Child Support Guidelines Worksheet A
ADVERTISEMENT
1
2Circuit Court for
Case No.
City or County
vs.
Name
Name
Street Address
Apt #
PO Box
Street Address
Apt #
PO Box
(
)
(
)
Area
Area
City
State
Telephone
City
State
Zip Code
Telephone
Zip Code
Code
Code
Plaintiff
Defendant
CHILD SUPPORT GUIDELINES WORKSHEET A
(Primary Physical Custody to One Parent)
(DOM REL 34)
Name of Child
Name of Child
Date of Birth
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Mother
Father
Combined
1. MONTHLY ACTUAL INCOME (Before taxes)(Code, Family
Law Article, §12-201(b))
$
$
-
-
a. Minus pre-existing child support payment actually paid
b. Minus alimony actually paid
-
-
c. Plus / minus alimony awarded in this case
+/-
+/-
2. MONTHLY ADJUSTED ACTUAL INCOME
$
$
3. PERCENTAGE SHARE OF INCOME (Divide each parent's
%
%
income on Line 2 by the combined income on Line 2)
4. BASIC CHILD SUPPORT OBLIGATION
(Apply Line 2 Combined Income to Child Support Schedule)
$
a. Work-Related Child Care Expenses (Code, FL § 12-204(g))
+
b. Health Insurance Expenses (Code, FL § 12-204(h)(1))
+
c. Extraordinary Medical Expenses (Code, FL § 12-204 (h)(2))
+
d. Cash Medical Support (Code, Family Law Article, § 12-102(c)
(3)(ii)) - This subsection applies only to child support case
+
brought under Title IV, Part D of the Social Security Act.
e. Additional Expenses (Code, Family Law Article § 12-104(i))
+
5. TOTAL CHILD SUPPORT OBLIGATION
$
(Add lines 4, 4a, 4b, 4c, 4d and 4e)
6. EACH PARENT'S CHILD SUPPORT OBLIGATION
$
$
(Multiply Line 5 by Line 3 for each parent)
7. TOTAL DIRECT PAY BY EACH PARENT
(Add the expenses shown on lines 4a, 4b, 4c, 4d and 4e paid by
$
$
each parent.)
8. RECOMMENDED CHILD SUPPORT AMOUNT
$
$
(Subtract line 7 from line 6 for each parent.)
CC-DR 34 (Rev. 10/2009)
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal