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Child Support Obligation Worksheet Form. This is a Indiana form and can be use in Family Law (Pro-Se) Statewide.
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Tags: Child Support Obligation Worksheet, Indiana Statewide, Family Law (Pro-Se)
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:
CASE NO:
FATHER:
MOTHER:
CHILD SUPPORT OBLIGATION WORKSHEET (CSOW)
Children
1. WEEKLY GROSS INCOME
Subsequent Children Multipliers (Circle
DOB
Children
FATHER
DOB
MOTHER
.935 .903 .878 .863 .854)
A.
Child Support (Court Order for Prior Born Child(ren)
B.
Child Support (Legal Duty for Prior Born Child(ren)
C.
Maintenance Paid
D.
WEEKLY ADJUSTED INCOME (WAI)
Line 1 minus 1A, 1B, and 1C
2.
PERCENTAGE SHARE OF TOTAL WAI
3.
COMBINED WEEKLY ADJUSTED INCOME (Line 1D)
4.
%
BASIC CHILD SUPPORT OBLIGATION
Apply CWAI to Guideline Schedules
A.
Weekly Work-Related Child Care Expense of each parent
B.
%
Weekly Premium – Children’s Portion of Health Insurance Only
5.
TOTAL CHILD SUPPORT OBLIGATION (Line 4 plus 4A and 4B)
6.
PARENT’S CHILD SUPPORT OBLIGATION (Line 2 times Line 5)
7.
ADJUSTMENTS
(
) Obligation from Post-Secondary Education Worksheet Line J.
(
) Payment of work-related child care by each parent.
+_____________
-_____________
(Same amount as Line 4A )
+______________
-______________
(
-_____________
-_______________
(
8.
) Child(ren)’s Portion of Weekly Health Insurance Premium $ _____.
(This will be a credit to the payor)
) Parenting Time Credit $ __________.
-_____________
-_______________
RECOMMENDED CHILD SUPPORT OBLIGATION
EXPLAIN ANY DEVIATION FROM GUIDELINE SCHEDULES IN ORDER/DECREE.
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) $________ + (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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