Dissolution of Marriage - CDDM001889

E-FILED 2014 JAN 09 1:19 PM SAC - CLERK OF DISTRICT COURT
E-FILED 2014 JAN 09 1:19 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 JAN 21 10:43 AM SAC - CLERK OF DISTRICT COURT
E-FILED 2014 JAN 21 10:43 AM SAC - CLERK OF DISTRICT COURT
2RDM04

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

IN RE THE MARRIAGE OF
ROBYN L DAVIS and BRIAN S DAVIS

UPON THE PETITION OF

ROBYN L DAVIS ,

PETITIONER,

AND CONCERNING

BRIAN S DAVIS ,

RESPONDENT.

Case No. 02811 CDDM001889

ORDER SETTING HEARING

On April 10, 2014, the above-entitled matter is presented to the Court for attention,
pursuant to Local Rule 2.7.

Proof of service on file reflects that the Respondent has been properly served or
accepted service of a copy of the petition for dissolution of marriage. The Respondent
has not filed an answer or other responsive pleading. Accordingly, the Court finds
that this matter should be set for hearing, at which time the Petitioner shall appear and
present evidence in support of a default judgment.

Pursuant to Iowa Rule of Civil Procedure 1.972, this order setting hearing shall
constitute written notice of intention to enter default judgment. THE RESPONDENT
IS ADVISED THAT UNLESS YOU ACT PRIOR TO THE TIME SET FOR HEARING,
A DEFAULT JUDGMENT WILL BE ENTERED AGAINST YOU AT THAT TIME AND
YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU
SHOULD SEEK LEGAL ADVICE AT ONCE.

IT IS, THEREFORE,THE ORDER OF THE COURT as follows:

1. A hearing to determine whether the Respondent is in Default is scheduled on
05/05/2014 at 11:00 AM at the Sac Co. Courthouse, 100 NW State St., Sac City, Iowa.
at which time the Petitioner shall appear and present evidence in support of a default
judgment. The Petitioner shall provide the court with a proposed decree at that time.
1 of 3
E-FILED 2014 APR 10 11:38 AM SAC - CLERK OF DISTRICT COURT

2. The clerk of court shall send a copy of this order to the Respondent not later than
ten days prior to said hearing.

If you need assistance to participate in court due to a disability, call the disability
coordinator at 641-421-0990. Persons who are hearing or speech impaired may call
Relay Iowa TTY (1-800-735-2942). Disablity coordinators cannot provide legal advice.

CLERK TO FURNISH COPIES TO:

