STATE OF SOUTH CAROLINA	)	IN THE FAMILY COURT
)	JUDICIAL CIRCUIT
COUNTY OF	)
)	TEMPORARY HEARING
)	BACKGROUND INFORMATION
Plaintiff,	)	PROVIDED BY:
vs.	)
)
)
Defendant.	)	Docket No.

1.	Date of Marriage:

2.	Date of Separation:

3.	Unemancipated Children:

Child’s Name	Date of Birth	Child’s Name	Date of Birth
1.	4.
2.	5.
3.	6.

4.	Gross Monthly Incomes (indicate if imputed):

Husband/Father:	$ ( imputed)

Wife/Mother:	$ ( imputed)

5.	If child support is a contested issue, complete the following, using monthly amounts:

Father	Mother

A. Previously Ordered Alimony OR Child Support:

B. Other Children in the Home:

C. Health Insurance Premium for Children:

D. Regularly Occurring Extraordinary Med. Exp.:

E. Gross Work-Related Child Care Expense:

6.	The following are issues that are settled or contested as indicated on a temporary basis:

Contested	Settled

Paternity

Custody

Visitation

Child Support

Alimony

Use of Property

Attorney’s Fees and Costs

Vehicles

Health insurance

Other:

Attached is a completed and signed Financial Declaration.

If child support is a contested issue, attach a child support calculation pursuant to the South Carolina Department of Social Services Child Support Guidelines.

________________________________

Attorney for the Plaintiff/Defendant

SCCA 459 (11/2012)

Cody Lidge

2012-11-26