Appendix IX-C
CHILD SUPPORT GUIDELINES - SOLE PARENTING WORKSHEET
Case Name:
v.
County:
Plaintiff Defendant Docket #:
Custodial Parent is the: Plaintiff Defendant
Number of Children:
All amounts must be weekly
CUSTODIAL
NON-
CUSTODIAL
COMBINED
1. Gross Taxable Income $ $
1a. Mandatory Retirement Contributions (non-taxable) -$ -$
1b. Alimony Paid (Current and/or Past Relationships) -$ -$
1c. Alimony Received (Current and/or Past Relationships) +$ +$
2. Adjusted Gross Taxable Income ((L1-L1a-L1b)+L1c) $ $
2a. Federal, State and Local Income Tax Withholding -$ -$
2b. Mandatory Union Dues -$ -$
2c. Child Support Orders for Other Dependents -$ -$
2d. Other Dependent Deduction (from L14 of a separate worksheet) -$ -$
3. Net Taxable Income (L2-L2a-L2b-L2c-L2d) $ $
4. Non-Taxable Income (source: ) +$ +$
5. Government (Non-Means Tested) Benefits for the Child +$ +$
6. Net Income (L3+L4+L5) $ $ $
7. Each Parent’s Share of Income (L6 Each Parent ÷ L6 Combined) 0._____ 0._____ 1.00
8. Basic Child Support Amount (from Appendix IX-F Schedules) $
9. Net Work Related Child Care (from Appendix IX-E Worksheet) +$
10. Child's Share of Health Insurance Premium +$
11. Unreimbursed Health Care Expenses over $250 per child per year +$
12. Court-Approved Extraordinary Expenses +$
13. Total Child Support Amount (L8+L9+L10+L11+L12) $
14. Each Parent's Share of Support Obligation (L7 x L13) $ $
15. Government Benefits for the Child Based on Contribution of NCP -$
16. Net Work-Related Child Care Paid -$
17. Health Insurance Premium for the Child Paid -$
18. Unreimbursed Health Care Expenses Paid (>$250/child/year) -$
19. Court-Approved Extraordinary Expenses Paid -$
20. Adjustment for Parenting Time Expenses
(L8 x L20b for Non-Custodial Parent x 0.37)
Note: Not presumptive in some low income situations (see App IX-A., ¶13)
-$
20a. Number of Annual Overnights with Each Parent
20b. Each Parent’s Share of Overnights with the Child
(L20a for Parent ÷ L20a Combined)
0._____ 0._____ 1.00
21. Net Child Support Obligation (L14-L15-L16-L17-L18-L19-L20) $
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