BRIAN S DAVIS
DISTRICT COURT ADMINISTRATOR

2 of 3
State of Iowa Courts
Case Number Case Title
CDDM001889 ROBYN LEE DAVIS VS. BRIAN SCOTT DAVIS
Type: ORDER SETTING HEARING
So Ordered
Electronically signed on 2014-04-10 11:38:54
3 of 3
AND CONCERNING
BRIAN SCOTT DAVIS
UPON THE PETITION OF
)
ROBYN LEE DAVIS
]
No. CDDMO0I889
)
Petit:ioner,
)
)
CHILDREN IN THE MIDDLE
)
CERTIFICATES
)
)
)
Respondent.
)
COME NOW the Parties and hereby file completion certificates from
the Children in the Middle Educational Program from their earlier
attendance in a orior filed dissolution action.
/S/Charles A. Schulte AT0007137
SCHULTE LAW FIRM, L C
421 Main St., P.O. Box 392
Sac City, IA 50583
(712) 662-47ls
Fax:(712) 662-4884
schulaw(rDprairieinet.net
E-FILED 2014 APR 16 2:57 PM SAC - CLERK OF DISTRICT COURT
)
)
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Cg
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l N THI: DIS' I' RICT COURT OF TI IE ST{IF' OF l O\\A
IN AND FOR SAC COUNTY
IN I{E THE MARRIAGE
OF ROBYN DAVIS AND BRIAN DAVIS
Upon the Petition ol
ROBYN DAVIS
Petitioner,
And Concerning
tsRIAN DAVIS
ResPondent.
Total Debt:
NO. CDDN, I 0l 889
AFFIDAVIT OF
I-INANC]IAL STATIJS
t . Rob1' nDav i s . t l l e} , et l t l oner i nt l , } eabov eent i t l edmat t et bei ngf r r s t dul y s wor n. s t at el hat l hei b| | or r i n' l i l l t r t | el nd
compl ete statement of ml , assets ancl l i abj l i ti es under Di vi si on I (and m1' present i ncome undor Di vi si on Il i fappl i cabl e)
as ot
t h< dal of ,
201. 1.
Division |
-
NETWOIITH
STATIIMENT
( Reqi r cd r t xl l dr $. l r t i on cases. Secl i " 593 l l l
ASSETS
O$nershi P
Market
Net
l )escnptron
IHXWXJ)
Val ue
Encumbrance
Val ue
Real Estate
Vehi cl es
(make,
Year.)
( a r
(
)
Li fe Insurance
(cash val ue)
( a ,
(
)
Securi ti cs
Cash & Bank Accounts
( a )
Househol d Contents
l a )
Other Asscts
-
l tem i ze
c o 0 O $
O O0 5
0 0 0
s
o . o o
l -ess: Othef debts
-
Itemi zcd bel o$
s
o oo
NIT WOR' IIT:
Other Debts:
( a ,
$
o . 0 o
E-FILED 2014 MAY 01 2:33 PM SAC - CLERK OF DISTRICT COURT
Di vi si on II
-
CIJRRIINT INCOME AND EXPENSE
INFORMATION
1l o bc conr pl et ed b! al l pr nr es s. ckr ng or r esi sl r ng al i r noi ) or s' Pp' ! 1al l o$encesl
Gross
Deducti on(s)
(see bel orv)
Net l ncome
A. I ncome Sour ce
( i ncl udi ngADC
& other supporl
PaYme
nts.i
( a) Sac c ount Y Cat t 1e c o
Deducti ons Expl ai ned
(sPeci !
l ncome Sour ce:
i ncome suur ce ( a) . ( b ) . ( r ) . et c. )
( a )
( a )
{ a )
l ncome Sourcer
(a'
( a )
( a l
House Pal menE or l enE
Meal s or f , ood
Cl ot shang
car expense, t r ansPor t at i on
Medi ca] , dent al
ut i l i t l es and t el ePhone
Ot hei exPenses:
s
s
s
s
s
s
$
l nst al l mcnt Pal ment s and Odl cr Debt s Pa) abl e t o:
AI l j anI r cLr Lr ( \ l s
:
I
933. 33
per nont h
^ - r F 6 n f h
' t r . 4a
TOt sAL :
f or Feder aL Tax
f or st at e Tax
f , o! Soci a] Secui l t y Tax
< F < r
q ?
7---------------
$
9 (
9 3 3 . 3 3
7 1 . 4 0 J
$
o . o o
S
o . o o
$
? 1 . 4 0
B. Al Il ant' s esti mate of the other
spouse' s i ncome
( i ncl udi ngADC &
other support
PaYments
)
( a) Cent r al Mi l vr r aqr ht s
Deduct i ons
Deducti ons Ii xpl ai ned
(speci [ i ncome source
(a).(b).(c). etc.)
Gross
3, 054 . 17 per t nonEb
per honth
Deducti on(s)
(see bel orv)
4 5 6 . 9 0
Tot al :
Net Income
$
3 , 0 s 4 1 ?
s {
4s 6. 90)
$
2 , s 9 1 . 2 6
S
108 33
Per
$
1 1 4 . 9 3
Pe i
S
233. 64
Pe!
nont h f or Eeder al Tax
nont h f or st at e Tax
monl h f or soci al secur i t y Tax
C. Resi denti al Arrangements
Are both spouses l i vi ng i n the same drvel l i ng? No
l fthere are chi l dren.
$hi ch spouse or other person has physi cal care ofthe chi l dren? l l tl sband
Do the chi l dren rcsi de i n the fami l y' drvel l i ng or el sewhere? El sewhere
D. Personal expcnses l or Suppon ofAl l i ant
(and 1 chi l dren)
(Note; ALI expenses are reponed monthl )):
0. 00 per mont r t
0. 00 pe! nLont h
0. 00
pe! nont h
0. 00
per mont h
0. 00
per nont h
0. 00 pet nont h
0 . 00 pe! mont h
0 . 00 per monEn as
0. 00
per nonEh as
0. 00 as t enPor ar y
TOTAI :
lenporarY afinony
at shor neYs
f ees
$
0 . 0 0
V E R I F I C A I I O N
S]'ATE OF IOWA
COUNTY oF r-/.18. L
I. Robyn Davi s. bei ng fi rst dul l s\\om upon rny oath, depose and sl atc that I am the Peti ti oner i n
the above enti tl ccl cause ofacti on: that I l tave read the statements contai ned i n the l oregoi ng Fi nanci al
Atl l davi t and that the statcl nents therei n contai ned are true as I veri l y bel i eve
Daredrhi s
1-o"r' ,j ^
n
-t
Subscribed and suorn to berirre me this
1l
dat or
(fu("/
.zotl
x-
In and For-l he State of l orva
NOTAR
2014.
Docket No. : CDDMOl 889
CHILD SUPPORT GUIDELINES WORKSHEET
Counry: Sac
I. Net Monthl v l ncome of Peti ti oner:
Ix ]Custodi al
Parent
I l r' voncustodi al
Parent
[ ]Joi nt
Physi cal Care
(cl ai mi ng
! chi l d.i chi l dren as tax dependents)
A. Sour ces and Amount s of Annual I ncome:
sac cg{Lly
!9lJ lS !9.
Robyn Davrs
unl axeo)
Iess l /2 sel f empl oyment
(FICA) tax
Iess federal ad.j ustments to i ncome
l ess Personal exempti ons: sel f+
1
dependents
l ess standard deducti on
si ngl eI
I
head ofhousehol dl x] marri ed ti l i ng seperate[
]
Net taxabl e i ncome
-
f-ederal
Federal tax l i abi l i q'
Federal fax Credi t for Dependent Chi l dren (nonrefundabl e)
Fi nal Federal Tax Li abi l i tl
C. Statc Tax Deducti on
Gr oss Annual I ncome
l css 112 sel f empl o)ment (FICA) tax
l ess state adj ustments to i ncome
l ess f' ederal tax l i abi l i ty (adj usted l or dcpcndcnt tax crcdi t)
l ess state standard dcducti on
si ngl c[
]
head ol househol dI x]
Net taxabl e i ncotne
-
state
stare ta\ l i abi l i tv
mrni ed fi l i ng scpcrrte[
]
B. Federal Tax Deducti on
Gross Annual Taxabl e Income (
E.
S
5
S
1 1 , 2 0 0 . 0 0
1 1 , 2 0 0 _ 0 0
7 , 9 0 0 . 0 0. '
:
S
:
9 , 1 0 0 . 0 0 >
!r
8-9!
!!
0 . 0 0 >
1 t 2 C A 0 0
0 . 0 0 . -
$
lL
?!q:.q.!
0 . 0 0 >
0 . 0 0 >
8 5 6 . 8 0 >
T0tal :
s
< 4 , ' 7 4 C . A A
$
6 , ' 1 6 0 , 0 0
S
0 . 0 0
D.
l ess personi rl and dcpendent credi ts
pl us school di stri ct surtax (
o *
)
Fi nal Srate Tax Li abi l i tv
Soci al Securi ty and Nl edi carc Tax / Mandal ory Pensi on Deducti on
Annual eamed Incomc
Appl i cabl e rate (7.65% or 15.3%, as adj usted)
Annual Soci al Securi ry and Medi care tax l i abi l i t)' (adj usted)
Ot her Deduct i ons ( Annual )
l . Mandator)' occupai i onal l i cense fees
2. Uni on dues
i . Actual medi cal suppoft pai d pursuant to courl order or admi ni strati ve
order i n another ordcr for other chi l dren, not the pendi ng matter
4. Pri or obl i gati on of chi l d support and spouse suppon actual l y
pai d pursuant to coufi or admi ni strati ve order
5. Deducti ons for 9
addi ti onal qual i ti ed dependents
6. Chi l d care expcnses
(present acti on)
l ess federal chi l d care tax crcdi t
l ess state chi l d care tax credi t
l -et chi l d care expenses
Pr el i mi nar y Net Annual l ncome
Prel i mi nar] Average Monthl y Incom of Peti ti oner
7. Cl ash Monthl y Medi cal Suppon ordered i n thi s pendi ng acti on
$
1 1 , 2 0 0 . 0 0
' 7 . 6 5
+
Adj usted Net Ntonthl y Income of Peti ti oner (Prcl i mi nary Average Monthl )
i ncome mi nus monthl l cash medi cal support ordered i n thi s acti on)
S
$;
r o
,
3 1 3 . 2 A
8 6 1 . 9 3
8 6 1 . 9 3
CHI LD SUPPORT GUI DELI NES WORKSHEET
I . Net Mont hl r I ncome of Respondent :
[ ]Custodi al
Parenl
Ix ]Noncustodi al
Parent
[ ]Joi nt
Physi cal Carc
(cl ai mi ng
I chi l d' l chi l dren as tax dependents)
Cent r al Mi l wr l
qht
Br i an Davl s
Total :
s _ 3 5 , 6 s 0 . 0 0
s _
S
3 5 , 5 5 0 . 0 0
3 5 , 6 5 0 . 0 0
< 1 , 3 0 0 . 0 0 : -
. ; I , 3 / 9 . \ 2
. : 2 , A A 3 . 1 2
Gross Annual Taxabl e [ncomc ( untaxed)
l ess l / 2 sel f empl oyment ( FI CA) t ax
l ess federal adj ustments to i ncome
