| Standard Contributions Assessment Appendix C |
Guideline: State
Number: 30 (Appendix C) Effective Date: 6/96 |
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| CONTRIBUTION ASSESSMENT FORM | ||||||
| Category of Litigation Costs 1 2 3 see Table 1 | ||||||
| INCOME TEST | ||||||
| Weekly Gross Income | $ | |||||
| Tax and Medicare Levy | $ | |||||
| Housing (actual costs incurred per week) | ||||||
| a. | Rent | $ | ||||
| b. | Rates | $ | ||||
| c. | Mortgage | $ | ||||
| d. | 1/2 Board | $ | ||||
| Total Housing or Max $120 see Schedule 1 | $ | |||||
| Child Care Costs (Actual costs incurred per week or MAX $115 per child - see Schedule 1) | $ | |||||
| Maintenance Payments see Dependants' Table below for maximum allowance per dependant | $ | |||||
| Dependants | ||||||
| Allowance per Spouse/Child Dependant | ||||||
| 1 =$67 | 5 =$323 | |||||
| 2 =$131 | 6 =$387 | |||||
| 3 =$195 | 7 =$451 | |||||
| 4 = $259 | 8 =$515 | |||||
| Total Deductions | $ | |||||
| Net Income (Weekly Gross Income less Total Deductions) | $ | |||||
| Income Contribution (1) (see Table 1 to calculate) | $ | |||||
| ASSETS TEST | ||||||
| Cash | $ | |||||
| Shares, debentures etc. | $ | |||||
| Is there a car equity over $11,400? By how much? | $ | |||||
| Is there a home equity over the value in Schedule 1 ? |
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| If so, by how much? | $ | |||||
| Equity in second car/boat/caravan etc. | $ | |||||
| Other valuable disposable assets | $ | |||||
| TOTAL | $ | |||||
| Allowable Assets | ||||||
| Single = $740 | ||||||
| Two or more = $1490 | ||||||
| Less Allowable Assets | $ | |||||
| Net Assets | $ | |||||
| Assets Contribution (2) | $ | |||||
| Contribution [ add Contribution (1) and (2) ] | $ | |||||
| Commitment | $ | |||||
