SUPPORT CALCULATION QUESTIONAIRE AND CONTRACT FOR ATTORNEY SERVICES

COMPUTER SUPPORT CALCULATION

GENERAL INFORMATION RE COMPUTER SUPPORT CALCULATION

INSTRUCTIONS

QUESTIONAIRE

CONTRACT FOR OUR SERVICES

PAYMENT METHODS

COMPUTER SUPPORT CALCULATION

For several years in California child and spousal support amounts have been calculated using "Guidelines" developed by the State Legislature. Judges and attorneys use a computer program called "Dissomaster" to do the calculation and, in most cases, the guideline amount is what the Court will order.

Many variables are plugged into the program to produce the final calculation. The main factors for determining child support are 1) the relative incomes of the parties, 2) the amount of time each party spends with the children and, 3) the amount of any child care expense.

In working out divorce agreements, it helps greatly to know what the Court would probably order in a particular case. The best way to do this is to do a "Dissomaster" computer calculation. (Our fee to do the computer calculation is $75)

INSTRUCTIONS

Download, fill out, and print the questionare and attorney fee agreement below.
Attach relevant documents.
Fax or mail the questionare, agreement, and other documents to our office.
If you don't have an account with us, send us a check, give us your credit card number below, or call us with your credit card number after you have sent us the documents.
After we have received the documents and your payment, we will take it from there and will call you if we need anything more from you.

If you have questions or would like us to fax or mail you a questionare, give us a call at (562) 596-8177, send us a fax at (562) 596-0298, E-mail us at KinseyE@ix.netcom.com.

SUPPORT CALCULATION QUESTIONIARE

SECTION 1 CLIENT INFORMATION
*NAME & ADDRESS*
NAME/ADDRESS:	_____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________
COUNTY:	_____________________________________________
HOME PHONE:	(_____) _____ - __________
BUSINESS PHONE:	(_____) _____ - __________
FAX:	(_____) _____ - __________
E-MAIL:	________________________

*EMPLOYMENT*
EMPLOYER NAME & ADDRESS:	_____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________
HOW LONG WITH THIS EMPLOYER?	_____________________________________________
*GENERAL INFORMATION*
BIRTHDAY:	_____________________________________________
SOCIAL SECURITY #:	_____________________________________________
DRIVER'S LIC. #:	_____________________________________________
LENGTH RESIDENCE IN CA:	_____________________________________________
LENGTH RESIDENCE IN COUNTY:	_____________________________________________

SECTION 2 INFORMATION ABOUT YOUR SPOUSE
*SPOUSE NAME & ADDRESS*
NAME/ADDRESS:	_____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________
COUNTY:	_____________________________________________
HOME PHONE:	(_____) _____ - __________
BUSINESS PHONE:	(_____) _____ - __________
FAX:	(_____) _____ - __________
E-MAIL:	________________________

*SPOUSE EMPLOYMENT*
EMPLOYER NAME & ADDRESS:	_____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________
HOW LONG WITH THIS EMPLOYER?	_____________________________________________
*SPOUSE - GENERAL INFORMATION*
BIRTHDAY:	_____________________________________________
SOCIAL SECURITY #:	_____________________________________________
DRIVER'S LIC. #:	_____________________________________________
LENGTH RESIDENCE IN CA:	_____________________________________________
LENGTH RESIDENCE IN COUNTY:	_____________________________________________

SECTION 3 MARRIAGE & SEPARATION
*MARRIAGE*
DATE OF MARRIAGE:	_____________________________________________
PLACE OF MARRIAGE:	_____________________________________________
*SEPARATION*
DATE OF MARRIAGE:	_____________________________________________
PLACE OF MARRIAGE:	_____________________________________________

SECTION 4 MINOR CHILDREN
*CHILDREN OF THIS MARRIAGE*
FULL LEGAL NAME	BIRTHDATE	AGE
1. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______
2. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______
3. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______
4. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______
*CHILDREN NOT OF THIS MARRIAGE*
FULL LEGAL NAME	BIRTHDATE	AGE
1. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______
2. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______
3. ______________________________________________ Living With Whom? ___________________________ Residence Address: ___________________________	____________	______

