LAKE COUNTY DOMESTIC RELATIONS COURT CHILD SUPPORT COMPUTATION SPLIT PARENTAL RIGHTS AND RESPONSIBILITIES NAME OF PARTIES......................................................... ...................................................................CASE NO. ................................ NUMBER OF MINOR CHILDREN .............................................................. ......................................................................................... NUMBER OF MINOR CHILDREN WITH MOTHER.................................................... FATHER .. ..................................................... Father has _______pay periods annually; Mthoer has _____ pay periods annually. COLUMN I COLUMN II LUMN III CO FATHER MOTHER COMBINEDINCOME 1.a. ANNUAL GROSS INCOME FROM EMPLOYMENT OR, WHEN DETERMINED APPROPRIATE BY THE COURT OR AGENCY, AV- ERAGE ANNUAL GROSS INCOME FROM EMPLOYMENT OVER A REASONABLE PERIOD OF YEARS. (EXCLUDE OVERTIME, BONUSES, SELF-EMPLOYMENT INCOME, OR COMMISSIONS) $ ................... $ ................... b . AMOUNT OF OVERTIME, BONUSES, AND COMMISSIONS (YEAR 1 REPRESENTING THE MOST RECENT YEAR) FATHER MOTHER YR. 3 $ ................................... YR. 3 $ ............ ........................ (THREE YEARS AGO) (THREE YEARS AGO) YR. 2 $ ................................... YR. 2 $ ............ ....................... (TWO YEARS AGO) (TWO YEARS AGO) YR. 1$ ................................... YR. 1 $ ........... ........................ (LAST CALENDAR YEAR) (LAST CALENDAR YEAR) AVERAGE $......................... $........................ (INCLUDE IN COL. I AND/OR COL. II THE AVERAGE OF THE THREE YEARS OR THE YEAR 1 AMOUNT, WH ICHEVER IS LESS, IF THERE EXISTS A REASONABLE EXPECTATION THAT THE TOTAL EARNINGS FROM OVERTIME AND/ OR BONUSES DUR- ING THE CURRENT CALENDAR YEAR WILL MEET OR EXCEED THE AMOUNT THAT IS THE LOWER OF THE AVERAGE OF THE THREE YEARS OR THE YEAR 1 AMOUNT. IF, HOWEVER, THERE EXISTS A REASONABLE EXPECTATION THAT THE TO- TAL EARNINGS FROM OVERTIME/BONUSES DURING THE CURRENT CALENDAR YEAR WILL BE LESS THAN THE LOWER OF THE AVERATE OF THE 3 YEARS OR THE YEAR 1 AMOUNT, INCLUDE ONLY THE AMOUNT REASONABLY EXPECTED TO BE EARNED THIS YEAR.).................................................. ................. $ ................... $ ................... 2. FOR SELF-EMPLOYMENT INCOME a. GROSS RECEIPTS FROM BUSINESS...................................... ...........$ ................... $ ................... b. ORDINARY AND NECESSARY BUSINESS EXPENSES ................. $ ................... $ ................... c. 5.6% OF ADJUSTED GROSS INCOME OR THE ACTUAL MAR- GINAL DIFFERENCE BETWEEN THE ACTUAL RATE PAID BY THE SELF-EMPLOYED INDIVIDUAL AND THE F.I.C.A. RATE. $ ................... $ ................... d. ADJUSTED GROSS INCOME FROM SELF-EMPLOYMENT (SUB- TRACT THE SUM OF 2b AND 2c FROM 2a).................................... .. $ ................... $ ................... 3. ANNUAL INCOME FROM INTEREST AND DIVIDENDS (WHETHER OR NOT TAXABLE)................................................. ..........$ ................... $ ................... 4. ANNUAL INCOME FROM UNEMPLOYMENT COMPENSATION $ ................... $ ................... 5. ANNUAL INCOME FROM WORKERS COMPENSATION, DIS- ABILITY INSURANCE BENEFITS OR SOCIAL SECURITY DIS- ABILITY/RETIREMENT BENEFITS..................................................... $ ................... $ ................... 6. OTHER ANNUAL INCOME (IDENTIFY)........................................ ..... $ ................... $ ................... 7. TOTAL ANNUAL GROSS INCOME (ADD LINES la, lb, 2d AND 3-6).................................................................. ..........................................$ ...................$ ................... ADJUSTMENTS TO INCOME 8. ADJUSTMENT FOR MINOR CHILDREN BORN TO OR ADOPTED BY EITHER PARENT AND ANOTHER PARENT WHO ARE LIVING WITH THIS PARENT; ADJUSTMENT DOES NOT APPLY TO STEP- CHILDREN (NUMBER OF CHILDREN TIMES FEDERAL IN- COME TAX EXEMPTION LESS CHILD SUPPORT RECEIVED, NOT TO EXCEED THE FEDERAL TAX EXEMPTION)......................$ ................... $ ................... American LegalNet, Inc. www.USCourtForms.com>>>> 29. ANNUAL COURT-ORDERED SUPPORT PAID FOR OTHER CHIL- DREN.................................................................... ...................................$ ...................$ ................... 10. ANNUAL COURT-ORDERED SPOUSAL SUPPORT PAID TO ANY SPOUSE OR FORMER SPOUSE................................................. ............ $ ................... $ ................... 11. AMOUNT OF LOCAL INCOME TAXES ACTUALLY PAID OR ESTI- MATED TO BE PAID........................................................ .......................$ ................... $ ...................12. MANDATORY WORK-RELATED DEDUCTIONS SUCH AS UNION DUES, UNIFORM FEES, ETC. (NOT INCLUDING TAXES, SOCIAL SECURITY, OR RETIREMENT)............................................... .............. $ ................... $ ...................13. TOTAL GROSS INCOME ADJUSTMENTS (ADD LINES 8 THROUGH 12)............................................................ ............................. $ ..................................... $ .14. ADJUSTED ANNUAL GROSS INCOME (SUBTRACT LINE 13 FROM 7)................................................................ ....................................$ ...................$ ................... 15. COMBINED ANNUAL INCOME THAT IS BASIS FOR CHILD SUP- PORT ORDER (ADD LINE 14, COL. I AND COL II)........................... .. $ ...................16. PERCENTAGE OF PARENTS INCOME TO TOTAL INCOME a. FATHER (DIVIDE LINE 14, COL I, BY LINE 15, COL III).................. % b. MOTHER (DIVIDE LINE 14, COL II, BY LINE 15, COL III)............... % 17. BASIC COMBINED CHILD SUPPORT OBLIGATION (REFER TO SCHEDULE, FIRST COLUMN, LOCATE THE AMOUNT NEAR- EST TO THE AMOUNT ON LINE 15, COL III, THEN REFER TO COLUMN FOR NUMBER OF CHILDREN WITH THIS PARENT. IF THE INCOME OF THE PARENTS IS MORE THAN ONE SUM BUT LESS THAN ANOTHER, YOU MAY CALCULATE THE DIF- FERENCE)............................................................... ...................................FOR CHILDRENFOR CHILDREN FOR WHOM THE FOR WHOM THE MOTHER IS THE FATHER IS THE RESIDENTIAL RESIDENTIAL PARENT AND PARENT AND LEGAL LEGAL CUSTODIAN CUSTODIAN $ ................... $ ................... 18. ANNUAL SUPPORT OBLIGATION PER PARENT a. OF FATHER FOR CHILDREN FOR WHOM MOTHER