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Fill and Sign the Neb Rev Ct Rules Ch 4 Art 2 Form

Fill and Sign the Neb Rev Ct Rules Ch 4 Art 2 Form

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Worksheet 2 SPLIT CUSTODY CALCULATION 1. Show com bined Show each m onthly share parent’s share from line 7, (apply percent worksheet 1, from line 6, Custod y divided by total worksheet 1) Child’s Name (F or M) number of children Father Mother ________________ ______ __________________ _______ _______ ________________ ______ __________________ _______ _______ ________________ ______ __________________ _______ _______ ________________ ______ __________________ _______ _______ ________________ ______ __________________ _______ _______ ________________ ______ __________________ _______ _______ ________________ ______ __________________ _______ _______ 2. Total amount owed to father by mother (m other’s share from above for children in father’s custody) ______________ 3. Total amount owed to mother by father (father’s share fro m above for children in mother’s custody) ______________ 4. Support to be paid by mother/father (difference between lines 2 and 3) ______________ (mother/father) Additional Adjustment for Child(ren)’s health insurance premium Father Mother Co mbined 5. Child(ren) health insurance premium* ______ _______ (from line 8, worksheet 1) 6. Combined health insurance premium(s) ______ 7. Each parent’s share of premium (line 6 from worksheet 1 times line 6 above) ______ _______ 8. Amount of premium paid (line 5) ______ _______ 9. Amount owed to other parent for premium (line 7 m inus line 8, if negative amount enter $0) ______ _______ 10.a. Which parent owes basic support on line 4? ____________ (mother/father) 10.b. Which parent owes support for health insurance on line 9? ____________ (mother/father) 10.c. Does the same parent owe support on lines 10a and 10b? ____________ (Yes/No) 11. Total support to be paid by parent on line 10a (if YES on li ne 10c, line 4 plus line 9; if NO on line 10c, line 4 minus line 9) ____________ * The parent requesting an adjustment for health insurance pr emiums must submit proof of the cost of the premium for the child(ren). Worksheet 2 amended effective July 1, 2007; amended October 24, 2007.

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