SECTION 5
YOUR INCOME & EXPENSE INFORMATION

*
GENERAL INFORMATION
*

1. Are you receiving or have you applied for or do you intend to apply for welfare or AFDC?

____ Receiving ____ Applied For ____ Intend To Apply For ____ No

2. What is your date of bitth (month/day/year) . . . . . . . . . . . . . . . . . . . . . ___________

3. What is your occupation? _______________________________________________

4. Highest year of education completed: _____________________________________

5. Are you currently employed? ____ Yes ____ No

a. If yes: (1) Where do you work? (name & address) _____________________

____________________________________________________

(2) When did you start work? (month/year) ____________________

b. If no: (1) When did you last work (month/year)? _______________________

(2) What were your gross monthly earnings? $_________________

6. What is the total number of minor children you are legally obligated to support? ____

*
INCOME INFORMATION
*

1. Total gross salary or wages, including commissions, bonuses, and

overtime paid during the last 12 months: . . . . . . . . . . . . . . . . . . . . $_____________

2. All other money received during the last 12 months except welfare

AFDC, SSI, spousal support from this marriage, or any child
support. (Include pensions, social security, disability, unemployment,
military basic allowance for quarters (BAQ), spousal support from a
different marriage, dividends, interest or royalty, trust income, and
annuities. Include income from a business, rental properties, and
reimbursement of job-related expenses.)

** Prepare and attach a schedule showing gross receipts less cash
expenses for each business or rental property . . . . . . . . . . . . . . . $____________

3. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________

DIVIDE THE RESULT IN LINE 3 ABOVE, DIVIDE IT BY 12 TO GET A MONTHLY AVERAGE FOR THE LAST 12 MONTHS, AND INSERT IN LINE 4a BELOW

ENTER YOUR GROSS INCOME FOR LAST MONTH INTO LINE 4b BELOW


	Average monthly last 12 months	Last month
4. Gross income	4a $__________	4b $__________

5. State income tax	5a $__________	5b $__________
6. Federal Income tax	6a $__________	6b $__________
7. Social Security and Hospital Tax ("FICA" and "MEDI") or self-employment tax, or the amount used to secure retirement or disability benefits	7a $__________	7b $__________
8. Health insurance for you and any children you are required to support	8a $__________	8b $__________
9. State disability insurance	9a $__________	9b $__________
10. Mandatory union dues	10a $__________	10b $__________
11. Mandatory retirement and pension fund contributions (Do not include any deduction claimed in item 7)	11a $__________	11b $__________
12. Court-ordered child support, court ordered spousal support, and voluntarily paid child support in an amount not more than the guideline amount actually being paid for a relationship OTHER than that involved in this proceeding.	12a $__________	12b $__________
13. Necessary job-related expenses (attach explanation)	13a $__________	13b $__________
14. Hardship deduction (Line 4d from Child Support Information below)	14a $__________	14b $__________
15. Add lines 5 through 14 TOTAL MONTHLY DEDUCTIONS:	15a $__________	15b $__________
16. Subtract line 15 from line 4 NET MONTHLY DISPOSABLE INCOME:	16a $__________	16b $__________

17. AFDC, welfare, spousal support from this marriage, and child support from other relationships received each month.	17 $__________
18. Cash and check accounts	18 $__________
19. Savings, credit union, certificates of deposit, and money market accounts.	19 $__________
20. Stocks, bonds, and other liquid assets:	20 $__________
21. All other property, real or personal (attach a list with values)	21 $__________
ATTACH A COPY OF YOUR THREE MOST RECENT PAY STUBS.

* EXPENSE INFORMATION *
1. PERSONS IN YOUR HOME:
	Name	Age	Relationship	Gross Monthly Income
a. List all persons living in your home whose expenses are included below (continue on attachment)	1. _____________________	____	___________	$_________
	2. _____________________	____	___________	$_________
	3. _____________________	____	___________	$_________
	4. _____________________	____	___________	$_________
===========================================================
b. List all other persons whose expenses are not included below living in your home	1. _____________________	____	___________	$_________
	2. _____________________	____	___________	$_________
	3. _____________________	____	___________	$_________
===========================================================

