Form D - The Family Court - Child Support Obligation Guidelines Worksheet Template
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1
2CHILD SUPPORT OBLIGATION
Form D
GUIDELINES WORKSHEET B
__________________________________
NO: __________________ DIV. ______
(
)
PETITIONER
THE FAMILY COURT
VERSUS
PARISH OF EAST BATON ROUGE
__________________________________
STATE OF LOUISIANA
(
)
DEFENDANT
Children’s Names
Children’s Names
Dates of Birth
Dates 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(C)
5
BASIC CHILD SUPPORT OBLIGATION
(compare line 3 to Child Support Schedule)
$
La. R.S. § 9:315.2(D)
6
SHARED CUSTODY BASIC OBLIGATION
$
(line 5 times 1.5) La. R.S. § 9:315.9(B)(2)
EACH PARTY’S THEORETICAL CHILD
7
SUPPORT OBLIGATION (multiply line 4
$
$
times line 6 for each party)
8
PERCENTAGE with each party (Use actual
percentage of time spent with each party if
%
%
percentage is not 50%)
9
BASIC CHILD SUPPORT OBLIGATION
FOR TIME WITH OTHER PARTY (cross
$
$
multiply line 7 for each party times line 8 for
the other party) La. R.S. § 9:315.9(A)(3)
a. Net child care costs (costs less Federal Tax
+
Credit)
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)
10
TOTAL EXPENSES / EXTRAORDINARY
ADJUSTMENTS (add lines 9a, 9b, 9c, & 9d;
$
subtract line 9e)
EACH PARTY’S PROPORTIONATE
11
SHARE of expenses / extraordinary
$
$
adjustments (line 4 times line 10)
12
DIRECT PAYMENTS made by ay party on
behalf of the child for work-related net child
−
−
care costs, health insurance premiums,
extraordinary medical expenses, or
extraordinary expenses
THE FAMILY COURT
FORM D, p. 1 of 2
REVISED: NOV 2013
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