Form 14 Child Support Amount Calculation Worksheet Page 35
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41Parent Receiving Support Parent Paying Support
Combined
1. MONTHLY GROSS INCOME
$ 5000.00
$ 2000.00
a. Court ordered maintenance being received.
$
$
2. ADJUSTMENTS (per month)
( $ )
( $ )
a. Other court or administratively ordered
child support being paid.
b. Court ordered maintenance being paid.
( $ )
( $ )
c. Support obligation for other children in parent's
( $ )
( $ )
primary physical custody.
3. ADJUSTED MONTHLY GROSS INCOME
$ 5000.00
$ 2000.00
$ 7000.00
(Sum of lines 1 and 1a, minus lines 2a, 2b, and 2c.
4. PROPORTIONATE SHARE OF COMBINED
71.4 %
28.6 %
ADJUSTED MONTHLY GROSS INCOME (Each
parent's line 3 income divided by combined line 3
income).
5. BASIC CHILD SUPPORT AMOUNT
$ 948.00
(From support chart using combined line 3
income).
6. ADDITIONAL CHILD-REARING COSTS (per
$
month)
a. Reasonable work-related child care costs of the
parent receiving support ($ )
less any child care tax credit ($ ).
b. Reasonable work-related child care costs of the
$
parent paying support.
c. Health insurance costs for the children who are
$
$ 100.00
subjects of this proceeding.
d. Uninsured extraordinary medical costs.
$
$
(Agreed by parents or ordered by court).
e. Other extraordinary child rearing costs.
$ 250.00
$
(Agreed by parents or ordered by court)
7. TOTAL ADDITIONAL CHILD-REARING
$ 250.00
$ 100.00
$ 350.00
COSTS (Sum of lines 6a, 6b, 6c, 6d and 6e).
8. TOTAL COMBINED CHILD SUPPORT
$ 1298.00
COSTS (Sum of line 5 and combined line 7).
9. EACH PARENT'S SUPPORT OBLIGATION
$
$ 371.00
(Multiply line 8 by each parent's line 4)
10. CREDIT FOR ADDITIONAL CHILD-
( $ 100.00 )
REARING COSTS (Line 7 of parent paying
support).
11. ADJUSTMENT FOR A PORTION OF THE
( $ )
AMOUNTS EXPENDED DURING PERIODS OF
OVERNIGHT VISITATION OR CUSTODY.
(Multiply line 5 by ___________ %).
12. PRESUMED CHILD SUPPORT AMOUNT
$ 271.00
(Line 9 minus lines 10 and 11).
PREPARED BY:
EXHIBIT 1
35
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