2. MONTHLY EXPENSES
a. Residence payments
(1) ____ Rent or ____ Mortgage		$_________
(2) If mortgage, include:
Average principle	$_________
Average interest	$_________
Impound for real proiperty taxes	$_________
Impound for homeowner's insurance	$_________
(3) Real property taxes (if not included in item 2)		$_________
(4) Homeowner's or renter's insurance (if not included in item 2)		$_________
(5) Maintenance		$_________
b. Unreimbursed medical and dental expenses		$_________
c. Child care		$_________
d. Children's education		$_________
e. Food at home and household supplies		$_________
f. Food eating out		$_________
g. Utilities		$_________
h. Telephone		$_________
i. Laundry and cleaning		$_________
j. Clothing		$_________
k. Insurance (Life, accident, etc. Do not include auto, home, or health insurance)		$_________
l. Education (specify)		$_________
m. Entertainment		$_________
n. Transportation and auto expenses (Insurance, gas, oil, and repair)		$_________
o. Installment payments (insert total and itemize in #3 below)		$_________
p. Other (specify)		$_________
q. TOTAL EXPENSES (a-p) (do not included amounts in a(2)		$_________


3. ITEMIZATION OF INSTALLMENT PAYMENTS OR OTHER DEBTS (Attach a continuation sheet if necessary)
Creditor's Name	Payment For	Monthly Payment	Balance	Date Last Payment Made
____________________	_______________	$_________	$_________	________
____________________	_______________	$_________	$_________	________
____________________	_______________	$_________	$_________	________
____________________	_______________	$_________	$_________	________


4. ATTORNEY FEES AND COSTS OF SUIT

a. To date I have paid my attorney for fees and costs:	$_________
The source of this money was: ____________________________________
b. I owe to date the following fees and costs over the amount paid:	$_________
c. My arrangement for attorney fees and costs is:
______________________________________________________________

* CHILD SUPPORT INFORMATION (THIS SECTION MUST BE COMPLETED ONLY IF CHILD SUPPORT IS AN ISSUE *
1. Health insurance for my children ____ is ____ is not available through my employer
a. Monthly cost paid by me or on my behalf for children only (Do not include the amount paid or payable by your employer:		$_________
b. Name of carrier: _________________
c. Address of carrier: ________________

d. Policy or group policy number: ________

2. Approximate percentage of time each parent has primary physical responsibility for the children: Mother ____% Father ____%

3. The court is requested to order the following as additional child support:
____ Child care costs related to employment or to reasonably necessary education or training for employment skills. (1) Monthly amount currently paid by mother: $_______ (2) Monthly amount currently paid by father: $_______ ____ Uninsured health care costs for the children (For each cost state the purpose for which the costs was incurred and the estimated monthly, yearly, or lump sum amount paid by each parent. ________________________ ________________________ ____ Educational or other special needs of the children (for each cost state the purpose for which the cost was incurred and the estimated monthly, yearly, or lump sum amount paid by each parent. ________________________ ________________________ ____ Travel expense for visitation; (1) Monthly amount currently paid by mother: $_________ (2) Monthly amount currently paid by father $_________
4. ____ The court is requested to allow the deductions identified below, which are justifiable expenses that have caused an extreme financial hardship:
Hardship Expense	Amount paid per month	How many months will you need to make these payments
a. ____ Extraordinary health care expenses (specify and attach any supporting documents)	$_________	_________
b. ____ Uninsured catastrophic losses (specify and attach supporting documents)	$_________	_________
c. ____ Minimum basic living expenses of dependent minor children from other marriages or relationships who live with you (specify names and ages of these children)	$_________	_________

d. Total hardship deductions requested (add lines a-c)	$_________

SECTION 6
INCOME & EXPENSE INFORMATION OF THE OTHER PARTY

*
GENERAL INFORMATION
*

1. Are you receiving or have you applied for or do you intend to apply for welfare or AFDC?

____ Receiving ____ Applied For ____ Intend To Apply For ____ No

2. What is your date of bitth (month/day/year) . . . . . . . . . . . . . . . . . . . . . ___________

3. What is your occupation? _______________________________________________

4. Highest year of education completed: _____________________________________

5. Are you currently employed? ____ Yes ____ No

a. If yes: (1) Where do you work? (name & address) _____________________

____________________________________________________

(2) When did you start work? (month/year) ____________________

b. If no: (1) When did you last work (month/year)? _______________________

(2) What were your gross monthly earnings? $_________________

6. What is the total number of minor children you are legally obligated to support? ____

*
INCOME INFORMATION
*

1. Total gross salary or wages, including commissions, bonuses, and

overtime paid during the last 12 months: . . . . . . . . . . . . . . . . . . . . $_____________

2. All other money received during the last 12 months except welfare

AFDC, SSI, spousal support from this marriage, or any child
support. (Include pensions, social security, disability, unemployment,
military basic allowance for quarters (BAQ), spousal support from a
different marriage, dividends, interest or royalty, trust income, and
annuities. Include income from a business, rental properties, and
reimbursement of job-related expenses.)

