Fill and Sign the Joint or Shared Form

STATE OF NORTH CAROLINA County WORKSHEET B CHILD SUPPORT OBLIGATION JOINT OR SHARED PHYSICAL CUSTODY G.S. 50-13.4(c) Name Of Defendant VERSUS Case No. (Code) UIFSA Case No. File No. IV-D Case No. In The General Court Of Justice District Superior Court Division Civil: Criminal: Plaintiff S TAT E Children Children Date Of Birth Date Of Birth Plaintiff Defendant Combined 1. MONTHLY GROSS INCOME 2. MONTHLY ADJUSTED GROSS INCOME 3. PERCENTAGE SHARE OF INCOME (line 2 for each parent’s income, divided by Combined income) 11. EACH PARENT’S FAIR SHARE OF ADJUSTMENTS (line 10d Combined × line 3 for each parent) 6. EACH PARENT’S PORTION OF SHARED CUSTODY SUPPORT OBLIGATION (line 3 × line 5 for each parent) 7. OVERNIGHTS WITH EACH PARENT (Combined must total 365 × total number of children) 8. PERCENTAGE WITH EACH PARENT (line 7 divided by 365 × total number of children) 9. SUPPORT OBLIGATION FOR TIME WITH OTHER PARENT (line 6 × other parent’s line 8) 10. ADJUSTMENTS (expenses paid directly by each parent) a. Work-related child care costs 5. SHARED CUSTODY BASIC OBLIGATION (multiply line 4 by 1.5) 4. BASIC CHILD SUPPORT OBLIGATION (apply line 2 Combined to the Schedule of Basic Support Obligations see AOC-A-162, Rev. 1/15) a. Minus pre-existing child support payment b. Minus responsibility for other children b. Health Insurance premium costs - child’s/children’s portion only (total premium ÷ # of persons covered × # of children subject to order = children’s portion) c. Extraordinary expenses d. Total Adjustments (for each column, add 10a, 10b, and 10c. Add two totals for Combined amount) Stop here if the number of overnights with either parent is less than 123 , in which case shared physical custody does not apply (and see Worksheet A, AOC-CV-627). STOP $ $ $ $ _ $ $ $ $ $ $ $ $ $ _ $ $ $ $ $ $ $ $ $ _ _ % % % % (NOTE: This form may be used in both civil and criminal cases. ) (Over) 12. ADJUSTMENTS PAID IN EXCESS OF FAIR SHARE (line 10d minus line 11. If negative number, enter zero) $ $ 13. EACH PARENT’S ADJUSTED SUPPORT OBLIGATION (line 9 minus line 12) 14. RECOMMENDED CHILD SUPPORT ORDER (subtract lesser amount from greater amount in line 13 and enter result directly under greater amount) Date Prepared By (type or print) $ $ $ $ AOC-CV-628, Rev. 1/15