l ess Personal exempti ons; sel ft !
dependents
l ess standard dedLtcti on
si ngl e[
]
head ofhousehol d[x] marri ed fi l i ng seperatc[
]
-
i ederal
Federal tax l i abi l i tl '
Federal l ax Credi t fol Dependent Chi l dren
(nonrefundabl e)
Iri nal Federal Tax Li abi l i t)'
Stal e Tax Deducti on
Gross Annual l ncome
l css 112 sel f empl ol ' ment
(FICA) tax
l ess state adj ustments l o i ncome
l ess fcderal tax l i abi l i tl ' (adj usted for dependent ta\ credi t)
l ess statc standard deducti on
si ngl e[
]
head ofhousehol d[xl marri ed tl l i ng scperate[
]
n-cl taxabl e i ncome
-
state
State tax l i abi l i t)
l ess personal and dependent credi ts
--0
z
)
Fi nal State Tax Li abi l i t)
Soci al Securi ty and Medi carc Tax / Mandatory Pensi on Deducti on
Annual eamed Income
Appl i cabl e rate
(7.65% or 15.39i ,. as adj usted)
Annual Soci al Securi ty' and Medi carc tax l i abi l i ty (adj usted)
L Mandatory occupati onal l i cense t' ecs
2. [Jni on ducs
3. Actual medi cal supporl pai d pursuant to coun order or admi ni stral i ve
order i n another order for other chi l dren. not the pndi ng matter
-1.
Pri or obl i gati on of chi l d support and spouse suppofi actual Ly
pai d pursuant to court or admi ni strati ve order
5. Deducti ons for ! addi ti onal qual i fi cd dependents
6 Chi l d care expenses
(present acti on)
l c. s f cdcr i l l chi l d car c r ar cr cdi
Iess state chi l d care tax credi t
Net chi l d care expenses
Pr el i mi nar y Net Annual l ncom e
Prel i mi narl Average Monthl y Income of l {espondent
$
1 , 4 e 9 . E
<
12!
i !
< 7 , 9 0 0 . 0 0
< 9 , 1 0 0 . 0 0
s
1 9 , 6 s 0 . 0 0
< 2 , 3 0 0 . 0 0
+ 1 , 0 0 0 . 0 0
s
3 6 , 5 5 0 . 0 0
< i , f o o . o o
< 1 , 1 4 4 . 4 4
$
3 0 , 5 1 0 . 0 0
C.
D.
s
3 6 , 6 5 0 . 0 0
1
7 . 6 5 ?
t , .
$
7. Cash Monthl l Medi cal Support ordered i n thi s pendi ng aci i on
Adj usted Net Monthl y l ncorne of Respondent
(Prel i mi naq' Average Monthl y
i ncome mi nus monthl l cash medi cal support ordcrcd i n thi s acti on)
s _ 3 1 , 1 6 7 . l s
s
2 , 5 9 ' 7 . 2 5
r 5 2 . ' / r >
I I I . Cal cul at i on of t he Gui del i ne Amount of Suppor t
A. Adj usted Net Monthl ) l ncome
B. Proporl i onal Share oi l ncome
( Al so used t or Ll ncover ed Nf cdi cal Lxpnses)
C. Numbcr ofChi l dren for Whom Support i s Soughl
D. Basi c Support Obl i gati on i f Usi ng Onl y NCP' s l ncome
E. Basi c Suppod Obl i gati on i f Usi ng Combi ned Income
F. Each Parent' s Share ofBasi c Suppon Obl i gati on
$ 8 6 1 - 9 3 , + $ 2 , 4 4 4 . 5 5 : S 3 , 3 0 6 . 4 8
2 6 . A t Z
+
a ] c ] r 9
1 0 0 z
2
Custodi al
Par cnt
Ix]Peti ti oner
[ ] Respondent
(appl i cabl e)
Noncustodi al
Par ent
[ ] Pet i t i oner
Ix]Respondent
Combi ned
( \ \ ' hcn l l si ng Combl ncd I nconl e)
$
0 9 . 0 0
( \ , A
-
Pr - Spl n Amounl s
)
Combi ned
G. NCP' s Basi c Support Obl i gati on Befi )re Hcal th Ins.
tl . Cost ofChi l d(ren)' s Heal th Insurance Premi um
( Di f l er ence bel $ccn t ami l ] and si ngl e con. or as Or dcr ed )
S
L Heal th l nsurance Add-On or Deducti on fi om NCP
J. Ci ui del i ne Amount of Chi l d Support for NCP
( NC P s l i nc
( i
pl us or mr nus NCI r s l i nc l )
l l l - a Ext r aor di nar ) Vi si t at i on Cr edi t
A. Adj usted Net Nl onthl 1" l ncome
B. Propodi onal Share ofl ncome
( Al so used f { ) r I JncLr r el ed l { edi cal E\ penses)
C. Number ofChi l dl cn fbr Whom Suppon i s Sought
S __50] ! . 1r
(
Spl rl Cusr{rd} Adl usl ed
)
$
5 0 4 . 1 1
( Sp l r t Cu s l o d ) Ad j u s t e d )
S
+ i $
( compl et e onl \ i f noncusl odi al par eni s coun or der ed ! t sr t al xi n e\ ceeds l 2? o! cr ni ghl s
per
! ear l
K. r' ' CP' s Basi c Suppod Obl i gati on Befbre heal th Insurance (l i ne G) S
l -. Number ofcourt-ordcrcd vi si tai on oventi ghts wi th thc NCP
Nt. Extraordi nary Vi si tati on cl redi t Perccntage
N. Extraordi nar)' Vi si tati on Crcdi t
(l i nc K mul trpl i ed b) Lrnc l vl l
O. Gui del i ne Amount of Chi l d Support (After Crcdi t for Extra Vi si tati on)
(l i ne J nrnut l i ne N. nol l ess th.rn $i 0 for I chrl d $50 i br 2 or more)
tV. Cal cul ati on of Joi nt (Equal l l - Shared) Physi cal Care Gui del i ne
Amount of Chl d Support
(not appl i cabl e)
Pet i t i oner Respondent
+ $ $
i + z - 1 C 0 :
CHILD SUPPORT GUIDELIh"ES WORKSHEET
D. Basi c Support Obl i gati on Befbre Hcal th Insurance
( t . Jse l i ne A combi ncd ar nount t o i l nd amoLr nl
f i om Schedul e of Basi c Suppon Obl r gat i ons)
Il . Each Parent' s Basi c Pri mary Care Amount
Before Heal th Insurance
(Li ne B mul i l i pl i ed b) l i ne D f or each parnt )
S
F. Each Parent ' s Share of Joi nt Physi cal Support
( l . r ne F nt ul i pl i ed bf l : f br each per r nl t o
i t ucounl l br exl r a cLr sl s f or l wo r esi dences. )
G. Each Parenl ' s Joi nt Ph-' -si cal Care Support
Obl l i gati on Before Heal th Insurancc
(Li ne F nul rpl red b) 5 l br etch parcnt k)
accounl i r r 509n ol t i me sper t $r t h each p r ent
)
$
H. Cost of Chi l d(ren)' s Heal th Insurance Premi um'
( L) i f l er encc bet \ \ cen t hnl i l t and si n. ! : l c cosl . )
( *Tl ) e heal t h r nnt r ance adi usl menl does not appl ) r i er l hcr
par cnf s nct r ncome on l i r l e A l al l s $i t hr t he Lor I ncc' nr c
shaded Ar ca A ar ea oi t he Basi c Chi l d Suppon Schcdul e
$
l . tl eal th Insurance Add-On to each Parent' s
Obl i gati on
S
J. Gui del i ne Amount of Chi l d Suppon
( r ach par cnt ' s l r ne G pl us cr ch par ent ' s l i ne l l
K. Nc1 Amount of Chi l d Support for Joi nt Phl si cal
Support After Offset
( Smal l cr ar l r ounl of l r ne . l subt r acl ed f l ol n l l t r ger anr ounl
of l i ne J Par enl $l 1h l ar ger ann) unl on l i ne J
f al s
t hc
ot hcr par enl t he di f i t r encc. as a met hod of pal nr cnl
I f cr t her par ent r ccr \ es a- ssi st ance t hr ough Fl P l hc)
ot her pr r cnt s obl t g. r hon r e' ' er 1\ t o enl ount on l i r e I
J $
V. Speci al Fi ndi ngs
A. Income i mputed to Peti ti oner:
Income i mputed to Respondent:
B. Esti l nated i ncome of Pcl i ti oner:
Esti mated i ncome of Respondenl
C. De!i ati ons made fi om Chi l d Support Cui del i nes:
s _ 5
$ _ .
$
D. Rcquesr eJ dmuunl ol cl r i l J suppon
$ -
per montl t
vl . changes i n chi l d support obl i cati on as Nunl ber of chi l dren Enti ti l ed to support changcs
f l , or c. t scs $r t h mul i pl e chi l dr en based on pr esent r ncome and apl l i cabl e gui dcl i nes cal cul at i on met hod)
VI - a t sasi cObl i gat i on
( appt i cabl e)
r Sf l Ll Cust od\ Adi usl cd
_
N{ ul t r pl c Rcduct i on sceni l r l os ar e
f ossr bl e. )
\ Lr nr ber oi NCP' s Basi c
Chi l Jr en SupponObl i gat i on
1NP( l ' \ Li ne G) "
5
5
S
S
s
Vl -b. Jount (Equal l t Shared) Phl si cal Care Obl i gati on
5 0 4 . 1 1
5 9 8 . 1 1
S
$
$
$ _
s
( q
|
9A - RL
r ' ndi nr
f n\ '
\
50. 1 . 11
( Res f o. dnl
Pi Ys )
s s _ _
$
s
s $ s -
*( Al l
L. i nc r ef er ences ar c t o l ) 1\ i si on l l l . C. r l cLr l l 1i i on of l he Gui del i ne Ann) unl of Suppon sect r on ol t hc ! ! or kt hcel )
l l eal th l nsurance
Add-on or Deducti on
(NPC' s l .rnc I)'
Extraordl nary
Vi si tati on Credi l
(i f appl i cabl e)
( NPCI ' s I i ne N) *
ftot
appl i cabl e)
Gui del i ne Amount of
Chi l d Support
Respondent
( CP2
-
Li ne l i *
Gui del i ne Amount
of Chi l d Support
( l i ne J oI O) *i
Numbe r of
(l hi l drcn
Ci ui del i ne Arrrount of
Chi l d Suppor t
Peti ti oner
( CI ) l
- l r n c J ) '
S
s
Net Amount of Chi l d
Support for Joi nt Physi cal
Care After Ofl tet
( Li ne K) 1
S
$
SI ATE OI ' I ( ) WA. COLI NTY OF
5 o c
l ,
!!q)f
!rytr . do hercbv swear or affi rm that the foregoi ng statement l s true. compl etc
and correct as I veri l l bel i eve fi orn al l i nforni ati on avai l abl e to me at thi \ ti nre
o^./4/
(
?u
l"(
