District Court Adams County State of Colorado Court

District Court — Adams County, Colorado

Court Address: Adams County Justice Center, 1100 Judicial Center Drive, Brighton, CO 80601

Attorney or Party Without Attorney (Name and Address):

Children Date of Birth

Children Date of Birth

MONTHLY GROSS INCOME

a. Maintenance received — Mother: Father:

b. Maintenance paid — Mother: Father:

c. Ordered child support payments for other children — Mother: Father:

d. Legal responsibility for prior-born children not of this marriage/relationship — Mother: Father:

e. Subtract ordered post-secondary education contributions — Mother: Father:

MONTHLY ADJUSTED GROSS INCOME — Mother: Father: Combined:

EACH PARENT'S PERCENTAGE SHARE OF INCOME — Mother: Father:

BASIC CHILD SUPPORT OBLIGATION (From Child Support Schedule)

Shared support obligation (basic obligation multiplied by 1.5)

Each parent's portion of support obligation — Mother: Father:

Overnights with each parent — Mother: Father:

Percentage of time with each parent — Mother: Father:

Support obligation for time with other parent — Mother: Father:

ADJUSTMENTS (Expenses paid directly by each parent)

a. Work related child care. Number of kids eligible

b. Actual child care costs minus Federal Tax Credit — Mother: Father:

c. Education related child care — Mother: Father:

d. Health insurance premium costs - children's portion only — Mother: Father:

e. Extraordinary medical expenses (uninsured only) — Mother: Father:

f. Extraordinary expenses (agreed to by parents or by order of the court) — Mother: Father:

g. Extraordinary adjustments (factors that diminish basic needs of the child(ren)) — Mother: Father:

TOTAL ADJUSTMENTS — Mother: Father: Combined:

Parent's share of adjustments — Mother: Father:

Adjustments in excess of parents share — Mother: Father:

Each parent's adjusted support obligation — Mother: Father:

RECOMMENDED CHILD SUPPORT ORDER

Comments: