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Each party shall complete that portion of the worksheet that applies to him or her, sign the form and file it with the court. This worksheet is required in all proceedings established or modifying child support. |
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| IN RE:
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CASE NO
______________________________________
FATHER _______________________________________ MOTHER ______________________________________ |
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CHILD SUPPORT OBLIGATION WORKSHEET |
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|
Children |
DOB | Children | DOB | ||
| 1. WEEKLY GROSS INCOME
Subsequent Children Multipliers (Circle .935 .9.03 .878. 863 .854) |
FATHER |
MOTHER | |||
|
$ |
$ |
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| 1A. Child Support (Court Order for Prior Born Children) | $ | $ | |||
| 1B. Child Support (Legal Duty for Prior Born Children) | $ | $ | |||
| 1C. Maintenance Paid | $ | $ | |||
| 1D. WEEKLY ADJUSTED INCOME (WAI)
Line 1 minus 1A, 1B, and 1 C |
$ | $ | $ | ||
| 2. PERCENTAGE SHARE OF TOTAL WAI | % | % | |||
| 2A. Work-Related Child Care Expenses | $ | $ | $ | ||
| 3. COMBINED WEEKLY ADJUSTED INCOME
Line 1D minus Line 2A |
$ | ||||
| 4. BASIC CHILD SUPPORT OBLIGATION
Apply CWAI to Guideline Schedules |
$ | ||||
| 4A. Work-Related Child Care Expense | $ | ||||
| 4B. Weekly Premium-Children's Portion of Health Insurance only | $ | ||||
| 5. TOTAL CHILD SUPPORT OBLIGATION
Line 4 plus 4A and 4B |
$ | ||||
| 6. PARENT'S CHILD SUPPORT OBLIGATION
Line 2 times Line 5 |
$ | $ | |||
| 7. ADJUSTMENTS | |||||
| Obligation from Post Secondary Education Worksheet Line J | +$ | +$ | |||
| Child(rens)'s Portion of Weekly Health Insurance Premium $______ (This will be a credit to the payor) | -$ | -$ | |||
| Visitation Credit$_________ | -$ | -$ | |||
| 8. RECOMMENDED CHILD SUPPORT OBLIGATION | $ | $ | |||
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EXPLAIN ANY DEVIATION FROM GUIDELINE SCHEDULES IN ORDER/DECREE. |
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| I affirm under penalties for perjury that the foregoing representations are true. | |||||
| Dated: ____________________________________ | Father: _______________________________
Mother: _______________________________ |
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UNINSURED HEALTH CARE EXPENSE CALCULATION |
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| A. Custodial Parent Annual Obligation: (Line
4) _____________ X 52 weeks X .06 - $ ______________
B. Balance of Annual Expenses to be Paid (Line 2)______________ % by Father;____________% by Mother. |
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