Arizona
Child Support Worksheet The child support worksheet is used in
domestic relations cases involving child custody issues and in conjunction with the
|
Arizona
Child Support Worksheet The child support worksheet is used in
domestic relations cases involving child custody issues and in conjunction with the
|
SUPERIOR COURT OF ARIZONA, COUNTY OF YAVAPAI
| ________________________ Petitioner, DOB: SSN: and |
CASE NO. DR PARENT'S
WORKSHEET FOR Prepared by (6) [ ] Father [ ] Mother
|
| MONTHLY GROSS INCOME | Father | Mother | |
|
Total Monthly Gross Income |
|||
| (7) Estimated/Attributed to: ¨ Father ¨ Mother | __________ |
( 8) |
__________ |
| (Explain on page 5) | |||
| DEDUCTIONS FROM / ADDITIONS TO MONTHLY GROSS INCOME | |||
| Court Ordered Spousal Maintenance Received +/- Paid | __________ |
( 9) |
__________ |
|
Court Ordered Child Support Actually Paid or |
|||
| Contributed for Other Children | __________ |
(10) |
__________ |
|
Cost of Supporting Other Children (Explain on page 5) |
__________ |
(11) |
__________ |
| Adjusted Monthly Gross Income for Each Parent | __________ |
(12) |
__________ |
| (add or subtract lines 9 through 11 from line 8) |
| COMBINED ADJUSTED MONTHLY GROSS INCOME | (13) __________ |
| BASIC CHILD SUPPORT OBLIGATION | |
| Number of children for whom support is requested: | (14) __________ |
| (Explain on page 5) | |
| Basic Child Support Obligation (from the Schedule) | (15) __________ |
| ADJUSTMENTS FOR NECESSARY EXPENSES | |
| Medical Insurance Premium for Children paid by ¨ Mother | (16) __________ |
| (You may also need to complete item 30) ¨ Father | |
| Child Care Costs ¨ Mother | (17) __________ |
| (Explain on page 5) ¨ Father | |
| Extra Education Expenses | (18) __________ |
| Number of ________ Child(ren) 12 and Over | (19) __________ |
| (Explain on page 5) | |
| Extraordinary Child | (20) __________ |
| Total Adjustments for Necessary Expenses | (21) __________ |
| TOTAL CHILD SUPPORT OBLIGATION | |
| Total Child Support Obligation (add lines 15 and 21) | (22) __________ |
| EACH PARENT'S PERCENTAGE (%) OF COMBINED INCOME | |||
| Calculate for Each Parent: | Father |
Mother |
|
| Adjusted Gross Income (from line 12) | __________ |
(23) |
__________ |
| Combined Adjusted Gross Income (from line 13) | __________ |
(24) |
__________ |
| Adjusted gross income DIVIDED BY combined adjusted | |||
| gross income EQUALS | __________% |
(25) |
__________% |
| EACH PARENT'S PERCENTAGE (%) OF THE TOTAL SUPPORT OBLIGATION | |||
| Calculate for each parent: | Father |
Mother |
|
| Total child support obligation (from line 22) | __________ |
(26) |
__________ |
| Percentage of combined adjusted gross income (from line 25) | __________% |
(27) |
__________% |
| Percentage TIMES the total obligation EQUALS the amount | __________ |
(28) |
__________ |
| of the parent's support obligation | |||
| ADJUSTMENT FOR COSTS ASSOCIATED WITH VISITATION | |||
| Requested Adjustment to be completed for paying parent ONLY | |||
| Number of Visitation Days (Explain on page 6) | |||
| Visitation Table Percentage X Line 15 = | _____ |
(29) |
_____ |
| MEDICAL INSURANCE PREMIUM ADJUSTMENT | (Father) |
(Mother) |
|
| Complete this item ONLY if the parent who will be ordered to pay | |||
| support is also the parent who will pay the medical insurance | _____ |
(30) |
_____ |
| premium. Enter the premium amount paid directly to insurance | |||
| carrier by parent ORDERED to pay support from line 16. | |||
| NON-CUSTODIAL CHILD CARE ADJUSTMENT | |||
| Enter the annualized amount paid directly by the non-custodial | _____ |
(31) |
_____ |
| parent for work related child care. | |||
| COURT APPROVED DISCRETIONARY VISITATION ADJUSTMENT | |||
| Adjustment for Additional Costs, NOT to exceed 16% of line 15. | _____ |
(32) |
_____ |
| (Explain on page 6) | |||
| ADJUSTMENTS SUBTOTAL | _____ |
(33) |
_____ |
| Add lines 29 through 32 | |||
| PRELIMINARY CHILD SUPPORT AMOUNT | |||
| Deduct line 33 from line 28. | _____ |
(34) |
_____ |
| SELF SUPPORT RESERVE TEST | |||
| Paying parent’s ADJUSTED gross income | _____ |
(35) |
_____ |
| minus -$645.00 = the resulting amount. (Line 12) | |||
| If this amount is less than the Preliminary Child Support Amount, the court SHALL | |||
| order the resulting amount as child support order on line 35, absent a deviation. | |||
| AMOUNT TO BE ORDERED BASED ON THESE CALCULATIONS | |||
| Enter the lesser of the amounts shown on line 34 or line 35. | _____ |
(36) |
_____ |
Father |
Mother |
||
| DEVIATION FROM THE GUIDELINES SUPPORT AMOUNT | |||
| If you believe the Guidelines support amount is too high or too | _____ |
(37) |
_____ |
| low in your case, enter the amount which you believe the court | (Father) |
(Mother) |
|
| should order as child support in this case. Explain why on page 6. |
| RESPONSIBILITY FOR VISITATION-RELATED TRAVEL EXPENSES | |||
| Enter on this line the amount or percentage you think each parent should pay | _____ |
(38) |
_____ |
| towards the travel/transportation expenses associated with visitation. The | (Father) |
(Mother) |
|
| allocation of travel expenses does not change the amount of the support | |||
| ordered. Explain on page 5. | |||
| RESPONSIBILITY FOR MEDICAL EXPENSES NOT PAID BY INSURANCE | |||
| Percentage of uninsured medical expenses that each parent should pay. | _____ |
(39) |
_____ |
(Father) |
(Mother) |
I have read this document, and the facts are true and correct to the best of my knowledge or belief.
