information. [Note: Delete social security numbers and account numbers from any documents you attach.]
PETITIONER
A.Gross Income (Do not list ATAP or SSI below.) Gross wages
Value of
Permanent fund dividend Other:
TOTAL INCOME
B.Deductions Allowable Under Civil Rule 90.3 Federal, state and local income tax Social security tax or
Employment security tax Mandatory retirement contributions Mandatory union dues
Voluntary retirement contributions if plan earnings are
Other mandatory deductions (specify)
Child support/alimony ordered in other cases and currently being paid
Child support for children from prior relationships living with this parent, calculated under Civil Rule 90.3
TOTAL DEDUCTIONS
C. Net Income
TOTAL INCOME from section A
TOTAL DEDUCTIONS from section B
Subtract deductions from income to get
NET INCOME
D.Adjusted Annual Income
1.If the above figures are based on monthly information, multiply NET INCOME from section C by 12 to get
ADJUSTED ANNUAL INCOME
2.If the above figures are based on yearly information, repeat the NET INCOME amount from section C to show
ADJUSTED ANNUAL INCOME
Page 2 of 4
CHILD SUPPORT INFORMATION
RESPONDENT
Civil Rule 90.3
AS 25.27.062(a)
AS 25.27.060(c)
III.Health Care Coverage for the Children. A. Health Insurance.
1.Does the petitioner have health insurance available for the child(ren) at reasonable cost through his/her employer, union or otherwise?
Yes |
No |
If yes, state name and address of employer, union or other |
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source through which insurance is provided or available. |
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Name: |
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Address: |
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Cost to petitioner: $ |
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month |
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2.Does the respondent have health insurance available for the child(ren) at reasonable cost through his/her employer, union or otherwise?
Yes |
No |
If yes, state name and address of employer, union or other |
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source through which insurance is provided or available. |
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Name: |
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Address: |
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Cost to respondent: $ |
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per |
month |
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3. Are the children eligible for services through the Indian Health Service?
Yes
No
4. Do the children have other health insurance or care available?
Yes Describe:
No
B.Children’s Health Care Expenses Not Covered By Insurance.
Is there any reason why the court should not require the parties to share equally the cost of reasonable health care expenses not covered by insurance?
IV. Travel Expenses. Travel expenses to exercise visitation should be allocated between the parties as follows:
Page 3 of 4 |
Civil Rule 90.3 |
AS 25.27.062(a) |
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CHILD SUPPORT INFORMATION |
AS 25.27.060(c) |
V.Immediate Income Withholding.
The Alaska Statutes require that child support be withheld from the income of the person paying support and paid through the Child Support Services Division (CSSD) unless one of the following exceptions is approved by the court:
We have made the following alternative arrangement (Note that if you receive ATAP, CSSD must agree to the arrangement):
Also, the person paying support agrees to keep the other party (or CSSD if CSSD is enforcing the order) informed of his/her current employer and the availability of
We believe there is good cause not to require immediate income withholding because it is not in the best interests of the child(ren) for the following reason:
Also, the person paying support agrees to keep the other party (or CSSD if CSSD is enforcing the order) informed of his/her current employer and the availability of
The person paying support currently receives social security or other disability compensation that includes regular payments to the child(ren) at least equal to the child support owed each month. Monthly payment to child(ren): $
Source of payment:
Note: To the extent that these payments to the children do not satisfy the monthly amount owed, the court will order that the remaining amount due be withheld from income.
VI. If you want the assistance of the Child Support Services Division (CSSD) to enforce the support order and keep records of the payments, you must apply for CSSD services. You can get an application from CSSD or you can fill out court form
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Type or Print Name |
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Subscribed and sworn to or affirmed before me at |
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, Alaska |
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(SEAL) |
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Clerk of Court, Notary Public or other |
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person authorized to administer oaths. |
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My commission expires: |
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Page 4 of 4 |
Civil Rule 90.3 |
AS 25.27.062(a) |
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CHILD SUPPORT INFORMATION |
AS 25.27.060(c) |