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:

DEFENDANTʼS AFFIDAVIT IN
CONNECTION WITH 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.

I am the mother/father (circle one) of the following minor child(ren):

____________________________________________

____________________________________________

____________________________________________

____________________________________________

2. The Plaintiff is the legal custodian of the above named child(ren).

3.

I work as a

________________________________________________________________________________.

I work for __________________________________________________________________________________,

whose address is ____________________________________________________________________________.

4. 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).

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

DEFENDANTʼS PRINTED NAME

DATE

DEFENDANTʼS SIGNATURE

FA-12 (1/12)

Defendant's Affidavit in Connection with 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): 41
Average fields per page: 41
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)
mother_one_minor_child was i_am_the_mother_father__circle_one__of_the_following_minor_child_ren (0.32 conf)
i was i (0.38 conf)
page_field__1 was page_0_field_3 (0.31 conf)
page_field__2 was page_0_field_4 (0.31 conf)
page_field__3 was page_0_field_5 (0.31 conf)
page_field__4 was page_0_field_6 (0.31 conf)
page_field__5 was page_0_field_7 (0.31 conf)
page_field__6 was page_0_field_8 (0.31 conf)
page_field__7 was page_0_field_9 (0.31 conf)
page_field__8 was page_0_field_10 (0.31 conf)
page_field__9 was page_0_field_11 (0.31 conf)
unknown was 1 (0.38 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)
plaintiff_legal_named_child was 2__the_plaintiff_is_the_legal_custodian_of_the_above_named_child_ren (0.38 conf)
page_field__13 was page_0_field_17 (0.31 conf)
page_field__14 was page_0_field_18 (0.31 conf)
page_field__15 was page_0_field_19 (0.31 conf)
page_field__16 was page_0_field_20 (0.31 conf)
page_field__17 was page_0_field_21 (0.31 conf)
page_field__18 was page_0_field_22 (0.31 conf)
page_field__19 was page_0_field_23 (0.31 conf)
page_field__20 was page_0_field_24 (0.31 conf)
page_field__21 was page_0_field_25 (0.31 conf)
whose_address was whose_address_is (0.41 conf)
work was i_work_as_a (0.29 conf)
page_field__22 was page_0_field_28 (0.31 conf)
page_field__23 was page_0_field_29 (0.31 conf)
page_field__24 was page_0_field_30 (0.31 conf)
page_field__25 was page_0_field_31 (0.31 conf)
gross_income_expenses was 4__my_gross_income_and_my_expenses_are_as_follows (0.42 conf)
page_field__26 was page_0_field_33 (0.31 conf)
page_field__27 was page_0_field_34 (0.31 conf)
af_f was AFF035 (0.51 conf)
page_field__28 was page_0_field_36 (0.31 conf)
page_field__29 was page_0_field_37 (0.37 conf)
page_field__30 was page_0_field_38 (0.37 conf)
page_field__31 was page_0_field_39 (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

Defendant's Affidavit in Connection with Request for a Child Support Order

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Identified Data Fields:

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