Thc undersi gned attomey fbr the Peti ti oner hcrebl cefti fi s that the fbregi ng chi l d Support Gui del i nc
workshects
were prepared b1' me or at m! di recti on i n good fai th rel i ance upon i nfomati ontvai l abl e
to ne at thi s
f .tt)
D^c:
fu!4 t[/
2"
l'1
s
q
5 _
5
5
$ - s
s -
s
( Robl n Davi s
)
Lcgal Works Gui deLi nes
Io'r'/a
Ap r l L 2 1 , 2 0 1 , 1
Pet i t l oner : Robyn Davi s
Cust odi af Chl l dr en: 1
Mont hl
y Gr oss I ncome:
Sa c Co u n L y Ca t t ] e Co . ' $
9 3 3 3 3 Ea r n e d
To L a l Gr o s s I n c o me : S
9 3 3 ' 3 1
I vl onLhl y Deduct l ons:
Fe d e r . a 1 Ta x : $
0 . 0 0
S t a t e T a x : $
0 . 0 0
So c l a l Se c u r i t y : $
7 1 4 0
c t h e r D e c i u c t i o n s : $
0 0 0
Cash Med Or . der : S 0 00
To t a f De d u c t i o n s : $
7 1 4 0
Mc n t h l y Ne t I n c o me : S 8 6 1 . 9 3
( 2 6 . A5 A2 )
{ L o " t I n c o me )
Fa mi l y Me d i c a l Co s t : $
0 . c 0
Mont hl y Suppol : t ol ^/ ed: $
9' i . 0C
( I r l dependent Cal cul at i cn)
Respondent :
Br l an Davl s
Cu s t o d i a l Ch i l d r e n : I
Mont hl l Gr oss I ncome:
Ce n t r a l Mi l wr l g h l - ' $
3 ! 5 ' l 1 ?
g a r n e d
To t a l Gr o s s I n c o me : $
3 0 5 4 1 7
Mor t hl y Deduct l ons:
F e d e r a l T a x : $
1 0 8 . 3 3
( l n c i u d e s
$
8 3 . 3 3 C T C )
s t a t e T a x : $
1 1 4 . 9 3
s o c i a l Se c u r r t Y: $
2 3 3 ' 5 1
o t h e r D e d u c L i o n s : $
0 0 0
Ca s h Me d Or d e r : i
" : t 2 - ' 1 7
To t a l De d u c t l o n s : $
5 0 9 6 1
Mo n t h l y Ne t I n c o me : I
2 4 4 4 . t 5 \ 7 3 9 1 2 2 )
Fa mi l y Me d l c a l Co s t : $
o o o
Mont hl y Sr . r ppor t Owed: $
598. 11
( I ndeper r deni Cal cul aLl on)
Moni Ll l y Suppor L Payabi e t o PeEi Li oner : I
50' ! 1 11
( Sp1r t Cust odr - Adi ust ed)
$
1 1 5 . 3 3
w e e k l y
S
232 . 61 Bi week I y ( ever y t l l o weeks )
$
2 5 2 . A5
-
Se mi Mo n t h L y
( t wi c e a mo n t h l
$
5 0 1 , 1 1 Mo n t h l y
l N THI: DIS' I' RICT COURT OF TI IE ST{IF' OF l O\\A
IN AND FOR SAC COUNTY
IN I{E THE MARRIAGE
OF ROBYN DAVIS AND BRIAN DAVIS
Upon the Petition ol
ROBYN DAVIS
Petitioner,
And Concerning
tsRIAN DAVIS
ResPondent.
Total Debt:
NO. CDDN, I 0l 889
AFFIDAVIT OF
I-INANC]IAL STATIJS
t . Rob1' nDav i s . t l l e} , et l t l oner i nt l , } eabov eent i t l edmat t et bei ngf r r s t dul y s wor n. s t at el hat l hei b| | or r i n' l i l l t r t | el nd
compl ete statement of ml , assets ancl l i abj l i ti es under Di vi si on I (and m1' present i ncome undor Di vi si on Il i fappl i cabl e)
as ot
t h< dal of ,
201. 1.
Division |
-
NETWOIITH
STATIIMENT
( Reqi r cd r t xl l dr $. l r t i on cases. Secl i " 593 l l l
ASSETS
O$nershi P
Market
Net
l )escnptron
IHXWXJ)
Val ue
Encumbrance
Val ue
Real Estate
Vehi cl es
(make,
Year.)
( a r
(
)
Li fe Insurance
(cash val ue)
( a ,
(
)
Securi ti cs
Cash & Bank Accounts
( a )
Househol d Contents
l a )
Other Asscts
-
l tem i ze
c o 0 O $
O O0 5
0 0 0
s
o . o o
l -ess: Othef debts
-
Itemi zcd bel o$
s
o oo
NIT WOR' IIT:
Other Debts:
( a ,
$
o . 0 o
Di vi si on II
-
CIJRRIINT INCOME AND EXPENSE
INFORMATION
1l o bc conr pl et ed b! al l pr nr es s. ckr ng or r esi sl r ng al i r noi ) or s' Pp' ! 1al l o$encesl
Gross
Deducti on(s)
(see bel orv)
Net l ncome
A. I ncome Sour ce
( i ncl udi ngADC
& other supporl
PaYme
nts.i
( a) Sac c ount Y Cat t 1e c o
Deducti ons Expl ai ned
(sPeci !
l ncome Sour ce:
i ncome suur ce ( a) . ( b ) . ( r ) . et c. )
( a )
( a )
{ a )
l ncome Sourcer
(a'
( a )
( a l
House Pal menE or l enE
Meal s or f , ood
Cl ot shang
car expense, t r ansPor t at i on
Medi ca] , dent al
ut i l i t l es and t el ePhone
Ot hei exPenses:
s
s
s
s
s
s
$
l nst al l mcnt Pal ment s and Odl cr Debt s Pa) abl e t o:
AI l j anI r cLr Lr ( \ l s
:
I
933. 33
per nont h
^ - r F 6 n f h
' t r . 4a
TOt sAL :
f or Feder aL Tax
f or st at e Tax
f , o! Soci a] Secui l t y Tax
< F < r
q ?
7---------------
$
9 (
9 3 3 . 3 3
7 1 . 4 0 J
$
o . o o
S
o . o o
$
? 1 . 4 0
B. Al Il ant' s esti mate of the other
spouse' s i ncome
( i ncl udi ngADC &
other support
PaYments
)
( a) Cent r al Mi l vr r aqr ht s
Deduct i ons
Deducti ons Ii xpl ai ned
(speci [ i ncome source
(a).(b).(c). etc.)
Gross
3, 054 . 17 per t nonEb
per honth
Deducti on(s)
(see bel orv)
4 5 6 . 9 0
Tot al :
Net Income
$
3 , 0 s 4 1 ?
s {
4s 6. 90)
$
2 , s 9 1 . 2 6
S
108 33
Per
$
1 1 4 . 9 3
Pe i
S
233. 64
Pe!
nont h f or Eeder al Tax
nont h f or st at e Tax
monl h f or soci al secur i t y Tax
C. Resi denti al Arrangements
Are both spouses l i vi ng i n the same drvel l i ng? No
l fthere are chi l dren.
$hi ch spouse or other person has physi cal care ofthe chi l dren? l l tl sband
Do the chi l dren rcsi de i n the fami l y' drvel l i ng or el sewhere? El sewhere
D. Personal expcnses l or Suppon ofAl l i ant
(and 1 chi l dren)
(Note; ALI expenses are reponed monthl )):
0. 00 per mont r t
0. 00 pe! nLont h
0. 00
pe! nont h
0. 00
per mont h
0. 00
per nont h
0. 00 pet nont h
0 . 00 pe! mont h
0 . 00 per monEn as
0. 00
per nonEh as
0. 00 as t enPor ar y
TOTAI :
lenporarY afinony
at shor neYs
f ees
$
0 . 0 0
V E R I F I C A I I O N
S]'ATE OF IOWA
COUNTY oF r-/.18. L
I. Robyn Davi s. bei ng fi rst dul l s\\om upon rny oath, depose and sl atc that I am the Peti ti oner i n
the above enti tl ccl cause ofacti on: that I l tave read the statements contai ned i n the l oregoi ng Fi nanci al
Atl l davi t and that the statcl nents therei n contai ned are true as I veri l y bel i eve
Daredrhi s
1-o"r' ,j ^
n
-t
Subscribed and suorn to berirre me this
1l
dat or
(fu("/
.zotl
x-
In and For-l he State of l orva
NOTAR
2014.
Docket No. : CDDMOl 889
CHILD SUPPORT GUIDELINES WORKSHEET
Counry: Sac
I. Net Monthl v l ncome of Peti ti oner:
Ix ]Custodi al
Parent
I l r' voncustodi al
Parent
[ ]Joi nt
Physi cal Care
(cl ai mi ng
! chi l d.i chi l dren as tax dependents)
sac cg{Lly
!9lJ lS !9.
Robyn Davrs
unl axeo)
Iess l /2 sel f empl oyment
(FICA) tax
Iess federal ad.j ustments to i ncome
l ess Personal exempti ons: sel f+
1
dependents
l ess standard deducti on
si ngl eI
I
head ofhousehol dl x] marri ed ti l i ng seperate[
]
-
f-ederal
Federal tax l i abi l i q'
Federal fax Credi t for Dependent Chi l dren (nonrefundabl e)
Fi nal Federal Tax Li abi l i tl
C. Statc Tax Deducti on
Gr oss Annual I ncome
l css 112 sel f empl o)ment (FICA) tax
l ess state adj ustments to i ncome
l ess f' ederal tax l i abi l i ty (adj usted l or dcpcndcnt tax crcdi t)
l ess state standard dcducti on
si ngl c[
]
head ol househol dI x]
Net taxabl e i ncotne
-
state
stare ta\ l i abi l i tv
mrni ed fi l i ng scpcrrte[
]
Gross Annual Taxabl e Income (
E.
S
5
S
1 1 , 2 0 0 . 0 0
1 1 , 2 0 0 _ 0 0
7 , 9 0 0 . 0 0. '
:
S
:
9 , 1 0 0 . 0 0 >
!r
8-9!
!!
0 . 0 0 >
1 t 2 C A 0 0
0 . 0 0 . -
$
lL
?!q:.q.!
0 . 0 0 >
0 . 0 0 >
8 5 6 . 8 0 >
T0tal :
s
< 4 , ' 7 4 C . A A
$
6 , ' 1 6 0 , 0 0
S
0 . 0 0
D.
l ess personi rl and dcpendent credi ts
o *
)
Fi nal Srate Tax Li abi l i tv
Soci al Securi ty and Nl edi carc Tax / Mandal ory Pensi on Deducti on
Annual eamed Incomc
Appl i cabl e rate (7.65% or 15.3%, as adj usted)
Annual Soci al Securi ry and Medi care tax l i abi l i t)' (adj usted)
l . Mandator)' occupai i onal l i cense fees
2. Uni on dues
i . Actual medi cal suppoft pai d pursuant to courl order or admi ni strati ve
order i n another ordcr for other chi l dren, not the pendi ng matter
4. Pri or obl i gati on of chi l d support and spouse suppon actual l y
pai d pursuant to coufi or admi ni strati ve order
5. Deducti ons for 9
addi ti onal qual i ti ed dependents
6. Chi l d care expcnses
(present acti on)
l ess federal chi l d care tax crcdi t
l ess state chi l d care tax credi t
l -et chi l d care expenses
Pr el i mi nar y Net Annual l ncome
Prel i mi nar] Average Monthl y Incom of Peti ti oner
