DR-24 (11/08) Revised June 2016 MONTGOMERY COUNTY DOMESTIC RELATIONS COURT CHILD SUPPORT COMPUTATION WORKSHEET SOLE RESIDENTIAL PARENT OR SHARED PARENTING ORDER Name of Parties_____________________________ Case No. ____________ Number of minor children ____. The following parent was designated as residential parent and legal custodian: ____mother; ____father; ____shared. Father has ______ pay periods annually, Mother has ______ pay periods annually. Column I Father Column II Mother Column III Combined INCOME 1a. Annual gross income from employment, or, when determined appropriate by the court or agency, average 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 (Yr. 1 representing the most recent year) Father Mother Yr. 3 $_________ Yr. 3 $_________ Three years ago Yr. 2 $_________ Two years ago Yr. 2 $_________ Yr. 1 $_________ $_________ Yr. 1 $_________ Last calendar year Average $_________ (Include in Col. I and/or Col. II the average of the three years or the year 1 amount, whichever is less, if there exists a reasonable expectation that the total earnings from overtime and/or bonuses during the current calendar year will meet or exceed the amount that is the lower of the average of the three years or the year 1 amount. If, however, there exists a reasonable expectation that the total earnings from overtime/bonuses during the current calendar year will be less than the lower of the average of the 3 years or the year 1 amount, include only the amount reasonably expected to be earned this year).................................................................................$________....$________ 2. For Self-Employment Income: a. Gross receipts from business.......................................................$________....$________ b. Ordinary and necessary business expenses.................................$________....$________ c. 5.6% of adjusted gross income or the actual marginal difference between the actual rate paid by the self-employed individual and the F.I.C.A. rate.............................................................................$________....$________ d. Adjusted gross income from self-employment (subtract the sum of 2b and 2c from 2a) ...................................................................$________....$________ 3. Annual income from interest and dividends (whether or not taxable)..........................................................................$________....$________ 4. Annual income from unemployment compensation..........................$________....$________ 5. Annual income from workers' compensation, disability insurance benefits or social security disability/retirement benefits....................$________....$________ American LegalNet, Inc. www.FormsWorkFlow.com Page 2/Sole Custody-Shared Parenting Worksheet Column I Father Column II Mother Column III Combined 6. Other annual income (identify) _______________________.............$________....$________ 7a. Total annual gross income (add lines 1a, 1b, 2d, and 3-6).......................$________...$_______ 7b. Health Insurance maximum (multiply line 7a by 5%).........................$________...$_______ ADJUSTMENTS TO INCOME 8. Adjustment for minor children born to or adopted by either parent and another parent who are living with this parent; adjustment does not apply to stepchildren (number of children times federal income tax exemption less child support received, not to exceed federal tax exemption) ..................................$________....$________ 9. Annual court-ordered support paid for other children.........................$________....$________ 10. Annual court-ordered spousal support paid to any spouse or former spouse...............................................................................$________....$________ 11. Amount of local income taxes actually paid or estimated to be paid...$________....$________ 12. Mandatory work-related deductions such as union dues, uniform fees, etc. (not including taxes, social security, or retirement).......................$________....$________ 13. Total gross income adjustments (add lines 8 through 12)........................$________....$________ 14a. Adjusted annual gross income (subtract line 13 from line 7a)..................$________....$________ 14b. Cash medical support maximum (If the amount on line 7a, Col. I, is under 150% of the federal poverty level for an individual, enter $0 on line 14b, Col I. If the amount on line 7a, Col. I is 150% or higher of the federal poverty level for an individual, multiply the amount on line 14a, Col. I by 5% and enter this amount on line 14b, Col. I. If the amount on line 7a, Col. II is under 150% of the federal poverty level for an individual, enter $0 on line 14b, Col. II. If the amount on line 7a, Col. II is 150% or higher of the federal poverty level for an individual, multiply the amount on line 14a, Col. II by 5% and enter this amount on line 14b, Col. II.)......................................................................$________....$________ 15. Combined annual income that is basis for child support order (add line 14a, Col. I and Col. II)...............................................................................................$________ 16. Percentage parent's income to total income a. Father (divide line 14a, Col. I by line 15, Col. III)........_________% b. Mother (divide line 14a, Col. II by line 15, Col. III).... +_________% = 100% 17. Basic combined child support obligation (refer to schedule, first column, locate amount nearest to the amount on line 15, Col. III, then refer to column for number of children in this family. If the income of the parents is more than one sum but less than another, you may calculate the difference................................................................................................................................$________ American LegalNet, Inc. www.FormsWorkFlow.com Page 3/Sole Custody-Shared Parenting Worksheet Column I Father Column II Mother Column III Combined 18. ANNUAL SUPPORT OBLIGATION PER PARENT a. Father (multiply line 17, Column III, by line 16a).......................................$________ b. Mother (multiply line 17, Column III, by line 16b)...........................................................$________ 19. Annual child care expen