Fill and Sign the Companion Guide to Child Support Worksheetpdf Form

Worksheet 5 DEVIATIONS TO CHILD SUPPORT GUIDELINES This worksheet may be completed by the court and filed with the clerk in the event of a deviation or deviations under § 4-203 of the child support guidelines. Mother Father 1. Net income of the parties as computed under worksheet 1 $ _______ $ _______ 2. Combined monthly income $ _______ 3. Percent contribution of each _______ % _______ % 4. Monthly support for child(ren) from table 1 $ _______ $ _______ 5. Health insurance premium $ _______ $ _______ 6. Total obligation $ _______ 7. Each parent's monthly share $ _______ $ _______ 8. Each parent’s credit for health premium actually paid $ _______ $ _______ 9. Each parent’s final share of the obligation $ _______ $ _______ 10. Further deviations (specify) a. reason 1 ______________ $ _______ $ _______ b. reason 2 ______________ $ _______ $ _______ c. reason 3 ______________ $ _______ $ _______ d. Total $ _______ $ _______ 11. Each parent's monthly share (line 9 above) $ _______ $ _______ 12. (+/-) Line 10d $ _______ $ _______ 13. Adjusted child support $ _______ $ _______ Dated: _________________________ Judge County Case No. CI__-_____ Worksheet 5 adopted Dec. 23, 1992; amended effective Sept. 1, 2002; amended March 18, 2009; amended July 13, 2011, effective September 1, 2011.