IN THE _____________________________________ STATE OF OKLAHOMA [Add case style] [Add case style] [Add case style] [Add case style] [Add case style] ) ) ) ) ) ) ) ) ) ) Dist. Ct. Case No. OAH Case No: OK IV-D FGN: Obligor: Custodial Person: CHILD SUPPORT COMPUTATION Calculation for number of children Obligor (noncustodial parent) is (Enter "mother" or "father") A 1 2 3 4 5 6 B 7 8 Base monthly obligation Gross monthly income All sources, except child support received and means-tested public assistance Less court-ordered optional monthly adjustment for marital debt Less court-ordered monthly child support and support alimony actually paid for others Adjusted gross monthly income Line 1 minus Line 2 and/or Line 3, if used Percentage share of income Line 4 for each parent divided by Line 4 combined Base monthly obligation Apply Line 4 combined to Child Support Guideline Schedule and insert in Line 6 combined; then, Line 6 combined X Line 5 for each parent. Father Mother % % Shared parenting adjustment, if used Number of overnights with each parent If less than 121 for obligor, skip to C. Percentage with each parent Line 7 for each parent divided by 365 Father Mother OKDHS revised 04-20-2007 03EN005E Combined 100% Combined 365 % % 100% Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com B 9 10 11 12 13 C 14 15 16 D 17 18 Shared parenting adjustment, if used Shared parenting base obligation Line 6 combined X 1.5 Each parent's share Line 9 combined X Line 5 for each parent Amount retained by each parent Line 10 for each parent X Line 8 for each parent Offset amount Line 10 minus Line 11 for each parent Adjusted base monthly obligation Subtract smaller amount from larger amount on Line 12. If custodial person amount is larger than obligor amount, enter $0 for obligor. Father Mother Combined Health insurance premium Monthly health insurance premium Actual monthly premium amount for each parent, for child(ren) included in this calculation. If none, enter $0 and skip to Line 17. Monthly health insurance premium share Line 14 combined premium amount X Line 5 for each parent Adjusted premium share paid by obligor Leave custodial person amount blank. Subtract obligor Line 14 from obligor Line 15. Amount may be negative. Father Mother Combined Work and education-related child care expenses Monthly child care expenses for each parent, for child(ren) included in this calculation. Skip to line 18 if OKDHS child care subsidy case. OKDHS child care subsidy Line 18f X Line 18b divided by Line 18a a. Total children in custodial person's child care subsidy case b. Number of children of these parents in custodial person's child care subsidy case c. Custodial person's actual gross monthly income Father Mother Combined OKDHS revised 04-20-2007 03EN005E Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com D 19 20 21 E 22 23 24 Work and education-related child care expenses d. Obligor base monthly obligation amount e. Amount treated as custodial person's OKDHS household income - Line 18c plus Line 18d f. Amount treated as custodial person's family share co-payment from OKDHS Appendix C-4, page 2 Child care expense share Line 17 combined or custodial person Line 18, X Line 5 for each parent Adjusted child care contribution paid by obligor. Leave custodial person amount blank. Subtract obligor Line 17 or 18 from obligor Line 19. Amount may be negative. Total monthly child support obligation Add obligor Line 6 or Line 13 and Lines 16 and 20, if positive amounts. Subtract Lines 16 and 20, if negative amounts from obligor Line 6 or Line 13. Father Mother Combined Other contributions, if agreed or ordered Recurring monthly medical expenses Line 22 combined X Line 5 for each parent Other medical expenses percentage share - Line 5 Visitation transportation costs Line 24 combined X Line 5 for each parent Father Mother Combined % % Page 3 of 4 03EN005E OKDHS revised 04-20-2007 American LegalNet, Inc. www.FormsWorkflow.com Payments shall commence on the day of are due on the same date of each month thereafter. , , and Guidelines were followed. Deviation from child support guidelines by Court-Specific findings of Court supporting each deviation: Dated this day of , . JUDGE APPROVED AS TO FORM: Printed name Printed name Address Address Address Address Phone Phone Attorney for Attorney for OBA# OBA# Address Address Address Address Phone Phone State's Attorney, CSE, OKDHS OBA# Address Phone Address OKDHS revised 04-20-2007 03EN005E Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com