** Prepare and attach a schedule showing gross receipts less cash
expenses for each business or rental property . . . . . . . . . . . . . . . $____________

3. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________

DIVIDE THE RESULT IN LINE 3 ABOVE, DIVIDE IT BY 12 TO GET A MONTHLY AVERAGE FOR THE LAST 12 MONTHS, AND INSERT IN LINE 4a BELOW

ENTER YOUR GROSS INCOME FOR LAST MONTH INTO LINE 4b BELOW


	Average monthly last 12 months	Last month
4. Gross income	4a $__________	4b $__________

5. State income tax	5a $__________	5b $__________
6. Federal Income tax	6a $__________	6b $__________
7. Social Security and Hospital Tax ("FICA" and "MEDI") or self-employment tax, or the amount used to secure retirement or disability benefits	7a $__________	7b $__________
8. Health insurance for you and any children you are required to support	8a $__________	8b $__________
9. State disability insurance	9a $__________	9b $__________
10. Mandatory union dues	10a $__________	10b $__________
11. Mandatory retirement and pension fund contributions (Do not include any deduction claimed in item 7)	11a $__________	11b $__________
12. Court-ordered child support, court ordered spousal support, and voluntarily paid child support in an amount not more than the guideline amount actually being paid for a relationship OTHER than that involved in this proceeding.	12a $__________	12b $__________
13. Necessary job-related expenses (attach explanation)	13a $__________	13b $__________
14. Hardship deduction (Line 4d from Child Support Information below)	14a $__________	14b $__________
15. Add lines 5 through 14 TOTAL MONTHLY DEDUCTIONS:	15a $__________	15b $__________
16. Subtract line 15 from line 4 NET MONTHLY DISPOSABLE INCOME:	16a $__________	16b $__________

17. AFDC, welfare, spousal support from this marriage, and child support from other relationships received each month.	17 $__________
18. Cash and check accounts	18 $__________
19. Savings, credit union, certificates of deposit, and money market accounts.	19 $__________
20. Stocks, bonds, and other liquid assets:	20 $__________
21. All other property, real or personal (attach a list with values)	21 $__________
ATTACH A COPY OF YOUR THREE MOST RECENT PAY STUBS.

* EXPENSE INFORMATION *
1. PERSONS IN YOUR HOME:
	Name	Age	Relationship	Gross Monthly Income
a. List all persons living in your home whose expenses are included below (continue on attachment)	1. _____________________	____	___________	$_________
	2. _____________________	____	___________	$_________
	3. _____________________	____	___________	$_________
	4. _____________________	____	___________	$_________
===========================================================
b. List all other persons whose expenses are not included below living in your home	1. _____________________	____	___________	$_________
	2. _____________________	____	___________	$_________
	3. _____________________	____	___________	$_________
===========================================================

2. MONTHLY EXPENSES
a. Residence payments
(1) ____ Rent or ____ Mortgage		$_________
(2) If mortgage, include:
Average principle	$_________
Average interest	$_________
Impound for real proiperty taxes	$_________
Impound for homeowner's insurance	$_________
(3) Real property taxes (if not included in item 2)		$_________
(4) Homeowner's or renter's insurance (if not included in item 2)		$_________
(5) Maintenance		$_________
b. Unreimbursed medical and dental expenses		$_________
c. Child care		$_________
d. Children's education		$_________
e. Food at home and household supplies		$_________
f. Food eating out		$_________
g. Utilities		$_________
h. Telephone		$_________
i. Laundry and cleaning		$_________
j. Clothing		$_________
k. Insurance (Life, accident, etc. Do not include auto, home, or health insurance)		$_________
l. Education (specify)		$_________
m. Entertainment		$_________
n. Transportation and auto expenses (Insurance, gas, oil, and repair)		$_________
o. Installment payments (insert total and itemize in #3 below)		$_________
p. Other (specify)		$_________
q. TOTAL EXPENSES (a-p) (do not included amounts in a(2)		$_________


