Each party shall complete that portion of the worksheet that applies to him or her, sign the form and file it with the court.  This worksheet is required in all proceedings establishing or modifying child support.

IN RE:                                                                                CASE NO:

                                                                                      FATHER:

                                                                                      MOTHER:

CHILD SUPPORT OBLIGATION WORKSHEET (CSOW)

Children

DOB

Children

DOB

  1.   WEEKLY GROSS INCOME

 Subsequent Children Multipliers (Circle    .935  .903  .878  .863  .854)

FATHER

MOTHER

A.     Child Support (Court Order for Prior Born Child(ren)

B.     Child Support (Legal Duty for Prior Born Child(ren)

            C.     Maintenance Paid

D.        WEEKLY ADJUSTED INCOME (WAI)

 Line 1 minus 1A, 1B, and 1C, and 1D

   2.     PERCENTAGE SHARE OF TOTAL WAI

                        %

                       %

          A.     Work-Related Child Care Expenses

   3.     COMBINED WEEKLY ADJUSTED INCOME   (Line 1D minus Line 2A)

4.       BASIC CHILD SUPPORT OBLIGATION

Apply CWAI to Guideline Schedules

            A.      Weekly Work-Related Child Care Expense of each parent

          B.      Weekly Premium – Children’s Portion of Health Insurance Only

   5.     TOTAL CHILD SUPPORT OBLIGATION   (Line 4 plus 4A and 4B)

   6.     PARENT’S CHILD SUPPORT OBLIGATION  (Line 2 times Line 5)

7.        ADJUSTMENTS

        (     ) Obligation from Post-Secondary Education Worksheet Line J.

        (     ) Payment of work-related child care by each parent.

                                           (Same amount as Line 4A )

        (     ) Child(ren)’s Portion of Weekly Health Insurance Premium $ _____.

                 (This will be a credit to the payor)

        (     ) Visitation Parenting Time Credit $ __________.

+_____________

-_____________

-_____________

-_____________

+______________

-______________

-_______________

-_______________

 8.    RECOMMENDED CHILD SUPPORT OBLIGATION

EXPLAIN ANY DEVIATION FROM GUIDELINE SCHEDULES IN ORDER/DECREE.

I affirm under penalties for perjury that the foregoing representations are true.

                                                                                    Father: __________________________________________

    Dated: ________________________________________                    Mother: _________________________________________

    UNINSURED HEALTH CARE EXPENSE CALCULATION

A.       Custodial Parent Annual Obligation:  (Line 4) _____________  x  52 weeks x  .06  =  $ _____________.

A.     Custodial Parent Annual Obligation: (CSOW Line 4) $________ + (PSEW § Two, Line I) $_______ = $______ x  52 weeks x .06 = $ _       __.

 B.     Balance of Annual Expenses to be Paid:   (Line 2) ____________ % by Father; ____________ % by Mother.