7. Cl ash Monthl y Medi cal Suppon ordered i n thi s pendi ng acti on
$
1 1 , 2 0 0 . 0 0
' 7 . 6 5
+
Adj usted Net Ntonthl y Income of Peti ti oner (Prcl i mi nary Average Monthl )
i ncome mi nus monthl l cash medi cal support ordered i n thi s acti on)
S
$;
r o
,
3 1 3 . 2 A
8 6 1 . 9 3
8 6 1 . 9 3
I . Net Mont hl r I ncome of Respondent :
[ ]Custodi al
Parenl
Ix ]Noncustodi al
Parent
[ ]Joi nt
Physi cal Carc
(cl ai mi ng
I chi l d' l chi l dren as tax dependents)
Cent r al Mi l wr l
qht
Br i an Davl s
Total :
s _ 3 5 , 6 s 0 . 0 0
s _
S
3 5 , 5 5 0 . 0 0
3 5 , 6 5 0 . 0 0
< 1 , 3 0 0 . 0 0 : -
. ; I , 3 / 9 . \ 2
. : 2 , A A 3 . 1 2
Gross Annual Taxabl e [ncomc ( untaxed)
l ess l / 2 sel f empl oyment ( FI CA) t ax
l ess federal adj ustments to i ncome
l ess Personal exempti ons; sel ft !
dependents
l ess standard dedLtcti on
si ngl e[
]
head ofhousehol d[x] marri ed fi l i ng seperatc[
]
-
i ederal
Federal tax l i abi l i tl '
Federal l ax Credi t fol Dependent Chi l dren
(nonrefundabl e)
Iri nal Federal Tax Li abi l i t)'
Stal e Tax Deducti on
Gross Annual l ncome
l css 112 sel f empl ol ' ment
(FICA) tax
l ess state adj ustments l o i ncome
l ess fcderal tax l i abi l i tl ' (adj usted for dependent ta\ credi t)
l ess statc standard deducti on
si ngl e[
]
head ofhousehol d[xl marri ed tl l i ng scperate[
]
n-cl taxabl e i ncome
-
state
State tax l i abi l i t)
l ess personal and dependent credi ts
--0
z
)
Fi nal State Tax Li abi l i t)
Soci al Securi ty and Medi carc Tax / Mandatory Pensi on Deducti on
Annual eamed Income
Appl i cabl e rate
(7.65% or 15.39i ,. as adj usted)
Annual Soci al Securi ty' and Medi carc tax l i abi l i ty (adj usted)
L Mandatory occupati onal l i cense t' ecs
2. [Jni on ducs
3. Actual medi cal supporl pai d pursuant to coun order or admi ni stral i ve
order i n another order for other chi l dren. not the pndi ng matter
-1.
Pri or obl i gati on of chi l d support and spouse suppofi actual Ly
pai d pursuant to court or admi ni strati ve order
5. Deducti ons for ! addi ti onal qual i fi cd dependents
6 Chi l d care expenses
(present acti on)
l c. s f cdcr i l l chi l d car c r ar cr cdi
Iess state chi l d care tax credi t
Net chi l d care expenses
Pr el i mi nar y Net Annual l ncom e
Prel i mi narl Average Monthl y Income of l {espondent
$
1 , 4 e 9 . E
<
12!
i !
< 7 , 9 0 0 . 0 0
< 9 , 1 0 0 . 0 0
s
1 9 , 6 s 0 . 0 0
< 2 , 3 0 0 . 0 0
+ 1 , 0 0 0 . 0 0
s
3 6 , 5 5 0 . 0 0
< i , f o o . o o
< 1 , 1 4 4 . 4 4
$
3 0 , 5 1 0 . 0 0
C.
D.
s
3 6 , 6 5 0 . 0 0
1
7 . 6 5 ?
t , .
$
7. Cash Monthl l Medi cal Support ordered i n thi s pendi ng aci i on
Adj usted Net Monthl y l ncorne of Respondent
(Prel i mi naq' Average Monthl y
i ncome mi nus monthl l cash medi cal support ordcrcd i n thi s acti on)
s _ 3 1 , 1 6 7 . l s
s
2 , 5 9 ' 7 . 2 5
r 5 2 . ' / r >
I I I . Cal cul at i on of t he Gui del i ne Amount of Suppor t
A. Adj usted Net Monthl ) l ncome
B. Proporl i onal Share oi l ncome
( Al so used t or Ll ncover ed Nf cdi cal Lxpnses)
C. Numbcr ofChi l dren for Whom Support i s Soughl
D. Basi c Support Obl i gati on i f Usi ng Onl y NCP' s l ncome
E. Basi c Suppod Obl i gati on i f Usi ng Combi ned Income
F. Each Parent' s Share ofBasi c Suppon Obl i gati on
$ 8 6 1 - 9 3 , + $ 2 , 4 4 4 . 5 5 : S 3 , 3 0 6 . 4 8
2 6 . A t Z
+
a ] c ] r 9
1 0 0 z
2
Custodi al
Par cnt
Ix]Peti ti oner
[ ] Respondent
(appl i cabl e)
Noncustodi al
Par ent
[ ] Pet i t i oner
Ix]Respondent
Combi ned
( \ \ ' hcn l l si ng Combl ncd I nconl e)
$
0 9 . 0 0
( \ , A
-
Pr - Spl n Amounl s
)
Combi ned
G. NCP' s Basi c Support Obl i gati on Befi )re Hcal th Ins.
tl . Cost ofChi l d(ren)' s Heal th Insurance Premi um
( Di f l er ence bel $ccn t ami l ] and si ngl e con. or as Or dcr ed )
S
L Heal th l nsurance Add-On or Deducti on fi om NCP
J. Ci ui del i ne Amount of Chi l d Support for NCP
( NC P s l i nc
( i
pl us or mr nus NCI r s l i nc l )
l l l - a Ext r aor di nar ) Vi si t at i on Cr edi t
A. Adj usted Net Nl onthl 1" l ncome
B. Propodi onal Share ofl ncome
( Al so used f { ) r I JncLr r el ed l { edi cal E\ penses)
C. Number ofChi l dl cn fbr Whom Suppon i s Sought
S __50] ! . 1r
(
Spl rl Cusr{rd} Adl usl ed
)
$
5 0 4 . 1 1
( Sp l r t Cu s l o d ) Ad j u s t e d )
S
+ i $
( compl et e onl \ i f noncusl odi al par eni s coun or der ed ! t sr t al xi n e\ ceeds l 2? o! cr ni ghl s
per
! ear l
K. r' ' CP' s Basi c Suppod Obl i gati on Befbre heal th Insurance (l i ne G) S
l -. Number ofcourt-ordcrcd vi si tai on oventi ghts wi th thc NCP
Nt. Extraordi nary Vi si tati on cl redi t Perccntage
N. Extraordi nar)' Vi si tati on Crcdi t
(l i nc K mul trpl i ed b) Lrnc l vl l
O. Gui del i ne Amount of Chi l d Support (After Crcdi t for Extra Vi si tati on)
(l i ne J nrnut l i ne N. nol l ess th.rn $i 0 for I chrl d $50 i br 2 or more)
tV. Cal cul ati on of Joi nt (Equal l l - Shared) Physi cal Care Gui del i ne
Amount of Chl d Support
(not appl i cabl e)
Pet i t i oner Respondent
+ $ $
i + z - 1 C 0 :
CHILD SUPPORT GUIDELIh"ES WORKSHEET
D. Basi c Support Obl i gati on Befbre Hcal th Insurance
( t . Jse l i ne A combi ncd ar nount t o i l nd amoLr nl
f i om Schedul e of Basi c Suppon Obl r gat i ons)
Il . Each Parent' s Basi c Pri mary Care Amount
Before Heal th Insurance
(Li ne B mul i l i pl i ed b) l i ne D f or each parnt )
S
F. Each Parent ' s Share of Joi nt Physi cal Support
( l . r ne F nt ul i pl i ed bf l : f br each per r nl t o
i t ucounl l br exl r a cLr sl s f or l wo r esi dences. )
G. Each Parenl ' s Joi nt Ph-' -si cal Care Support
Obl l i gati on Before Heal th Insurancc
(Li ne F nul rpl red b) 5 l br etch parcnt k)
accounl i r r 509n ol t i me sper t $r t h each p r ent
)
$
H. Cost of Chi l d(ren)' s Heal th Insurance Premi um'
( L) i f l er encc bet \ \ cen t hnl i l t and si n. ! : l c cosl . )
( *Tl ) e heal t h r nnt r ance adi usl menl does not appl ) r i er l hcr
par cnf s nct r ncome on l i r l e A l al l s $i t hr t he Lor I ncc' nr c
shaded Ar ca A ar ea oi t he Basi c Chi l d Suppon Schcdul e
$
l . tl eal th Insurance Add-On to each Parent' s
Obl i gati on
S
J. Gui del i ne Amount of Chi l d Suppon
( r ach par cnt ' s l r ne G pl us cr ch par ent ' s l i ne l l
K. Nc1 Amount of Chi l d Support for Joi nt Phl si cal
Support After Offset
( Smal l cr ar l r ounl of l r ne . l subt r acl ed f l ol n l l t r ger anr ounl
of l i ne J Par enl $l 1h l ar ger ann) unl on l i ne J
f al s
t hc
ot hcr par enl t he di f i t r encc. as a met hod of pal nr cnl
I f cr t her par ent r ccr \ es a- ssi st ance t hr ough Fl P l hc)
ot her pr r cnt s obl t g. r hon r e' ' er 1\ t o enl ount on l i r e I
J $
V. Speci al Fi ndi ngs
A. Income i mputed to Peti ti oner:
Income i mputed to Respondent:
B. Esti l nated i ncome of Pcl i ti oner:
Esti mated i ncome of Respondenl
C. De!i ati ons made fi om Chi l d Support Cui del i nes:
s _ 5
$ _ .
$
D. Rcquesr eJ dmuunl ol cl r i l J suppon
$ -
per montl t
vl . changes i n chi l d support obl i cati on as Nunl ber of chi l dren Enti ti l ed to support changcs
f l , or c. t scs $r t h mul i pl e chi l dr en based on pr esent r ncome and apl l i cabl e gui dcl i nes cal cul at i on met hod)
VI - a t sasi cObl i gat i on
( appt i cabl e)
r Sf l Ll Cust od\ Adi usl cd
_
N{ ul t r pl c Rcduct i on sceni l r l os ar e
f ossr bl e. )
\ Lr nr ber oi NCP' s Basi c
Chi l Jr en SupponObl i gat i on
1NP( l ' \ Li ne G) "
5
5
S
S
s
Vl -b. Jount (Equal l t Shared) Phl si cal Care Obl i gati on
5 0 4 . 1 1
5 9 8 . 1 1
S
$
$
$ _
s
( q
|
9A - RL
r ' ndi nr
f n\ '
\
50. 1 . 11
( Res f o. dnl
Pi Ys )
s s _ _
$
s
s $ s -
*( Al l
L. i nc r ef er ences ar c t o l ) 1\ i si on l l l . C. r l cLr l l 1i i on of l he Gui del i ne Ann) unl of Suppon sect r on ol t hc ! ! or kt hcel )
l l eal th l nsurance
