Rule 9.27 Child Support Guidelines Worksheets. Rule 9.27 — Form 1: Child Support Guidelines Worksheet. February 2002 FORM 1 CHILD SUPPORT GUIDELINES WORKSHEET Docket No: ____________ I. NET MONTHLY INCOME OF PETITIONER, ________________ (claiming ____ child/children as tax dependents) A. Sources and Amounts of Annual Income: ____________________________ $ ____________________________ $ ____________________________ $ TOTAL: B. Federal Tax Deduction: Gross Annual Taxable Income ( _________ untaxed) $ less ½ self employment (FICA) tax < less federal adjustments to income < less personal exemptions, self  +____ dep. < less standard deduction single [ ] h of h [ ] mfs [ ] < Net taxable income – federal $ Federal tax liability (from tax table) Federal Tax Credit for Dependent Children (nonrefundable) C. State Tax Deduction: Gross Annual Taxable Income $ less ½ self employment (FICA) tax < less state adjustments to income < less federal tax liability (adjusted for dependent tax credit) < less standard deduction single [ ] h of h [ ] mfs [ ] < Net taxable income – state $ State tax liability (from tax table) $ _______ less personal and dependent credits < _______ > plus school district surtax ( ____ %) +_______ D. Social Security and Medicare Tax Deduction: Annual earned income $ Applicable rate (7.65% or 15.3%, as adjusted) x Annual Social Security and Medicare tax liability E. Other Deductions (Annual) 1. Union dues 2. Mandatory pension 3. Medical insurance premium 4. Affiant’s unreimbursed medical expenses (up to $300) 5. Prior court–ordered child support obligations 6. Court–ordered spousal support obligations 7. Deduction for ____ additional qualified dependents (from tables) 8. Child care expenses (present action) $ less federal child care tax credit < less state child care tax credit < Net child care expenses Net Annual Income $ > > > > < + > < > < > < < < < < < < > > > > > > > < $ > > > > > % > > $ Average Monthly Income (Petitioner) 1 American LegalNet, Inc. www.USCourtForms.com Child Support Guidelines Worksheet (cont’d) II. NET MONTHLY INCOME OF RESPONDENT, ________________ (claiming ____ child/children as tax dependents) A. Sources and Amounts of Annual Income: ____________________________ $ ____________________________ $ ____________________________ $ TOTAL: B. Federal Tax Deduction: Gross Annual Taxable Income (_________ untaxed) $ less ½ self employment (FICA) tax < less federal adjustments to income < less personal exemptions, self  +____ dep. < less standard deduction single [ ] h of h [ ] mfs [ ] < Net taxable income – federal $ Federal tax liability (from tax table) Federal Tax Credit for Dependent Children (nonrefundable) C. State Tax Deduction: Gross Annual Taxable Income $ less ½ self employment (FICA) tax < less state adjustments to income < less federal tax liability (adjusted for dependent tax credit) < less standard deduction single [ ] h of h [ ] mfs [ ] < Net taxable income – state $ State tax liability (from tax table) $ _______ less personal and dependent credits < _______ > plus school district surtax (____ %) +_______ D. Social Security and Medicare Tax Deduction: Annual earned income Applicable rate (7.65% or 15.3%, as adjusted) Annual Social Security and Medicare tax liability E. Other Deductions (Annual) 1. Union dues 2. Mandatory pension 3. Medical insurance premium 4. Affiant’s unreimbursed medical expenses (up to $300) 5. Prior court–ordered child support obligations 6. Court–ordered spousal support obligations 7. Deduction for ____ additional qualified dependents (from tables) 8. Child care expenses (present action) less federal child care tax credit less state child care tax credit Net child care expenses $ > > > > < > > < < < < < < < $ < < > < $ x < + > > > > > > > < > > > > > % > > Net Annual Income $ Average Monthly Income (Respondent) $ 2 American LegalNet, Inc. www.USCourtForms.com Child Support Guidelines Worksheet (cont’d) III. CALCULATION OF THE GUIDELINE AMOUNT OF SUPPORT A. Custodial parent’s net monthly income Noncustodial parent’s net monthly income $ $ B. Number of children for whom support is sought Guideline percentage: % C. Guideline amount of child support $ IV. EXTRAORDINARY VISITATION ADJUSTMENT (only if court–ordered visitation exceeds 127 overnights per year) A. Guideline amount of child support $ B. Number of court–ordered visitation overnights with noncustodial parent C. Extraordinary Visitation Adjustment Percentage: % If Line B above is 128–147 overnights 15% credit If Line B above is 148–166 overnights 20% credit If Line B above is 167 or more overnights 25% credit (but less than equally shared physical care) D. Extraordinary Visitation Adjustment (Line A times Line C) $ E. Guideline Amount Adjusted for Extraordinary Visitation (Line A minus Line D) $ V. SPECIAL FINDINGS A. Income imputed to Petitioner/Respondent B. Estimated income of Petitioner/Respondent C. Deviations made from Child Support Guidelines D. Requested amount of child support $ : STATE OF IOWA, COUNTY OF per month ss: , do hereby swear or affirm that the foregoing statement is true, complete I, and correct as I verily believe from all information available to me at this time. Date: (Petitioner/Respondent) The undersigned attorney for the (Petitioner/Respondent) hereby certifies that the foregoing Child Support Guidelines Worksheets were prepared by me or at my direction in good faith reliance upon information available to me at this time. (Attorney for Petitioner/Respondent) 3 American LegalNet, Inc. www.USCourtForms.com Rule 9.27 — Form 2: Child Support Guidelines Worksheet. February 2002 FORM 2 CHILD SUPPORT GUIDELINES WORKSHEET Date: Case No.: Dependents: Docket