Child Support Guidelines Worksheet
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CHILD SUPPORT GUIDELINES WORKSHEET
Case No.:
..................................................................................................................................
Commonwealth of Virginia Va. Code § 20-108.2
v.
...............................................................................................................................................
.....................................................................................................................................
...........................................................................
DATE
MOTHER
FATHER
1. Monthly Gross Income (see instructions on reverse)
$
$
..........................................
................................................
2. Adjustments for spousal support payments (see instructions on reverse)
$
$
..........................................
..................................................
3. Adjustments for support of child(ren) (see instructions on reverse)
$
$
..........................................
..................................................
4. Deductions from Monthly Gross Income allowable by law
-$
-$
............................................
..................................................
(see instructions on reverse)
5. a. Available monthly income
$
$
..........................................
................................................
b. Combined monthly available income
$
(combine both available monthly income figures from line 5.a.)
6. Number of children in the present case for whom support is sought:
7. a. Monthly basic child support obligation
(from schedule — see instructions on reverse)
a.
$
.....................................................
b. Monthly amount allowable for health care coverage
b.
$
.....................................................
(see instructions on reverse)
c. Monthly amount allowable for employment-related child care expenses
c.
$
.....................................................
(see instructions on reverse)
$
8. Total monthly child support obligation (add lines 7.a., 7.b., and 7.c.)
MOTHER
FATHER
%
%
9. Percent obligation of each party (divide “available monthly income” on
...............................................
...............................................
line 5.a. by line 5.b.)
10. Monthly child support obligation of each party (multiply line 8 by line 9)
$
$
11. Deduction by non-custodial parent for health care coverage when paid directly by
non-custodial parent (from line 7.b.)
$
$
..........................................
..........................................
MOTHER
FATHER
12. Adjustments (if any) to Child Support Guidelines Calculation
(see instructions on reverse)
a. Credit for benefits received by or for the child derived from the parent’s
-$
-$
...........................................
................................................
entitlement to disability insurance benefits to the extent that such derivative
benefits are included in a parent’s gross income
b.
$
$
....................................................................................................................................................................................................
............................................
...............................................
c.
$
$
...................................................................................................................................................................................................
............................................
...............................................
$
$
13. Each party’s adjusted share
FORM DC-637 (PAGE ONE OF TWO) 07/04 PDF
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