Add-on or Deducti on
(NPC' s l .rnc I)'
Extraordl nary
Vi si tati on Credi l
(i f appl i cabl e)
( NPCI ' s I i ne N) *
ftot
appl i cabl e)
Gui del i ne Amount of
Chi l d Support
Respondent
( CP2
-
Li ne l i *
Gui del i ne Amount
of Chi l d Support
( l i ne J oI O) *i
Numbe r of
(l hi l drcn
Ci ui del i ne Arrrount of
Chi l d Suppor t
Peti ti oner
( CI ) l
- l r n c J ) '
S
s
Net Amount of Chi l d
Support for Joi nt Physi cal
Care After Ofl tet
( Li ne K) 1
S
$
SI ATE OI ' I ( ) WA. COLI NTY OF
5 o c
l ,
!!q)f
!rytr . do hercbv swear or affi rm that the foregoi ng statement l s true. compl etc
and correct as I veri l l bel i eve fi orn al l i nforni ati on avai l abl e to me at thi \ ti nre
o^./4/
(
?u
l"(
Thc undersi gned attomey fbr the Peti ti oner hcrebl cefti fi s that the fbregi ng chi l d Support Gui del i nc
workshects
were prepared b1' me or at m! di recti on i n good fai th rel i ance upon i nfomati ontvai l abl e
to ne at thi s
f .tt)
D^c:
fu!4 t[/
2"
l'1
s
q
5 _
5
5
$ - s
s -
s
( Robl n Davi s
)
Lcgal Works Gui deLi nes
Io'r'/a
Ap r l L 2 1 , 2 0 1 , 1
Pet i t l oner : Robyn Davi s
Cust odi af Chl l dr en: 1
Mont hl
y Gr oss I ncome:
Sa c Co u n L y Ca t t ] e Co . ' $
9 3 3 3 3 Ea r n e d
To L a l Gr o s s I n c o me : S
9 3 3 ' 3 1
I vl onLhl y Deduct l ons:
Fe d e r . a 1 Ta x : $
0 . 0 0
S t a t e T a x : $
0 . 0 0
So c l a l Se c u r i t y : $
7 1 4 0
c t h e r D e c i u c t i o n s : $
0 0 0
Cash Med Or . der : S 0 00
To t a f De d u c t i o n s : $
7 1 4 0
Mc n t h l y Ne t I n c o me : S 8 6 1 . 9 3
( 2 6 . A5 A2 )
{ L o " t I n c o me )
Fa mi l y Me d i c a l Co s t : $
0 . c 0
Mont hl y Suppol : t ol ^/ ed: $
9' i . 0C
( I r l dependent Cal cul at i cn)
Respondent :
Br l an Davl s
Cu s t o d i a l Ch i l d r e n : I
Mont hl l Gr oss I ncome:
Ce n t r a l Mi l wr l g h l - ' $
3 ! 5 ' l 1 ?
g a r n e d
To t a l Gr o s s I n c o me : $
3 0 5 4 1 7
Mor t hl y Deduct l ons:
F e d e r a l T a x : $
1 0 8 . 3 3
( l n c i u d e s
$
8 3 . 3 3 C T C )
s t a t e T a x : $
1 1 4 . 9 3
s o c i a l Se c u r r t Y: $
2 3 3 ' 5 1
o t h e r D e d u c L i o n s : $
0 0 0
Ca s h Me d Or d e r : i
" : t 2 - ' 1 7
To t a l De d u c t l o n s : $
5 0 9 6 1
Mo n t h l y Ne t I n c o me : I
2 4 4 4 . t 5 \ 7 3 9 1 2 2 )
Fa mi l y Me d l c a l Co s t : $
o o o
Mont hl y Sr . r ppor t Owed: $
598. 11
( I ndeper r deni Cal cul aLl on)
Moni Ll l y Suppor L Payabi e t o PeEi Li oner : I
50' ! 1 11
( Sp1r t Cust odr - Adi ust ed)
$
1 1 5 . 3 3
w e e k l y
S
232 . 61 Bi week I y ( ever y t l l o weeks )
$
2 5 2 . A5
-
Se mi Mo n t h L y
( t wi c e a mo n t h l
$
5 0 1 , 1 1 Mo n t h l y
UPON ]'IIE PETITION OF
ROB\'N LEE DAVIS
No. CDDMOO1889
Petitioner,
STIPULATION AND
SETTLEMENT AGREEMENT
AND CONCERNING
BRIAN SCOTT DAVIS
Respondent.
This Stipulation and Settlernent Agreement is entered into between
Robyn Lee Davis, Petitioner and Brian Scott Davis, Respondent. Both
parties desire an amicable settlement of all their rights, duties and
obligations
growing out of their past marital relationship and growing out of
the issues presented in this cause.
IT IS AGREED. SUBJECT TO THE APPROVAL OF THE COURT, AS
FOLLOWS:
1. BREAKDOWN OF MARRIAGE: There has been a breakdown of the
rnarriage relationship between the parties and said breakdown has been to
the extent that the legitirnate objects of tnatrimony have been destroyed and
there remains no reasonable likelihood that the rnarriage can be preser-ved.
2. WAIVER OF CONCILIATION:
Because of the breakdown of the
marriage between the parties, conciliation would serve no uselul purpose
and the same should be waived.
3. PERSONAL PROPERTY: The parties have previously divided their
personal propefty. Each party shall be awarded the personal property in his
or her possession at the time a decree is entered herein.
j oi nt
l egal custody of M.S.D. Robyn shal l be awarded pri mary care. Bri an
shall have reasonable and liberal visitation rights such as the pafties can
agree on. In any event, Brian shall be entitled to visitation every other
weekend from Friday at 5:00 P.M. until the following Sunday at 5:00 P.M.
ln even numbered years, he shall also be entitled to Christmas visitation
which shall begin at 9:00 A.M., on the day after school lets out for the
Chri stmas Hol i day, and shal l end December 25"' at Noon..Duri ng even
numbered years he shal l al so be enti tl ed to vi si tati on on 4"' of Jul y and
Mernorial Day and Thanksgiving. During odd numbered years, Brian shall
have visitation during the second half of the Christmas vacation which shall
being on Christmas Day at noon and end at 5:00 P.M., the day before school
is scheduled to resume. During odd numbered years, Brian shall also be
entitled to visitation on Easter and Labor Day. Brian shall be entitled to
visitation each Father's Day and Robyn shall be entitled to custody of the
child each Mother's Day. Holiday visitation takes precedence over regular
week-end visitation. Brian shall also be entitled to three weeks of summer
vi si tati on when school i s not i n sessi on and to vi si tati on on the chi l d' s
birthday.
Bri an shal l pay $504.11
per month as chi l d suppoft unti l such ti me as
M.S.D. attains the age of eighteen years or graduates from high school,
whichever occurs later. This amount is in compliance with the Iowa Child
Supporl Guidelines. Support shall be paid to Collection Services Center,
P.O. Box 9215, Des Moi nes, IA 50306-9125. Al l sums subrni tted shal l be
labeled to identify the respondent and shall furlher be labeled by the
fol l owi ng case number: Sac County CDDM 1889.
5. COLLEGE SUBSIDY: The parties agree that the Courl shall retain
j uri sdi cti on
to detenni ne the i ssue ofa col l ege subsi dy i n the event the chi l d
pursues post secondary education.
6. MEDICAL SUPPORT: Brian shall provide health insurance for M.S D.
Each party shall pay up to $250.00
toward non-covered medical costs. The
balance due, if any, shall be paid by the parlies in proporlion to their income.
7. INCOME TAX EXEMPTIONS: Bri an shal l be enti tl ed to cl ai m the
child as a dependent for purposes of State and Federal Income Taxes for
even numbered tax years. Robyn shall be entitled to claim the child as a
dependant for purposes of State and Federal Income Taxes for odd
numbered tax years.
8. ATTORNEY FEES AND COSTS: Each party shall be responsible for
their own attorney fees. The respondent shall be responsible fbr the courl
costs.
9. FULL AND COMPLETE AGREEMENT: Thi s agreement shal l
represent the full, complete and final settletnent of the parlies' rights, titles,
interests, duties and obligations growing out of the marriage of the panies.
Each party covenants and agrees not to make any further claims against the
other and each parly releases the other from all claims ofinheritance and
dower which had existed because of the marriage relationship. Each party
agrees to execute and deliver to the other any titles, deeds or other
documents deemed necessary or convenient to carry out any ofthe terms or
conditions of this agreement. This agreement shall inule to and bind the
heirs, executors, administrators and assigns of the parties hereto.
Dated this I day of
2014
l - , r
i
I
Robyn Lee Davi s. Peti ti oner
Dated this
9
7
dav ot
AD. . ' l , 2014
DISCLAIMER
The undersigned, Brian Davis, understands that Charles A' Schulte
represents the interests of the Petitioner Robyn Davis only. Charles A.
Schulte has given the undersigned no legal advice whatsoever; has
Scott Davis. Respondent
Charles A. Schulte, Attori-ey fbi Petiti
recommended that the undersigned seek independent legal counsel and has
given no indication to the undersigned as to the advisability ofentering into
t hi c c orpprn, -n t
, \ \
\ - \
J
Bri an Davi s

