Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address
Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address
Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address
Mailing Address (Street or Post Office Box)
Telephone
Email Address
, Case No.
Petitioner,
PETITIONER’S RESPONDENT’S
vs. AFFIDAVIT
IN SUPPORT OF
, IN OPPOSITION
Respondent. TO MOTION FOR TEMPORARY ORDERS
INSTRUCTIONS
1. Complete the entire Affidavit in black ink. If the spaces provided on this form are
inadequate, use separate sheets of paper to complete the answers and attach them to
the Affidavit. Answer every question completely! You must complete every blank. If
you do not know the answer to a question or are guessing, please state that. If a
question does not apply, write “NA” for “not applicable” to indicate you read the question.
Round all amounts of money to the nearest dollar.
1. GENERAL INFORMATION:
A. Name: Date of Birth:
C. Current Address:
E. Last date when you and the other party lived together:
F. Names of children common to the parties in this case, their dates of birth, and Social
Security Number(s):
H. For the past five years, the children have resided with Petitioner and/or Respondent as
follows: [PUT IN ADDRESSES, BEGINNING AND ENDING DATES].
A. I have not participated as a party or witness or in any other capacity, in any other
proceeding concerning the custody of or visitation with the child/ren identified above.
or
B. I do not know of any proceeding that could affect the current proceeding, including
proceedings for enforcement and proceedings related to domestic violence, protective
orders, termination of parental rights, and adoptions.
I know of the following proceedings that could affect the current proceeding: (identify
each proceeding by court, case number, and the nature of the proceeding)
C. There is not a child protection proceeding pending involving any of the children
identified above.
or
There is a child protection proceeding pending involving the children identified above.
(identify the court and case number)
A. Your job/occupation/profession/title:
Previous job/occupation/profession/title:
E. Your total gross income from January 1 of this year to the date of this Affidavit (year-to-
date income): $
4. YOUR EDUCATION/TRAINING: List name of school, length of time there, a year of last
attendance, and degree earned:
A. High School:
B. College:
C. Post-Graduate:
D. Occupational Training:
3. Lodging $
4. Other (explain) $
C. Commissions/Bonuses $
D. Tips $
H. Unemployment compensation $
I. Gifts/Prizes $
M. Other (explain): $
INSTRUCTIONS
Both parties must answer item 7 if either party asks for child support. These expenses include
only those expenses for children who are common to the parties, which means one party is the
birth/adoptive mother and the other is the birth/adoptive father of the children.
A. HEALTH INSURANCE:
1. Total monthly cost: $
B. DENTAL/VISION INSURANCE:
1. Total monthly cost: $
TOTAL: $
H. EXTRAORDINARY EXPENSES:
Explain:
2. For Self: $
Explain:
INSTRUCTIONS
Both parties must answer items 8 and 9 if either party is requesting:
Spousal maintenance
Division of expenses
Attorneys’ fees and costs
Adjustment or deviation from the child support amount
Enforcement
A. HOUSING EXPENSES:
1. House payment:
a. First Mortgage: $
b. Second Mortgage: $
d. Rent: $
5. Other (explain) $
TOTAL: $
B. UTILITIES:
1. Water, sewer, and garbage: $
2. Electricity: $
4. Telephone: $
5. Mobile Phone/Pager: $
6. Internet Provider: $
7. Cable/Satellite Television: $
8. Other (explain): $
TOTAL: $
2. School lunches: $
TOTAL: $
D. CLOTHING:
1. Clothing for you: $
TOTAL: $
7. Other (explain): $
TOTAL: $
F. MISCELLANEOUS:
1. School and school supplies: $
4. Church/Contributions: $
8. Disability insurance: $
9. Recreation/Entertainment: $
14. Cigarettes: $
15. Alcohol: $
TOTAL: $
10. CUSTODY:
A. The opposing party and I were unable to reach an agreement in mediation regarding
the temporary custody of our child.
or
I have asked the opposing party to participate in mediation and he/she has refused.
Attach copy of letter requesting mediation.
B. A temporary custody schedule is necessary for the well-being of the child because:
.
C. During our marriage, we cared for the child in the following manner: (input care given i.e. I
have been the primary caretaker and my spouse has been the primary breadwinner.)
D. Since our separation (or since entry of the last custody order), our child has been with
each of us according the following schedule:
G. The child has been with the following care providers when we are unable to care for
him/her/them because of work:
.
H. Our child attends school at (name of school)
which is located miles away from my residence and miles from the
opposing party’s residence.
L. Our child has the following special needs: (input any physical health or mental health conditions)
or
There has been domestic violence in our relationship. The most recent incident
occurred on (date) .
Describe incident and summarize any other notable history of domestic violence.
Describe and identify any criminal and civil cases involving the parties.
Describe the nature and extent of any circumstances known to the moving party that
would subject the child/ren to a risk of neglect or abuse in either parent’s custody
including, but not limited to, substance abuse or dependence, and domestic violence. If
there is substance dependence or abuse, identify the substance and the affiant’s
personal knowledge of the issue.
B. I am requesting the court enter a temporary custody schedule as follows: (identify schedule
desired/in the best interest of the child)
I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is
true and correct.
Date:
Typed/printed Signature