DHS
ORS CSS GWMO
10/94
IN THE
________________________ DISTRICT COURT
|
______________________________________ vs. ______________________________________ |
WORKSHEET TO DETERMINE MOTHER'S OBLIGATION TO
CHILDREN IN HER PRESENT HOME Civil No. ______________________ |
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|
OTHER PARENT NAME _____________________________ |
MOTHER |
OTHER PARENT |
COMBINED |
|
1. |
Enter the #
of natural and adopted children of the mother and the other parent. |
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2a. |
Enter the
mother's and other parent's gross monthly income. Refer to Instructions for
definition. |
$ |
$ |
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|
2b. |
Enter
previously ordered alimony that is actually paid. (Do not enter alimony
ordered for this case). |
_ |
_ |
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|
2c. |
Enter
pre-existing ordered child support. (Do not enter obligations ordered for the
children in this case). |
_ |
_ |
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3. |
Subtract
Lines 2b and 2c, from 2a. This is the Adjusted Monthly Gross Income for child
support purposes. |
$ |
$ |
$ |
|
4. |
Take the
COMBINED figure in Line 3 and the number of children in Line 1 to the Support
Table. Find the Combined Support Obligation. Enter it here. |
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|
$ |
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5. |
Divide each
parent's adjusted monthly gross in Line 3 by the COMBINED adjusted monthly
gross in Line 3. |
% |
% |
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6. |
Multiply
Line 4 by Line 5 for each parent to obtain each parent's share of the Base
Support Obligation. |
$ |
$ |
|
|
7. |
Enter the
amount of the children's portion of the insurance premium actually paid. |
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|
$ |
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8. |
Enter the
monthly work or training related child care expense for the children in Line
1. |
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$ |
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9. |
MOTHER'S SHARE OF BASE CHILD SUPPORT AWARD FOR THE
CHILDREN IN LINE 1. Enter the amount for the mother from line 6. |
$ |
|
10. |
MOTHER'S SHARE OF CHILDREN'S INSURANCE FOR THE CHILDREN IN LINE 1. Multiply
Line 7 by .50, and enter the result here. |
$ |
|
11. |
MOTHER'S SHARE OF WORK OR TRAINING RELATED CHILD CARE
EXPENSES FOR
THE CHILDREN IN LINE 1. Multiply Line 8 by .50, and enter the result here. |
$ |
|
12. |
MOTHER'S SHARE OF TOTAL CHILD SUPPORT OBLIGATION TO
THE CHILDREN IN LINE 1. Add lines 9,10, and 11.
This amount may be used to adjust the mother's gross income on the sole,
split, or joint custody worksheets. |
$ |
10/94
Use this worksheet to determine the mother's obligation
for natural or adopted children who live in her home and who are not children
of the father listed on the Sole,
Line 1. Enter the number of natural or adopted children of the mother and the
other parent named on this worksheet. The other parent may be a current spouse,
partner, or and ex-husband of the mother listed on the primary worksheet. If the mother has children in her home by
more than one father, complete a separate worksheet for the children of each
other parent.
Line 2a. Enter the mother's and other parents gross monthly income. Definition
of gross monthly income ‑ prospective income from any source, salaries,
wages, commissions, royalties, bonuses, rents, gifts, prizes, dividends, severance
pay, pensions, interest, trust income, alimony from previous marriages,
annuities, capital gains, social security benefits, workers' compensation
benefits, unemployment compensation, disability insurance benefits and payments
for "non‑means‑tested" government programs. Income from
earned sources is limited to the equivalent of one full time job. For self‑employed
parents, see UCA 78‑45‑7.5(4)(a) and (b).
The
guidelines do not provide for imputing income to the other parent. Therefore, use the other parent’s actual
earnings. The mother may be the
custodial parent of children in her home from a previous marriage. If the divorce decree form her previous
marriage was entered prior to
Excluded
from gross income are: cash assistance provided under Title 35A, Chapter 3,
Family Employment Program, benefits from: the housing subsidy program, the Job
Training Partnership Act, S.S.I., S.S.D.I., Medicaid, Food Stamps, General
Assistance, and other "means‑tested" benefits received by a
parent; earnings or benefits of a child who is subject to this award.
All
income must be verified. Verification includes: year to date pay stubs,
employer statements or records, the last year's tax return and documentation of
non‑earned income appropriate to the source.
Line 2b. In the MOTHER'S column, enter the monthly alimony amount she is paying
to a parent other than the one listed on this worksheet or the primary
worksheet. In the other parents column enter the monthly alimony that father is
paying to someone other than the mother listed on this worksheet.
Line 2c. In the MOTHER'S column, enter the court ordered child support she is
ordered to pay for children other than the children listed on the primary
worksheet. In the other parent's column, list the amount that father is ordered
to pay for children other than those listed on this worksheet.
Line 7. In the combined column, enter the children's portion of insurance
premium that is actually paid. To determine the children's portion divide the
total premium by the number of persons covered by the policy and then multiply
that number by the number of children listed on this worksheet that are covered
by the policy.
Line 8. Enter the amount of work‑related, reasonable, child care
expenses for up to a full-time work week or training schedule.
Line 10. The guideline evaluation committee determined that the non-routine
uninsured medical expenses should be evenly split between the mother and the
other parent, unless a judge or presiding administrative authority determines
otherwise.
Line 12. Enter the amount on this line on Line 2d of the Sole Custody, Line 3d of the Split Custody or Line 4d of the Joint Custody Worksheets.