CHILD SUPPORT GUIDELI NES WORKSHEET SH ARED CUS TODY Case No.: ................................................... Commonwealth of Virginia Va. Code 20-108.2 ....................................................... v. .................................................... .......................................... DATE I. GUIDELINE CAL CULATION Mother Father Combined A. INCOME Monthly Gross Income (see instructions on Page 2) (1) $. . . . . . . . . . . . . . . . (2) $. . . . . . . . . . . . . . . . Adjustments for spousal support payments (see instructions on Page 2) (3) $. . . . . . . . . . . . . . . . (4) $. . . . . . . . . . . . . . . . Adjustments for support of child(ren) (see instructions on Page 2) (5) $. . . . . . . . . . . . . . . . (6) $. . . . . . . . . . . . . . . . Deductions from Monthly Gross Income (7) -$. . . . . . . . . . . . . . . . (8) - $. . . . . . . . . . . . . . . . allowable by law (see instructions on Page 2) ___________________________ _______________________ Available Gross Income (9) $. . . . . . . . . . . . . . . . (10) $. . . . . . . . . . . . . . . . = (11) $. . . . . . . . . . . . . . . Percentage of Combined Gross Income (12) $. . . . . . . . . . . . . . ..% (13) $. . . . . . . . . . . . . . . . = 100% B. CHILD SUPPORT NEEDS Number of children for whom support is sought (14) . . . . . . . . . . . . . . . . Child support from guideline table apply lines (11) and (14) to table (15) $. . . . . . . . . . . . . . . . Total shared support line (15) x 1.40 (16) $. . . . . . . . . . . . . . . . Mother Father Total days in year each parent has custody (17) . . . . . . . . . . . . . . . . (18) . . . . . . . . . . . . . . . = 365 Each parents custody share (19) . . . . . . . . . . . . . . . % (20) . . . . . . . . . . . . . . .. % = 100% C. EACH PARE NTS SUPPORT OBLIGATION TO OTHER PARENT Mother Father 1. Fathers obligation to Mother Basic support to Mother lines (19) x (16) (21) $. . . . . . . . . . . . . . . . Health care coverage PAID by Mother (if any) (22) $. . . . . . . . . . . . . . . . Work-related child care of Mother (if any) (23) $. . . . . . . . . . . . . . . . Total lines (21) + (22) + (23) (24) $. . . . . . . . . . . . . . . . Fathers obligation lines (24) x (13) = (25) $. . . . . . . . . . . . . . . . 2. Mothers obligation to Father Basic support to Father lines (20) x (16) (26) $. . . . . . . . . . . . . . . . Health care coverage PAID by Father (if any) (27) $. . . . . . . . . . . . . . . . Work-related child care of Father (if any) (28) $. . . . . . . . . . . . . . . . Total lines (26) + (27) + (28) (29) $. . . . . . . . . . . . . . . . Mothers obligation lines (29) x (12) = (30) $. . . . . . . . . . . . . . . . D. NET MONTHLY CHILD SUPPORT PAYABLE FR OM ONE PARENT TO THE OTHER PARENT Shared custody child support guideline amount difference between lines (25) and (30) = (31) (31) $. . . . . . . . . . . . . . . . (32) Payable to [ ] Mother [ ] Father (see instructions on Page 2) II. ADJ USTM ENTS (IF ANY) TO SHAR E D CUSTODY CHIL D SUPPORT GUIDELINE AM OUNT A. ADJUSTMENT ITEMS Mother Father 1. Credit for benefits received by or for the child derived from the parents entitlement to disability insurance benefits to the extent that such derivative benefits are included in a parents gross income (33) $. . . . . . . . . . . . . . . . (34) $. . . . . . . . . . . . . . . . 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . Total adjustments (35) $. . . . . . . . . . . . . . . . (36) $. . . . . . . . . . . . . . . . Net adjustment (difference between lines (35) and (36) (37) $. . . . . . . . . . . . . . . . (38) Owed to [ ] Mother [ ] Father (see instructions on Page 2) B. TOTAL ADJUSTED SUPPORT (see instructions on Page 2) (39) $. . . . . . . . . . . . . . . . (40) Payable to [ ] Mother [ ] Father American LegalNet, Inc.FORM DC-640 (PA07/04 GE ONE OF TWO) PDF www.USCourtForms.com>>>> 2 CHILD SUPPORT GUIDELINES WORKSHEET INSTRUCTIONS General Use monthly financial information rounded to the nearest dollar in making these calculations. To convert data to monthly figures, multiply weekly financial data by 4.33 multiply bi-weekly financial data by 2.167 multiply semi-monthly financial data by 2 divide annual financial data by 12 Amounts of $.50 or more should be rounded up to the nearest dollar; amounts less than $.50 should be roundeddow to nthe nearest dollar. Lines 1 and 2 Gross income is defined by Virginia Code 20-108.2(C). a. Gross income shall mean all income from all sources, and sall include, but not hbe limited to, income from salaries, wages, commissions, royalties, bonuses, dividends, severance payns, peions, interest, trust income, annuities, capital gains, social security benefits, workers compensation benefits, disability insurance benefits, veterans benefits, spousal support, rental income, gifts, prizes or awards.nts gross income If a pareincludes disability insurance benefits, it shall also include any amounts paid to or for the child who is the subject of the order and derived by the child from the parents entitlement to disability insurance benefits. b. Gross income shall not include benefits from public assistance programs as defined in Virginyia A ssistance to Needy Families, auxiliary grants to the aged, blind and disabled, medical assistance, energy assistance, food stamps, employment services, child care, general Code 63.2-100 [Temporary A ived, or income received by the payor from secondary emplont ymincome not preveiously included in gross income, where the payor obtained the income to discharge a child support arrearage established by a court or administrative order and the payor is paying the arrearage pursuant to the order. Lines 3 and 4 If spousal support is paid ba y party pursuant to an existing court or rative orderadminist or written agreement, regardless of whether it is being paid to the other party or to a person not a partyis proceeding, subtract to ththat amount under the payors column. If spousal support is being received by a party pursuant to an existing court or administrative ord writter oren agreement, regardless of whether it is being paidy bthe other party to this proceeding, add the amount under the payees column. Use plus aminus signs and pp