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Week3

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Worksheet – Child Support Obligation

|Each party shall complete that portion of the worksheet that applies to him or her, sign the form and file it with the court. This worksheet is required in |
|all proceedings establishing or modifying child support. |
| |
|IN RE: Anthony P. Lewis CASE NO: |
|And Crystal F. Lewis |
|FATHER: Anthony P. Lewis |
|MOTHER: Crystal F. Lewis |
| |
|CHILD SUPPORT OBLIGATION WORKSHEET (CSOW) |
| | | | |
|Children |DOB |Children |DOB |
|Hailey L. Lewis |07/25/2002 | | |
| | | | |
| | | | |
| | | | |
|1. WEEKLY GROSS INCOME |FATHER |MOTHER | |
| | | | |
| |480 | | |
| A. Subsequent Children Multiplier Credit | | | |
|(.065 .097 .122 .137 .146 .155 .164 .173) | | | |
| |0 | | |
|B. Child Support (Court Order for Prior Born) | | | |
| |0 | | |
|C. Child Support (Legal Duty for Prior Born) | | | |
| |0 | | |
|D. Maintenance Paid | | | |
| | | | |
|E. WEEKLY ADJUSTED INCOME (WAI) | | | |
|Line 1 minus 1A, 1B, 1C and 1D | | | |
| | | | |
|2. PERCENTAGE SHARE OF TOTAL WAI | |% | |
| |% | | |
| | | | |
|3. COMBINED WEEKLY ADJUSTED INCOME (Line 1E) | | | |
| | | | |
|BASIC CHILD SUPPORT OBLIGATION | | | |
|Apply CWAI to Guideline Schedules | | | |
| | | | |
|A. Weekly Work-Related Child Care Expense of each parent | | | |
| | | | |
|B. Weekly Health Insurance Premium – Total from HIPW, Line I | | | |
| | | | |
|5. TOTAL CHILD SUPPORT OBLIGATION (Line 4 plus 4A and 4B) | | | |
| | | | |
|6. PARENT’S CHILD SUPPORT OBLIGATION (Line 2 times Line 5) | | | |
| | | | |
|ADJUSTMENTS | | | |
| |+_____________ |+______________ | |
|( ) Obligation from Post-Secondary Education Worksheet Line J. | | | |
| | | | |
|( ) Payment of work-related child care by each parent. | | | |
| |-_____________ |-______________ | |
|(Same amount as Line 4A ) | | | |
| | | | |
| |-_____________ |-_______________ | |
|( ) Child(ren)’s Portion of Weekly Health Insurance Premium | | | |
|for parent(s) ordered to provide health insurance. | | | |
| | | | |
|( ) Parenting Time Credit |-_____________ |-_______________ | |
| | | | |
| | | | |
|8. RECOMMENDED CHILD SUPPORT OBLIGATION | | | |
| |
| |
| |
|I affirm under penalties for perjury that the foregoing representations are true. |
| |
|Father: __________________________________________ |
| |
| |
|Dated: ________________________________________ Mother: _________________________________________ |
| |
|UNINSURED HEALTH CARE EXPENSE CALCULATION |
| |
|A. Custodial Parent Annual Obligation: (CSOW Line 4 Total) $______ + (PSEW § Two, Line I) $_____ = $____ x 52 weeks x .06 = $ _______. |
| |
| |
|B. Balance of Annual Expenses to be Paid: (Line 2) ____________ % by Father; ____________ % by Mother. |

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