Form C - Child Support Worksheet A
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1The 18th Judicial District, Iberville, Pointe Coupee, West Baton Rouge Parishes
State of Louisiana
Form C
CHILD SUPPORT WORKSHEET A – R.S. 9:315.15
________________________________
NO: ___________________ DIV.__________
(PETITIONER)
VERSUS
THE 18TH JUDICIAL DISTRICT COURT
________________________________
PARISH OF __________________________
(DEFENDANT)
STATE OF LOUISIANA
Names of Children
Date of Birth
Names of Children
Date of Birth
_________________________
___________
_________________________
___________
_________________________
___________
_________________________
___________
_________________________
___________
_________________________
___________
PETITIONER
DEFENDANT
COMBINED
1.
MONTHLY GROSS INCOME
$
$
a. Preexisting child support payment
-
-
b. Preexisting spousal support payment
-
-
2.
MONTHLY ADJUSTED GROSS INCOME
$
$
$
(line 1 minus 1a and 1b)
3.
Combined Monthly Adjusted Gross Income (line 2
Column A plus line 2 Column B). (La. R.S. §
9:315.2(C)
4.
PERCENTAGE SHARE OF INCOME (line 2
%
%
divided by line 3) ( La. R.S. § 9:315.2(D)
5.
BASIC CHILD SUPPORT OBLIGATION
(compare line 3 to Child Support Schedule) ( La.
$
R.S. §9:315.2 (D)
a. child care costs (Costs minus Federal
Tax Credit) ( La. R.S. § 9:315.3
+
b. Child’s Health Insurance Premium Cost
+
c. Extraordinary Medical Expenses (uninsured only;
agreed to by parties or by court order)
+
d. Extraordinary Expenses (agreed to by parties or
by court order)
+
e. Optional, minus extraordinary adjustments
(child’s income if applicable)
-
6.
TOTAL CHILD SUPPORT OBLIGATION (add
$
lines 5, 5a, 5b, 5c, and 5d; subtract line 5e)
7.
EACH PARTY’S CHILD SUPPORT
$
$
OBLIGATION (multiply line 4 times line 6)
8.
DIRECT PAYMENTS made by the noncustodial
$
parent on behalf of the child for child care costs,
health insurance premiums, extraordinary medical
expenses, or extraordinary expenses.
9.
RECOMMENDED CHILD SUPPORT ORDER
$
(subtract line 8 from line 7)
Comments:
______________________________________________________________________________
______________________________________________________________________________
_____________________________________
______________________________
PREPARER’S SIGNATURE
Date
Form C, Child Support Worksheet A
18THJDC Revised: May 2015
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