Fill and Sign the Child Support Guidelines Shared Parenting Worksheet Appendix Ix D Child Support Guidelines Shared Parenting Worksheet Appendix Form

Appendix IX-D Amended May 9, 2019 to be effective June 1, 2019, CN 10727 (Appendix IX-D) page 1 of 2 Child Support Guidelines - Shared Parenting Worksheet Case Name: v. County: Plaintiff Defendant Docket Number : PPR is the:  Plaintiff  Defendant Number of Children: All amounts must be weekly Parent of Primary Residence (PPR) Parent of Alternate Residence (PAR) Combined 1. Gross Taxable Income $ $ 1a. Mandatory Retirement Contributions (non-taxable) -$ -$ 1b. Tax -Deductible Alimony Paid (Current and/or Past Relationships) -$ -$ 1c. Taxable Alimony Received (Current and/or Past Relationships) +$ +$ 2. Adjusted Gross Taxable Income ((L1 - L1a - L1b) + L1c) $ $ 2a. Federal, State and Local Income Tax Withholding -$ -$ 2b. Mandatory Union Dues -$ -$ 2c. Child Support Orders for Other Dependents -$ -$ 2d. Other Dependent Deduction (from L14 of a separate worksheet) -$ -$ 3. Net Taxable Income (L2 - L2a - L2b - L2c - L2d) $ $ 4. Non -Taxable Income (source: ) +$ +$ 4a. Non -Tax -Deductible Alimony Paid (Current and/or Past Relationships -$ -$ 4b. Non -Taxable Alimony Received (Current and/or Past Relationships ) +$ +$ 5. Government (Non-Means Tested) Benefits for the Child +$ +$ 6. Net Income (L3 + L4 - L4a + L4b + L5) $ $ $ 7. Each Parent’s Share of Income (L6 Each Parent ÷ L6 Combined) 0._____ 0._____ 1.00 8. Basic Child Support Amount (from Appendix IX -F Schedules) $ 9. Number of Overnights with Each Parent 10. Each Parent’s Share of Overnights with the Child (L9 for Parent ÷ L9 Combined) 0._____ 0._____ 1.00 If PAR time sharing is less than the equivalent of two overnights per week (28%), use Sole Parenting Worksheet. 11. PAR Shared Parenting Fixed Expenses (L8 x PAR L10 x 0.38 x 2) +$ 12. Shared Parenting Basic Child Support Amount (L8 + L11) $ 13. Each Parent’s Share of SP Basic Child Support Amount (L7 x L12) $ $ 14. PAR Shared Parenting Variable Expenses (PAR L10 x L8 x 0.37) -$ 15. PAR Adjusted SP Basic Child Support Amount (PAR L13 – L11 – L14) $ 16. Net W ork -Related Child Care (from Appendix IX -E Worksheet) +$ 17. Child's Share of Health Insurance Premium +$ 18. Unreimbursed Health Care Expenses over $250 per child per year +$ 19. Court -Approved Extraordinary Expenses +$ 20. Total Supplemental Expenses (L16 + L17 + L18 + L19) $ 21. PAR’s Share of Total Supplemental Expenses (PAR L7 x L20) $ 22. Government Benefits for the Child Based on Contribution of PAR $ 23. PAR Net Work -Related Child Care PAID $ Continued on Page 2 Appendix IX-D Amended May 9, 2019 to be effective June 1, 2019, CN 10727 (Appendix IX-D) page 2 of 2 Child Support Guidelines - Shared Parenting Worksheet – Page 2 All amounts must be weekly PPR PAR Combined 24. PAR Health Insurance Premium for the Child PAID $ 25. PAR Unreimbursed Health Care Expenses >$250/child/year) PAID $ 26. PAR Court -Approved Extraordinary Expenses PAID $ 27. PAR Total Supplemental Expenses PAID (L23 + L24 + L25 + L26) $ 28. PAR Net Supplemental Expenses (L21 - L27) $ 29. PAR Net Child Support Obligation (L15 + L28) $ If there is no adjustment for other dependents , go to line 33. 30. Line 29 PAR CS Obligation WITH Other Dependent Deduction L2d and Child Support Orders for Other Dependents L2c $ 31. Line 29 PAR CS Obligation WITHOUT Other Dependent Deduction and Child Support Orders for Other Dependents $ 32. Adjusted PAR Child Support Obligation ((L30 + L31) ÷ 2) $ 33. Self -Support Reserve Test: (L6 - L29 or L32 for PAR; L6 – L13 for PPR) If L33 for PAR is greater than 105% of the federal poverty guideline for one person ( pg) or L33 for the PPR is less than the pg , enter the L29 or L32 amount on the PA L35. If PAR L33 is less than the pg and PPR’s L33 is greater than the pg, go to L34. If L29 or L32 is negative, see App. IX -B for instructions . $ $ 34. Maximum CS Obligation (Obligor Parent's L6 net income – 105% of the poverty guideline for one person) . Enter result here and on Line 35. $ $ 35. Child Support Order (negative L29 or L32 denotes PPR Obligation) $ $ If the PAR is the Obligor, continue on Line 36 36. PPR Household Income Test (L6 PPR net income from all sources + net income of other household members + L35 order) . If less than the PPR household income threshold (see App. IX -A, ¶14(c)), the SOLE PARENTING W ORKSHEET should be used . $ Comments, Rebuttals, and Justification for Deviations 1. This child support order for this case  was  was not based on the child support guidelines award. 2. If different from the child support guidelines award (Line 35), enter amount ordered: 3. The child support guidelines were not used or the guidelines award was adjusted because: 4. The following extraordinary expenses were added to the basic support obligation on Line 19: 5. PPR Taxes: App IX -H Circ E Other #Allowances: Marital: PAR Taxes: App IX -H Circ E Other #Allowances: Marital: Prepared By: Title: Date: