STATE OF NORTH CAROLINA County File No. Case No. (Code) IV-D Case No. UIFSA Case No. In The General Court Of Justice District Superior Court Division Civil: Criminal: Name Of Defendant Plaintiff STATE VERSUS WORKSHEET C CHILD SUPPORT OBLIGATION SPLIT CUSTODY G.S. 50-13.4(c) Children Date Of Birth Children Date Of Birth Plaintiff 1. MONTHLY GROSS INCOME a. Minus pre-existing child support payment b. Minus responsibility for other children 2. MONTHLY ADJUSTED GROSS INCOME 3. PERCENTAGE SHARE OF INCOME (line 2 for each 4. BASIC CHILD SUPPORT OBLIGATION (apply line 2 parent's income, divided by Combined income) Combined to the Schedule of Basic Support Obligations see AOC-A-162, Rev. 1/15) 5a. SPLIT CUSTODY ADJUSTMENT (enter number of children living with each parent and under Combined, enter total number of children) 5b. Number of children with each parent divided by total number of children $ _ _ $ % Defendant $ _ _ $ % Combined $ $ 5c.Multiply line 4 by line 5b for each parent 6a. PLAINTIFF'S SUPPORT FOR CHILDREN WITH DEFENDANT (multiply defendant's line 5c by plaintiff's line 3) 6b. DEFENDANT'S SUPPORT FOR CHILDREN WITH PLAINTIFF (multiply plaintiff's line 5c by defendant's line 3) 7. ADJUSTMENTS (expenses paid directly by each parent) a. Work-related child care costs b. Health Insurance premium costs - child's/children's portion only (total premium � # of persons covered � # of children subject to order = children's portion) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ c. Extraordinary expenses d. Total Adjustments (for each column, add 7a, 7b, and 7c. 8. EACH PARENT'S FAIR SHARE OF ADJUSTMENTS (line 9. ADJUSTMENTS PAID IN EXCESS OF FAIR SHARE (line 10. EACH PARENT'S ADJUSTED SUPPORT OBLIGATION 11. RECOMMENDED CHILD SUPPORT ORDER (subtract Date Prepared By (type or print) Add two totals for Combined amount) 7d Combined � line 3 for each parent) 7d minus line 8. If negative number, enter zero) (line 6a or 6b minus line 9 for each parent) lesser amount from greater amount in line 10 and enter result directly under greater amount) (NOTE: This form may be used in both civil and criminal cases.) (Over) AOC-CV-629, Rev. 1/15 � 2015 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING CHILD SUPPORT WORKSHEET C SPLIT CUSTODY OF CHILD(REN) Worksheet C is used when there is more than one child involved in the pending action and each parent has physical custody of at least one of the children. Lines 1 through 4 of Worksheet C are calculated in the same manner as lines 1 through 4 of Worksheet A. On line 5a, enter the number of children living with each parent and the total number of children for whom support is sought. Divide the number of children living with each parent by the total number of children and enter the result in the appropriate column for each parent on line 5b. (For example, if there are three children of the parties and one child lives with the plaintiff, divide one by three and enter 33.33% in plaintiff's column, then divide two by three and enter 66.67% in defendant's column on line 5b.) Multiply line 4 by line 5b for each parent and enter the results on line 5c. On line 6a, multiply defendant's line 5c by plaintiff's line 3 (plaintiff's percentage share of income) and enter the result in the column for plaintiff. Multiply plaintiff's line 5c by defendant's line 3 and enter the result on line 6b. Lines 7a through 7d of Worksheet C are calculated in the same manner as lines 5a through 5d of Worksheet A. On line 8, multiply line 7d (Combined) by line 3 for each parent and enter the result under the column for that parent. Subtract line 8 from line 7d for each parent and enter the result on line 9 (if negative, enter zero). Subtract line 9 from line 6a or 6b for each parent and enter the result on line 10 under the appropriate column. In some cases, the result may be a negative number. If the result is negative, enter it as a negative number on line 10, not as a positive number or as a zero. If plaintiff's line 10 is greater than defendant's line 10, enter the difference between these two amounts on line 11 under plaintiff's column and leave defendant's column blank. If defendant's line 10 is greater than plaintiff's line 10, enter the difference between these two amounts on line 11 under defendant's column and leave plaintiff's column blank. [Note that if either of the numbers on line 10 is a negative number, you must change the signs when you subtract. For example, $100 minus negative $50 equals $150.] NOTE TO PLAINTIFF AND DEFENDANT: The information required to complete the worksheet is known only to the parties. It is the responsibility of the parties to provide this information to the Court so that the Court can set the appropriate amount of child support. The Clerk of Superior Court CANNOT obtain this information or fill out this worksheet for you. If you need assistance, you may contact an attorney or apply for assistance at the IV-D agency within your county. AOC-CV-629, Side Two, Rev. 1/15 � 2015 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com