STATE OF HAWAI'I FAMILY COURT OF THE __________ CIRCUIT CHILD SUPPORT GUIDELINES WORKSHEET Attorney for: CASE NUMBER: FC-_ No. _________ This worksheet, and any attachments, was prepared by: Parent (A) Parent (B) Plaintiff/Petitioner/Parent (A) vs. Defendant/Respondent/Parent (B) Name: Address: City,St,Zip: Phone No: Parent (A) + % [Line 2(A) ÷ 2(C)] x 100 PARENTS' INCOMES 1. Monthly Gross Income from all sources . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Monthly Net Income (from Table of Incomes) . . . . . . . . . . . . . . . . . . . . . 3. Percentage of Total Net Income on Line 2 from each parent . . . . . . . . . . CHILD SUPPORT NEED 4. Base Primary Support: Parent (B) = % TOTAL (C) Round to nearest % [Line 2(B) ÷ 2(C)] x 100 ($385) x TOTAL (C) (# of children) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .=. . . . . . + + = 5. Plus Monthly Child Care Expense (to allow custodial parent to work or attend voc. ed. or training) . . . . . . . . . . . . 6. Plus Monthly Health Insurance Expense (for the child(ren) and paid by parents). If no insurance, use Cash Medical support amount (10% of Net Income on Line 2) 7. PRIMARY CHILD SUPPORT NEED (add Lines 4, 5 & 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STANDARD OF LIVING ADJUSTMENT (SOLA) Parent (A) Parent (B) TOTAL (C) = 8. SOLA Income (from Table of Incomes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + 9. Less PRIMARY CHILD SUPPORT NEED (copy from Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Remaining SOLA Income (Line 8(c) - Line 9; but if result is negative enter 0 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .= . . . . . . . . . . . . . . . . . . . . . . . . 11. SOLA Percentage (10% per child, up to 30% maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x % . 12. SOLA Amount (Line 10 x Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =. . . . 13. CHILD SUPPORT CALCULATION (Line 7 + Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .= . . . . . . . . . Parent (A) CHILD SUPPORT OBLIGATIONS / CREDITS 14. Total Support Obligation for each parent (Line 13 x % in Line 3) . . . . . Minimum: $77 per child. Maximum: The Total Support Obligation for a parent should not exceed that parent's Net Income on Line 2, if the Net Income exceeds $77 per child. 15. Credit for Child Care Expense (for parent who pays) . . . . . . . . . . . . . . 16. Credit for Health Ins./Cash Medical amount (for parent who pays) . . . . . . . . . . . - . . 17. REMAINING CHILD SUPPORT OBLIGATION AFTER CREDITS . . . = SUMMARY OF CHILD SUPPORT PAYMENTS Parent (A) Parent (B) pays monthly child support of Parent (A) Parent (B) pays health ins./cash medical. EXTENSIVE TIME-SHARING WORKSHEET attached. EXCEPTIONAL CIRCUMSTANCES FORM attached. CERTIFICATION: I declare, under penalty of perjury, that I have examined this worksheet, and any attached worksheets or forms, and to the best of my knowledge and belief the information provided is true, correct and complete. = Parent (B) 70% of Net Income: Parent (A): Parent (B): Round to nearest dollar Parent (A) to other parent, per child per mo. Parent (B) pays child care expense. For Court Use Only Parent (A) Parent (B) Date Date Rev. 12/30/2014 Appendix A-1 American LegalNet, Inc. www.FormsWorkFlow.com 1 STATE OF HAWAI'I FAMILY COURT OF THE FIRST CIRCUIT SAMPLE WORKSHEET SOLE PHYSICAL CUSTODY CHILD SUPPORT GUIDELINES WORKSHEET Attorney for: 2 CASE NUMBER: FC-D No. 14-1-0000 3 This worksheet, and any attachments, was prepared by: 4 5 6 X Parent (B) JOHN MIDDLE ALOHA Plaintiff/Petitioner/Parent (A) vs. JANE ALOHA Defendant/Respondent/Parent (B) Name: Address: City,St,Zip: Phone No: Parent (A) JANE ALOHA 1111 Mahalo Street Honolulu, Hawaii 96813 (808) 555-5555 Parent (A) $2,500 $946 61% + Parent (B) $2,000 $597 39% TOTAL (C) PARENTS' INCOMES 1. Monthly Gross Income from all sources . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. 7 Monthly Net Income (from Table of Incomes) . . . . . . . . . . . . . . . . . . . . . 9 Percentage of Total Net Income on Line 2 from each parent . . . . . . . . . . 12 14 ($385) x 3 8 = 10 $1,543 11 Round to nearest % [Line 2(A) ÷ 2(C)] x 100 [Line 2(B) ÷ 2(C)] x 100 13 15 16 17 20 CHILD SUPPORT NEED 4. Base Primary Support: TOTAL (C) (# of children) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .=. . . . . . $1,155 + + = $400 $200 $1,755 5. Plus Monthly Child Care Expense (to allow custodial parent to work or attend voc. ed. or training) . . . . . . . . . . . . 6. Plus Monthly Health Insurance Expense (for the child(ren) and paid by parents). If no insurance, use Cash Medical support amount (10% of Net Income on Line 2) $95 $60 18 7. PRIMARY CHILD SUPPORT NEED (add Lines 4, 5 & 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parent (A) Parent (B) TOTAL (C) STANDARD OF LIVING ADJUSTMENT (SOLA) 21 23 = 8. SOLA Income (from Table of Incomes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,349 + $849 $2,198 $1,755 9. Less PRIMARY CHILD SUPPORT NEED (copy from Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 10. Remaining SOLA Income (Line 8(c) - Line 9; but if result is negative enter 0 ) . . . . . . . . . . . . . . . . . . 22 . . . . . . . . .= . . . . . . . .$443 . . . . . . . . . . . ... . .... 25 11. SOLA Percentage (10% per child, up to 30% maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . x 30% ... $133 12. SOLA Amount (Line 10 x Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 . . . =. . . . ... . 13. CHILD SUPPORT CALCULATION (Line 7 + Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .= . . . . . . $1,888 . .. 28 Parent (A) CHILD SUPPORT OBLIGATIONS / CREDITS $946 14. Total Support Obligation for each parent (Line 13 x % in Line 3) . . . . . 29 Minimum: $77 per child. Maximum: The Total Support Obligation for a parent should not exceed that parent's Net Income on Line 2, if the Net Income excee