The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

PLAINTIFFʼS AFFIDAVIT IN
SUPPORT OF REQUEST
FOR A CHILD SUPPORT ORDER

DOCKET NO. (FOR COURT USE ONLY)

TRIAL COURT OF MASSACHUSETTS

PLAINTIFFʼS NAME

DEFENDANTʼS NAME

COURT DIVISION

I, _______________________________, do state or affirm that the following is true to the best of my knowledge and belief:

1. The Defendant is the mother/father (circle one) and I am the legal custodian of the following child(ren).

____________________________________________

____________________________________________

____________________________________________

____________________________________________

2. The Defendant works as a

____________________________________________________________________.

The Defendant works for ______________________________________________________________________,

whose address is ____________________________________________________________________________.

3. My gross income and my expenses are as follows:

Gross income

Health insurance

(income before taxes)

I make $__________ per week/month (circle one).

Dental and/or vision insurance

My child care expenses for child(ren) listed in Par. 1

Other child support obligations

I pay

$__________ per week/month (circle one).

I pay

$__________ per week/month (circle one).

I pay

$__________ per week/month (circle one).

I pay

$__________ per week/month (circle one).

4. Based on my knowledge, the Defendantʼs gross income and his/her expenses are as follows:

(income before taxes)

S/he makes $__________ per week/month (circle one).

Gross income

Health insurance

Dental and/or vision insurance

Defendant’s child care expenses

for child(ren) listed in Par. 1

Other child support obligations

S/he pays $__________ per week/month (circle one).

S/he pays $__________ per week/month (circle one).

S/he pays $__________ per week/month (circle one).

S/he pays $__________ per week/month (circle one).

I state that the above is true, signed under penalties of perjury.

PLAINTIFFʼS PRINTED NAME

DATE

PLAINTIFFʼS SIGNATURE

FA-11 (1/12)

Plaintiff's Affidavit in Support of Request for a Child Support Order

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 1
Fields(s): 43
Average fields per page: 43
Reading Level: Grade 5
LIST Grouping(s): GO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

affirm_true_knowledge_belief was do_state_or_affirm_that_the_following_is_true_to_the_best_of_my_knowledge_and_belief (0.58 conf)
plaintiff_name was plaintiffʼs_name (0.43 conf)
i was i (0.38 conf)
page_field__1 was page_0_field_3 (0.31 conf)
mother_one_custodian_child was 1__the_defendant_is_the_mother_father__circle_one__and_i_am_the_legal_custodian_of_the_following_child_ren (0.40 conf)
page_field__2 was page_0_field_5 (0.31 conf)
page_field__3 was page_0_field_6 (0.31 conf)
page_field__4 was page_0_field_7 (0.31 conf)
page_field__5 was page_0_field_8 (0.31 conf)
page_field__6 was page_0_field_9 (0.31 conf)
page_field__7 was page_0_field_10 (0.31 conf)
page_field__8 was page_0_field_11 (0.31 conf)
page_field__9 was page_0_field_12 (0.31 conf)
page_field__10 was page_0_field_13 (0.31 conf)
page_field__11 was page_0_field_14 (0.31 conf)
page_field__12 was page_0_field_15 (0.31 conf)
page_field__13 was page_0_field_16 (0.31 conf)
page_field__14 was page_0_field_17 (0.31 conf)
page_field__15 was page_0_field_18 (0.31 conf)
page_field__16 was page_0_field_19 (0.31 conf)
page_field__17 was page_0_field_20 (0.31 conf)
page_field__18 was page_0_field_21 (0.31 conf)
page_field__19 was page_0_field_22 (0.31 conf)
page_field__20 was page_0_field_23 (0.31 conf)
page_field__21 was page_0_field_24 (0.31 conf)
page_field__22 was page_0_field_25 (0.31 conf)
page_field__23 was page_0_field_26 (0.31 conf)
page_field__24 was page_0_field_27 (0.31 conf)
page_field__25 was page_0_field_28 (0.31 conf)
gross_income_expenses was 3__my_gross_income_and_my_expenses_are_as_follows (0.42 conf)
page_field__26 was page_0_field_30 (0.31 conf)
defendant_works was the_defendant_works_for (0.39 conf)
af_f was AFF032 (0.51 conf)
page_field__27 was page_0_field_33 (0.31 conf)
page_field__28 was page_0_field_34 (0.31 conf)
page_field__29 was page_0_field_35 (0.31 conf)
page_field__30 was page_0_field_36 (0.31 conf)
makes was s_he_makes (0.34 conf)
page_field__31 was page_0_field_38 (0.37 conf)
pays was s_he_pays (0.44 conf)
page_field__32 was page_0_field_40 (0.31 conf)
page_field__33 was page_0_field_41 (0.37 conf)
state_signed_penalties_perjury was i_state_that_the_above_is_true__signed_under_penalties_of_perjury (0.48 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Plaintiff's Affidavit in Support of Request for a Child Support Order

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02