Navigating the complexities of legal proceedings in situations involving domestic violence in Alaska involves various steps and documentation, one of which is the Alaska DV 101 form. This pivotal document is prepared and submitted in the context of seeking a long-term protective order, specifically when child support comes into play. The form operates under the guidelines set by Civil Rule 90.3 and pertinent statutes, ensuring all parties—petitioner and respondent—are transparent about their financial circumstances for the determination of child support obligations. It mandates the disclosure of income and deductions comprehensively, stretching from gross wages to specific allocations like employer-provided benefits, unemployment compensation, child support currently being paid, among other financial aspects. The form highlights the importance of not only providing but also verifying this financial information through the attachment of recent federal tax returns and pay stubs, thereby underpinning its commitment to accuracy and fairness in these sensitive proceedings. Additionally, it addresses health care coverage for children, emphasizing the court’s inclination to equitably distribute costs associated with uninsured health care needs and travel expenses for visitation, underscoring the child's well-being as paramount. The DV 101 form also touches on the protocol for immediate income withholding by the Child Support Services Division (CSSD), signifying the state's proactive approach in enforcing child support provisions, while offering a channel for alternative arrangements under specific circumstances. This intricate form, therefore, not only serves as a crucial tool in safeguarding the interests of children involved in domestic violence cases but also reinforces Alaska’s legal system's emphasis on meticulous procedural adherence to ensure justice and protection for the most vulnerable.
| 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
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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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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:
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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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(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) |