In the matter of the Marriage of Robyn Lee Davis and Brian Scott Davis,
Upon the Petition of )
) No !DDM""#$$%
Robyn Lee Davis, )
Petitioner, ) D&!R&& '( DISS'LU)I'N
) '( M*RRI*+&
*nd !oncerning )
)
Brian Scott Davis, )
Respondent )
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

)his matter comes on for hearing )he Petitioner appears a-ong .ith her attorney,
!har-es * Sch/-te )he respondent has neither appeared, ans.ered or fi-ed a motion
herein, b/t has signed a stip/-ation and sett-ement agreement More than ninety days
have e-apsed since the respondent .as served .ith origina- notice of this action )he
!o/rt has 0/risdiction of the parties and the s/b0ect matter herein )he matter proceeds to
hearing and the !o/rt is presented .ith a Stip/-ation and Property Sett-ement agreement
.hich has been signed by both parties )he !o/rt e1amines the same and finds it to be
fair and e2/itab-e )he !o/rt having read the p-eadings and the fi-e contents, having
heard the evidence presented by the petitioner3 having heard the statements of !o/nse-
and being f/--y advised in the premises finds that there has been a brea4do.n of the
marriage re-ationship to the e1tent that the -egitimate ob0ects of matrimony have been
destroyed and there remains no reasonab-e -i4e-ihood that the marriage can be preserved
)he necessary .aiting period prescribed by -a. has e-apsed and efforts at reconci-iation
have fai-ed

