Standard Child Support Worksheet Page 2
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1
2FATHER
MOTHER
COMBINED
6.
Other costs to be considered by the Court:
$
$
a. Work-related childcare expenses (+/-)
$
$
$
b. Health insurance premiums and uninsured health
care expenses paid by ( ) Mom ( ) Dad (+/-)
$
$
$
c. Total tax benefit for all exemptions divided by 12
$
Multiply benefit by line 2 % for each parent
$
$
+/- (to off-set any excess benefit)
$
$
7. Total AMOUNT TO BE ORDERED:
$
$
PREPARED ON THIS
DAY OF
, 20
.
BY: _________________________________
_______________________________
Signature
Typed/printed Name
STANDARD CH/ILD SUPPORT WORKSHEET
2
CAO 1-13 Revised 2/25/2005
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