Respondent.
|
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 |
|
|
|
|
$
_______ |
|
5. |
Shared Responsibility Basic Obligation
(Line 4 x 1.5) |
|
|
|
|
$
_______ |
|
6. |
Each Parent's Share (Line 5 x each parent's
percentage from Line 2) |
$
_______ |
|
$
_______ |
|
|
|
7. |
Number of 24 Hour Days With Each Parent
(Must Total 365) |
______ |
+ |
______ |
= |
365 |
|
8. |
Percentage of Year With Each Parent |
______ % |
+ |
______ % |
= |
100
% |
|
9. |
Amount Retained (Line 6 x Line 8 for each
parent) |
$
_______ |
|
$
_______ |
|
|
|
10. |
Each Parent's Obligation (Subtract Line 9
from Line 6) |
$
_______ |
|
$
_______ |
|
|
|
11. |
Amount Transferred (Subtract smaller amount
on Line 10 from larger amount on Line 10.) Parent with
larger amount on Line 10 pays the other parent the difference. |
|
|
|
|
$
_______ |
|
C. |
Additional Support Costs |
|
12. |
Children’s Health and Dental Insurance
Premium |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
13. |
Work-Related Child Care |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
14. |
Extraordinary Costs |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
15. |
Total Additional Support Costs |
$
_______ |
+ |
$
_______ |
= |
$
_______ |
|
16. |
Each Parent’s Obligation (Combined column
Line 15 x each parent's Line 2) |
$
_______ |
|
$
_______ |
|
|
|
17. |
Amount Transferred (Subtract each parent's
Line 16 from his/her Line 15.) Parent with a negative
number pays that amount to the other parent. |
$
_______ |
|
$
_______ |
|
|
|
D. |
Net Amount Transferred |
|
18. |
Combine Lines 11 and 17 by addition if same
parent pays on both lines, otherwise by subtraction. |
|
|
|
|
$
_______ |