Child Support Guidelines Worksheet printable pdf download

CHILD SUPPORT GUIDELINES WORKSHEET

(N.D. Admin. Code Ch. 75-02-04.1)

NONCUSTODIAL PARENT/OBLIGOR: _____________________________________

CUSTODIAL PARENT/OBLIGEE: __________________________________________

GROSS ANNUAL EMPLOYMENT INCOME:

Actual …………………………………………….

Source of financial data used; e.g., tax return,

Pay stubs, etc.: _________________

______________________________

Imputed (from Schedule A) …………………….

Total gross annual employment income…………………..

OTHER GROSS ANNUAL INCOME:

Children’s Benefits -01(3)&(5) ……………….. $__________

Military Subsistence -01(5) …………………… $__________

Spousal Support -01(5) ……………………….

$__________

Unemployment/Workers’ Comp. Benefits

-01(5) ……………………………………

$__________

Social Security Benefits -01(5) ………………. $__________

Pensions/Veterans’ Benefits/Retirement

Income -01(5) ………………………….. $__________

Refundable Tax Credits -01(5) ……………….. $__________

Dividends and Interest -01(5) …………………. $__________

In-kind Income -01(5) & (6) ……………………. $__________

Other: ______________________________ $__________

Total other gross annual income ………………………….. $_________

ANNUAL NET INCOME FROM SELF-EMPLOYMENT

(from Schedule B) ……………………………………………. $_________

TOTAL GROSS ANNUAL INCOME (Total of Lines 1, 2, and 3) .. $_________

ANNUAL DEDUCTIONS ……………………………………………... $_________

Federal income tax obligation (from

Schedule 1) -01(7)(a) …………………. $__________

State income tax obligation (from Schedule 1)

-01(7)(b) ………………………………… $__________

FICA/Medicare/RRTA -01(7)(c) ………………. $__________

Self-employment tax -01(7)(c) ………………… $__________

Medical insurance for children (from

Schedule 2) -01(7)(d) ………………….. $__________

Other medical expenses for children -01(7)(e) . $__________

Child Support Guidelines Worksheet