3. ITEMIZATION OF INSTALLMENT PAYMENTS OR OTHER DEBTS (Attach a continuation sheet if necessary)
Creditor's Name	Payment For	Monthly Payment	Balance	Date Last Payment Made
____________________	_______________	$_________	$_________	________
____________________	_______________	$_________	$_________	________
____________________	_______________	$_________	$_________	________
____________________	_______________	$_________	$_________	________


4. ATTORNEY FEES AND COSTS OF SUIT

a. To date I have paid my attorney for fees and costs:	$_________
The source of this money was: ____________________________________
b. I owe to date the following fees and costs over the amount paid:	$_________
c. My arrangement for attorney fees and costs is:
______________________________________________________________

* CHILD SUPPORT INFORMATION (THIS SECTION MUST BE COMPLETED ONLY IF CHILD SUPPORT IS AN ISSUE *
1. Health insurance for my children ____ is ____ is not available through my employer
a. Monthly cost paid by me or on my behalf for children only (Do not include the amount paid or payable by your employer:		$_________
b. Name of carrier: _________________
c. Address of carrier: ________________

d. Policy or group policy number: ________

2. Approximate percentage of time each parent has primary physical responsibility for the children: Mother ____% Father ____%

3. The court is requested to order the following as additional child support:
____ Child care costs related to employment or to reasonably necessary education or training for employment skills. (1) Monthly amount currently paid by mother: $_______ (2) Monthly amount currently paid by father: $_______ ____ Uninsured health care costs for the children (For each cost state the purpose for which the costs was incurred and the estimated monthly, yearly, or lump sum amount paid by each parent. ________________________ ________________________ ____ Educational or other special needs of the children (for each cost state the purpose for which the cost was incurred and the estimated monthly, yearly, or lump sum amount paid by each parent. ________________________ ________________________ ____ Travel expense for visitation; (1) Monthly amount currently paid by mother: $_________ (2) Monthly amount currently paid by father $_________
4. ____ The court is requested to allow the deductions identified below, which are justifiable expenses that have caused an extreme financial hardship:
Hardship Expense	Amount paid per month	How many months will you need to make these payments
a. ____ Extraordinary health care expenses (specify and attach any supporting documents)	$_________	_________
b. ____ Uninsured catastrophic losses (specify and attach supporting documents)	$_________	_________
c. ____ Minimum basic living expenses of dependent minor children from other marriages or relationships who live with you (specify names and ages of these children)	$_________	_________

d. Total hardship deductions requested (add lines a-c)	$_________

ATTORNEY FEE AGREEMENT


_________________________________hereinafter referred to as "CLIENT," agrees to pay KINSEY LAW OFFICES, hereinafter referred to as "ATTORNEYS," the sums specified below for the following services: COMPUTER CALCULATION OF CHILD AND/OR SPOUSAL SUPPORT USING INFORMATION PROVIDED BY CLIENT.
Client shall pay to Attorneys a NONREFUNDABLE fee in the amount ot $75 for one calculation.
EXCLUSIONS: Attorneys shall not:

Provide forms or advice in connection with any legal actions
Act as the attorneys of record for Client in court or in negotiations with opposing parties or attorneys.

Client understands and agrees that he/she shall represent him/herself in all court proceedings and Attorneys shall not be required to appear at any such proceedings.

In case suit or action is instituted to collect any sums due under this Agreement, Client agrees to pay such additional sum over and above the amount of Client's indebtedness to Attorneys as the court may adjudge reasonable as Attorney fees incurred in such suit or action.

This agreement will not take effect and Attorneys shall have no obligation to provide services until Client both 1) returns to Attorneys a signed copy of this agreement and, 2) makes the entire advance payment specified herein.

EXECUTED at Seal Beach, California. _________________________ DATED: ____________ CLIENT _________________________ DATED: ____________ ATTORNEY

PAYMENT OPTIONS

CREDIT CARD - VISA, MASTERCARD, AMERICAN EXPRESS-	Bring your card to the office or; Include your credit card information below; Call us with the information.
*CHECK,* *MONEY ORDER*	Mail you check or money order with your questionare and attorney fee agreement.

CREDIT CARD INFORMATION
CARD TYPE:	__________________________________________
CARD NUMBER:	__________________________________________
EXACT NAME ON CARD:	__________________________________________
CARD NUMBER:	__________________________________________
EXPIRATION DATE:	__________________________________________
BILLING ADDRESS FOR THIS CARD:	__________________________________________ __________________________________________ __________________________________________ __________________________________________