Fill and Sign the Az Child Support Form

SUPERIOR COURT OF ARIZONA IN (2) _____________________ COUNTY PARENT’S WORKSHEET FOR CHILD SUPPORT (3) __________________________________ _ Name of Petitioner ) ) ) (5) Case No. _______________________ (4) ___________________________________ Name of Respondent ) ) (6) ATLAS No. _____________________ (7) Name of parent filing: __________________________________ _ (8) Date prepared: __________________________________ _ (9) In this case, I am the [ ] Petitioner [ ] Respondent [ ] Represented by Attorney (10) Time-sharing arrangement: [ ] Essentially equal [ ] Mostly with Father [ ] Mostly with Mother Presumptive termination date ________________ _ Actual termination date ________________ _ Youngest grade ______ Number of minor children ______ Number of children age 12 or over ______ ( 12) Gr o s s In c o m e f i gu r es f or the O T H E R P A R E NT a r e: [ ] ACTUAL, with proof, such as a recent W2 or pay stub attached, or other party’s signed statement. [ ] ESTIMATED, based on facts or knowledge of pay before promotion or of others in similar job. [ ] ATTRIBUTED , based on what other party could and should be earning (see Guidelines 5e). Revised December 2016 1 of 3 DRS12F For Clerk Use Only (1) Name of Person Filing: Your Address: Your City, State, Zip Code: Your Telephone Number: ATLAS Number (if applicable): Attorney Bar Number (if applicable): Representing: Self (Without an Attorney) Or Attorney for Petitioner Respondent (11) Child(ren)’s names (First, middle initial, and last name) Date of birth Age Case No._____________________ Father Mother Gross Monthly Income (13) $ $ Spousal maintenance paid (14) $- $- Spousal maintenance received (15) $+ $+ Custodial parent of other children subject of court order(s) [ ] Father [ ] Mother (16) $- $- Court-ordered child support paid for children of other relationships (17) $- $- Other natural or adopted children not subject of court order(s) [ ] Father [ ] Mother (18) $- $- Standard deduction $- $- Alternate Deduction (only if less than standard deduction) $- $- Adjusted Gross Monthly Income (19) $ $ Combined Adjusted Gross Income (20) $ Basic Child Support Obligation for [ ] children (21) $ Additions : Adjusted for [ ] children over age 12 at [ ]% (22) $ Medical, dental and vision insurance paid (23) $ $ Monthly childcare costs for [ ] child(ren) (24) $ $ Less federal tax credit allowed to custodian at [ ]% $ $ Extra education expenses paid (25) $ $ Extraordinary (gifted or handicapped) child expenses paid (26) $ $ Subtotal (27) $ $ Total Adjustments for Costs (28) $ Total Child Support Obligation (29) $ Each p arent’s proportionate percentage of combined income (30) __________% __________ % Each parent’s proportionate share of the total support obligation (31) $ $ Less paying parent’s costs (32) $ $ Costs associated with parenting time: Table A [ ] Table B [ ] No. of parenting days ______ Line (21) x adjustment percentage ______% (33) $ $ Adjustments subtotal (34) $ $ Preliminary Child Support Amount (35) $ $ Revised December 2016 2 of 3 DRS12F Case No._____________________ Father Mother Self-Support Reserve Test for Payor Line (19) $ Less paid arrears $ Less $1,115 (36) $ $ Child support amount to be paid by: [ ] Father [ ] Mother (37) $ $ Travel related to parenting time (38) __________% __________% Medical, dental, and vision costs not paid by insurance (39) __________% __________% Revised December 2016 3 of 3 DRS12F