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Petitioner and Respondent CHILDREN AGE CHILDREN Child One Child Four Child Two Child Five Child Three AGE Child Six Parent Receiving Support Parent Paying Support 1. MONTHLY GROSS INCOME $ $ a. Court ordered maintenance being received. $ 2. ADJUSTMENTS (per month) a. Other court or administratively ordered child support being paid. ($ ) ($ ) b. Court ordered maintenance being paid. ($ ) ($ ) c. Support obligatio.

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