Date
____________________________
Petitioner, Pro Se
STATE OF ARIZONA
)
) ss.
COUNTY OF YAVAPAI )
Subscribed and sworn or affirmed and acknowledged before me this date:
Notary Expiration Date Notary Public or Clerk
I have read this document, and the facts are true and correct to the best of my knowledge or belief.
Date
__________________________
Respondent, Pro Se
STATE OF ARIZONA
)
) ss.
COUNTY OF YAVAPAI )
Subscribed and sworn or affirmed and acknowledged before me this date:
Notary Expiration Date Notary Public or Clerk
BASIS FOR AMOUNTS SHOWN ON WORKSHEET
( 7) Estimated/Attributed Income
- Explain why you believe the other party is or could be earning the amount you indicated.
Be as specific as possible. See the instructions for item 7 for examples.
(11) Cost of Supporting Other Children
- Follow the instructions for item 11. List the names and ages of the natural or
adopted children for whom you are requesting an adjustment and describe the support you
provide for these children.
Name Date of Birth Social Security Number
| __________________________ | _____________ | ______________ |
(14) Children for whom Support is
Requested - List the names and ages of the natural or adopted children for whom
you
are requesting support.
| Name | Date of Birth | 12 or over
Y/N |
Social Security Number | |||
| ____________________ | ________ | ____ | ________________ |
(17) Child Care Costs - If
the custodial parents income is in excess of the chart in [Guidelines 8.b.1.], the court
may adjust the cost of
day care in order to apportion the dependent care tax credit benefit. The court may reduce
the annualized amount of day care by 25% with
a maximum monthly reduction of $50 per month for one child, $100 per month for two or more
children.
Custodial Parent
Monthly Child Number Annual Adjusted
Care Costs X of months = Cost X .75 = Cost ¸ 12 = Adjusted Monthly Cost
X = X .75 = ¸ 12 =
Non-Custodial Parent
Child Care Costs X # of months ¸ 12 =
Adjusted Monthly Cost ¸ 12 =
(19) Child 12 and Over - Follow
the worksheet instructions for item 19. Explain why you need extra money to support the
child(ren) age 12 and over.
(29) Adjustment for Costs Associated with Visitation -
Calculate the number of visitation days per year. [Guidelines 10]
_____Extended periods
days _____Weekend periods days
_____Holidays periods days _____ Midweek periods
days
_____School breaks days
_____ Other periods days
(32) Court Approved Discretionary
Visitation Adjustment - Upon proof that in the best interests of the child costs
for
clothing and personal care items are duplicated, equally shared or incurred primarily by
the non-custodial parent, the court may
make a further adjustment if visitation exceeds 129 days. The amount of the adjustment
shall not exceed 16% of line 15. Explain
the basis of the requested adjustment:
(37) Deviation From the Guidelines
Support Amount - If you believe the Guidelines support amount is too high or too
low
in your case, explain why. READ THE GUIDELINES GENERALLY AND SECTION 17 IN PARTICULAR.
(This does not include
physical custody adjustments; those are considered in items 29 and 32.) Show the total
support amount you believe should be ordered.
A deviation can only be ordered if the court makes appropriate findings.
Requested Support Amount: $ __________________
(38) Visitation-Related Travel Expenses
- Describe the anticipated visitation plan and related travel/transportation costs. The
court may consider how the conduct of each parent has contributed to such costs. Explain
how you think the cost should be divided
between the parents. Enter the amount or percentage you think each parent should pay on
line 36. The allocation of travel expenses
does not change the amount of the support ordered.
Federal Tax Exemption - Explain how you want the tax exemptions for the child(ren) allocated. [Guidelines 25]
Other Requests - Identify and explain any additional issues
you want the court to address.
