State of Tennessee – Credit Worksheet Part I. Identification PRP ARP SPLIT Name of Mother: Name of Father: Name of non-parent Caretaker: TCSES case #: Docket #: Court name: Indicate the status of each parent or caretaker by placing an “X” in the appropriate column Part II. Other Children Column A Parent Income Information 1 2a 2b Monthly gross income of parent claiming credit Self-employment tax paid Applicable gross income for credit worksheet In-Home Children 3 Column B Below, list qualified children living in the parent's home (if none, skip to line 7): Name(s) of Child(ren) for PRP 4 5 $ $ $ Date of Birth $ $ $ Name(s) of Child(ren) for ARP 6 Not-In-Home Children Number of qualified children living in the parent’s home Theoretical child support order (this parent’s income on CS Schedule for number of children from line 4) 75% of theoretical child support order from line 5 7 Below, list qualified children not living in the parent's home (if none, skip to Part III): Name(s) of Child(ren) for PRP 8 9 10 11a 11b Date of Birth # # $ $ Date of Birth $ $ Name(s) of Child(ren) for ARP Number of qualified children not living in the parent’s home Average monthly amount of documented monetary support Theoretical child support order (this parent’s income on CS Schedule for number of children from line 8) 75% of theoretical child support order from line 10 Allowable credit for not-in-home children # $ # $ $ $ $ Date of Birth $ $ $ Part III. Pre-Existing Support Orders ü This section is not part of the calculation for Part II above List court name, docket number, TCSES number, monthly obligation, name and date of birth for each child supported under the order. Do not include arrears payments. 1 2 3 4 Total Column A $ $ $ $ $ Column B $ $ $ $ $ 11-4-04 American LegalNet, Inc. www.USCourtForms.com