I) IS )5&R&('R& 'RD&R&D, *D6UD+&D *ND D&!R&&D that the parties
are hereby granted a disso-/tion of marriage and each party is hereby restored to a-- the
rights and privi-eges of /nmarried persons
I) IS (UR)5&R 'RD&R&D, *D6UD+&D *ND D&!R&&D that the Stip/-ation
and Property Sett-ement *greement on fi-e herein is approved and the same is adopted
and made a part of this decree the same as if f/--y set forth
I) IS (UR)5&R 'RD&R&D that each party sha-- be responsib-e for their
attorney fees )he Respondent sha-- be responsib-e for the co/rt costs
I) IS (UR)5&R 'RD&R&D that the parties sha-- comp-y .ith Io.a !ode
Section 7%$88B

E-FILED 2014 MAY 05 9:04 AM SAC - CLERK OF DISTRICT COURT
State of Iowa Courts
Type: DECREE OR FINAL SUPPORT ORDER
Case Number Case Title
CDDM001889 ROBYN LEE DAVIS VS. BRIAN SCOTT DAVIS
So Ordered
Electronically signed on 2014-05-05 09:04:09 page 2 of 2
E-FILED 2014 MAY 05 9:04 AM SAC - CLERK OF DISTRICT COURT

Dissolution of Marriage - CDDM001889

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E-FILED 2014 JAN 09 1:19 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 JAN 09 1:19 PM SAC - CLERK OF DISTRICT COURT

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