Child Support Guidelines Worksheet A (Primary Physical Custody To One Parent) Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Child Support Guidelines Worksheet A (Primary Physical Custody To One Parent) Form. This is a Maryland form and can be use in Circuit Court Statewide.
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Circuit Court for
Case No.
City or County
Name
VS.
Street Address
City
Apt. #
State
Name
Street Address
Zip Code Area
Code
Telephone City
State
Apt. #
Zip Code
Area
Telephone
Code
CHILD SUPPORT GUIDELINES WORKSHEET A
(Primary Physical Custody to One Parent)
(DOM REL 34)
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Mother
Father
$
$
a. Minus pre-existing child support payment actually paid
-
-
b. Minus alimony actually paid
-
-
c. Plus / minus alimony awarded in this case
+/-
+/-
$
Combined
$
1. MONTHLY ACTUAL INCOME (Before taxes)(Code, Family
Law Article, §12-201(b))
2. MONTHLY ADJUSTED ACTUAL INCOME
3. PERCENTAGE SHARE OF INCOME (Divide each parent’s
income on Line 2 by the combined income on Line 2).
%
$
%
4. BASIC CHILD SUPPORT OBLIGATION (Apply Line 2
Combined Income to Child Support Schedule)
$
a. Work-Related Child Care Expenses (Code, Family Law
Article § 12-204(g))
+
b. Health Insurance Expenses (Code, Family Law Article §
12-204(h)(1))
+
c. Extraordinary Medical Expenses (Code, Family Law Article
§ 12-204(h)(2))
+
d. Additional Expenses (Code, Family Law Article § 12-204(i))
+
5. TOTAL CHILD SUPPORT OBLIGATION
(Add lines 4, 4a, 4b, 4c and 4d).
$
6. EACH PARENT’S CHILD SUPPORT OBLIGATION
(Multiply line 5 by line 3 for each parent).
7. TOTAL DIRECT PAY BY EACH PARENT (Add the
expenses shown on lines 4a, 4b, 4c and 4d paid by each
parent.)
8. RECOMMENDED CHILD SUPPORT AMOUNT
(Substract line 7 from line 6 for each parent.)
Page 1 of 2
$
$
$
$
$
$
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DR 34 - Revised 8 Jan 2008
9. RECOMMENDED CHILD SUPPORT ORDER
(Bring down amount form line 8 for the non-custodial parent
only. If this is a negative number, see Comment (2), below.)
$
$
Comments or special adjustments, such as (1) any adjustment for certain third party benefits paid to or for the child of an
obligor who is disabled, retired, or receiving benefits as a result of a compensable claim (see Code, Family Law Article, §12204(j) or (2) that there is a negative dollar amount on line 9, which indicates a recommended child support order directing the
custodial parent to reimburse the non-custodial parent this amount for “direct pay” expenses):
PREPARED BY:
Date
Page 2 of 2
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DR 34 - Revised 8 Jan 2008