Case Name Docket Number Date Prepared Name of Preparer CHILD SUPPORT GUIDELINES WORKSHEET All amounts are $ / week, rounded to the nearest dollar 1. INCOME a. Gross Weekly income b. Minus Child Care cost paid c. Minus Health insurance cost paid $ $( $( $( $( = $ = = $ % % ) ) ) ) Recipient $ $( $( $( $( $ ) ) ) ) Payor d. Minus Dental/Vision insurance cost paid e. Minus Other Support Obligations paid f. Available income g. Combined Available Income Recipient 1(f) + Payor 1(f) h. Percent of Combined Available Income 1(f) / 1(g) 2. CHILD SUPPORT CALCULATION a. Maximum combined available income maximum 1(g) but not more than $4,808 b. Combined support amount for one child from Table A of Guidelines Chart for 2(a) c. Adjustment for number of children covered by this order from Table B Number of children x = $ $( = % = $ $ . ) d. Total combined support amount 2(b) x 2(c) e. Minus Recipient's proportional share of support 2(d) x Recipient 1(h) f. Payor's proportional weekly support amount 2(d) - 2(e) g. Weekly support amount as % of Recipient income 2(f) ÷ Recipient 1(f) h. Payor's adjusted weekly support amount If 2(g) is 10% or more, then enter 2(f) here Otherwise, enter the lesser of 2(f) OR (10% + 2(g)) x Payor 1(f) 3. AVAILABLE INCOME ABOVE $4,808 (If applicable.) (Considered at the discretion of the Court.) a. Combined Maximum of $0 or 1(g)-$4,808 b. Proportional share for the Recipient and Payor 3(a) x 1(h) TABLE A: CHILD SUPPORT OBLIGATION SCHEDULE All amounts are $ / week, rounded to the nearest dollar COMBINED AVAILABLE INCOME FROM LINE 1(g) Minimum Maximum $ $150 $151 $319 $320 $750 $751 $1250 $1251 $2,000 $2,001 $3.000 $3,001 $4,000 $4,001 $4,808 = = $ $ $ CHILD SUPPORT AMOUNT (1 CHILD) At court discretion, but not less than $80/month 22% $70 + 22% above $319 $165 + 21% above $750 $270 + 19% above $1250 $413 + 15% above $2,000 $563 + 12% above $3,000 $683 + 11% above $4,000 TABLE B: ADJUSTMENT FOR NUMBER OF CHILDREN CHILDREN ADJUSTMENT 1 2 3 4 5 1.00 1.25 1.38 1.45 1.48 Child Support Guidelines Child Support Guidelines Chart CJD 304 (8/1/13 rev.) CSG American LegalNet, Inc. www.FormsWorkFlow.com