No.: Noncustodial Parent’s Income: Custodial Parent’s Income: Name: Name: Method(s) Used to Determine Income Method(s) Used to Determine Income ( ) Parent’s Financial Statement/Verified Income ( ) Parent’s Financial Statement/Verified Income ( ) Other Sources ( ) Other Sources ( ) CSRU Median Income ( ) CSRU Median Income Total Gross Monthly Income: $ Total Gross Monthly Income: Deductions: $ Deductions: Federal Income Tax: $ Federal Income Tax: $ State Income Tax: $ State Income Tax: $ Social Security: $ Social Security: $ Union Dues: $ Union Dues: $ Mandatory Pension: $ Mandatory Pension: $ Health Insurance Premium $ Parent’s unreimbursed medical expenses not to exceed $25 per month: Health Insurance Premium Parent’s unreimbursed medical expenses not to exceed $25 per month: $ Prior Court–Ordered Child Support or Alimony Obligation (if paid): $ $ $ Prior Court–Ordered Child Support or Alimony Obligation (if paid): $ Prior Court–Ordered Medical Support (if paid): $ Prior Court–Ordered Medical Support (if paid): $ *Qualif. Add. Depend. Deduct: $ Actual Child Care Expense Due to Employment (less the appropriate income tax credit): *Qualif. Add. Depend. Deduct: $ Total Net Monthly Income: $ Total Net Monthly Income: $ $ Unc Med Exp % I. Noncustodial Parent’s Total Net Monthly Income: $_________ ______ % Custodial Parent’s Total Net Monthly Income: $ _________ ______ % II. Number of Children for Whom Support is Sought: ____________ III. Guideline Percentage/Specified Dollar Amount: $_____________ IV. x Percentage $ = Noncustodial Parent’s Net Monthly Income $ Guideline Amount of Child Support 4 American LegalNet, Inc. www.USCourtForms.com Child Support Guidelines Worksheet (cont’d) V. EXTRAORDINARY VISITATION ADJUSTMENT: Complete only if noncustodial parent’s court– ordered visitation exceeds 127 overnights per year. A. Guideline Amount of Child Support (Line IV above) $ B. Number of court–ordered visitation overnights with the noncustodial parent C. Extraordinary Visitation Adjustment Percentage: If Line B above is 128–147 overnights 15% credit (0.15) If Line B above is 148–166 overnights 20% credit (0.20) If Line B above is 167 or more overnights 25% credit (0.25) (but less than equally shared physical care) D. Extraordinary Visitation Adjustment (Line A times Line C) $ E. $ Guideline Amount Adjusted for Extraordinary Visitation (Line A minus Line D) VI. Deviations: _____________________________________________________________ _______________________________________________________________________ VII. Recommended Amount of Support: $ per VII–a. Recommended Amount of Accrued Support: $ See attachment _______ VIII. Changes in Support Obligation as Number of Children Entitled to Support Changes (Based on present income and guidelines): Number of Children: ______ _____ % VIII–a. Guideline Percentage/Specified Dollar Amount: $ ________ VIII–b. x $ Percentage VIII–b(1). = $ Noncustodial Parent’s Net Monthly Income Guideline Amount of Child Support EXTRAORDINARY VISITATION ADJUSTMENT: Complete only if noncustodial parent’s court–ordered visitation exceeds 127 overnights per year. A. Guideline Amount of Child Support (Line VIII–b above) $ B. Number of court–ordered visitation overnights with the noncustodial parent C. Extraordinary Visitation Adjustment Percentage: If Line B above is 128–147 overnights If Line B above is 148–166 overnights If Line B above is 167 or more overnights (but less than equally shared physical care) 15% credit (0.15) 20% credit (0.20) 25% credit (0.25) D. Extraordinary Visitation Adjustment (Line A times Line C) $ E. $ Guideline Amount Adjusted for Extraordinary Visitation (Line A minus Line D) Number of Children: ______ _____% VIII–c. Guideline Percentage/Specified Dollar Amount: $ ________ VIII–d. x Percentage $ = Noncustodial Parent’s Net Monthly Income $ Guideline Amount of Child Support 5 American LegalNet, Inc. www.USCourtForms.com Child Support Guidelines Worksheet (cont’d) VIII–d(1). EXTRAORDINARY VISITATION ADJUSTMENT: Complete only if noncustodial parent’s court–ordered visitation exceeds 127 overnights per year. A. Guideline Amount of Child Support (Line VIII–c above) $ B. Number of court–ordered visitation overnights with the noncustodial parent C. Extraordinary Visitation Adjustment Percentage: If Line B above is 128–147 overnights If Line B above is 148–166 overnights If Line B above is 167 or more overnights (but less than equally shared physical care) 15% credit (0.15) 20% credit (0.20) 25% credit (0.25) D. Extraordinary Visitation Adjustment (Line A times Line C) $ E. $ Guideline Amount Adjusted for Extraordinary Visitation (Line A minus Line D) IX. Qualified Additional Dependent Deduction: (See guidelines for the definition of this term.): Paternity Establishment Method Child’s Name Whose Child Date of Birth Court/ Admin. Order : STATE OF IOWA, COUNTY OF In Court Stmt. & Consent Paternity Affidavit Child Born During Marriage ss: , do hereby swear or affirm that the foregoing statement is true, I, complete and correct as I verily believe from all information available to me at this time. Date: (Petitioner/Respondent)* The undersigned attorney for the (Petitioner/Respondent) hereby certifies that the foregoing Child Support Guidelines Worksheets were prepared by me or at my direction in good faith reliance upon information available to me at this time. Date: (Attorney for the Petitioner/Respondent)* Prepared by: ___________________________________________ ___________________________________________ Date: ________________ Date: ________________ *Child Support Recovery Unit is not required to obtain signatures. 6 American LegalNet, Inc. www.USCourtForms.com