|
MONTHLY CHILD SUPPORT OBLIGATION
WORKSHEET A - BASIC VISITATION
IN THE
FAMILY COURT OF THE NAVAJO NATION
DISTRICT
OF ____________
________________________________,
Petitioner,
|
vs. |
NO. ____________________ |
________________________________,
Respondent.
MONTHLY CHILD SUPPORT
OBLIGATION
|
A. |
Gross Monthly Income and Percentage |
| |
|
Custodial Parent |
|
Absent Parent |
|
Combined |
|
1. |
Gross Monthly Income |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
2. |
Percentage of Combined Income (Each
parent's income divided by combined income) |
______ % |
+ |
______ % |
= |
100
% |
|
B. |
Computation of Basic Support |
|
3. |
Number of Children for Whom Support is
Sought |
|
|
|
|
_______ |
|
4. |
Basic Support for Number of Children |
|
|
|
|
$
_______ |
|
C. |
Additional Support Costs |
|
5. |
Children’s Health and Dental Insurance
Premium |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
6. |
Work-Related Child Care |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
7. |
Extraordinary Costs |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
8. |
Total Additional Support Costs |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
D. |
Calculation of Support Amount |
|
9. |
Total Basic and Additional Support Costs
(Add Combined Column Figures from Line 4 and Line 8) |
|
|
|
|
$
_______ |
|
10. |
Each Parent’s Obligation |
$
_______ |
|
$
_______ |
|
|
|
11. |
Enter Each Parent's Total Additional
Support Costs from Line 8 |
$
_______ |
|
$
_______ |
|
|
|
12. |
Each Parent’s Net Child Support Obligation
(Subtract Line 11 from Line 10) |
$
_______ |
|
$
_______ |
|
|
Absent Parent pays $ ________ each month to Custodial Parent for
Child Support Costs.
|
_________________________________
Custodial Parent's
Signature |
_______________
Date |
|
_________________________________
Absent Parent's
Signature |
_______________
Date |
|
_________________________________
Child Support
Enforcement Officer |
_______________
Date |
|