Fill and Sign the Ok Iv D Fgn Form

) ) ) ) ) ) ) ) ) STATE OF OKLAHOMADist. Ct. Case No. OAH Case No. OK IV-D FGN: Obligor:Custodial Person: Child Support Computation for Period Prior to July 1, 2009 Calculation for number of children Obligor (noncustodial parent) is (Enter "mother" or "father") A Base monthly obligation Father Mother Combined 1 Gross monthly income All sources, except child support received and means-tested public assistance 2 Less court-ordered optional monthly adjustment for marital debt 3 Less court-ordered monthly child support and support alimony actu ally paid for others 4 Adjusted gross monthly income Line 1 minus Line 2 and/or Line 3, if used 5 Percentage share of income Line 4 for each parent divided by Line 4 combined % % 100% 6 Base monthly obligation Apply Line 4 combined to Child Support Guideline Schedule and insert in Line 6 combined; then, Line 6 combined X Line 5 for each parent. B Shared parenting adjustment, if used Father Mother Combined 7 Number of overnights with each parent If less than 121 for obligor, skip to C. 365 8 Percentage with each parent Line 7 for each parent divided by 365 % % 100% 9 Shared parenting base obligation Line 6 combined X 1.5 Revised 7-1-2009 03E N005E Page 1 of 4 [Refer to instructions] [Add case style. Refer to instructions] [Add case style. Refer to instructions] [Add case style. Refer to instructions] [Add case style. Refer to instructions] [Add case style. Refer to instructions] B Shared parenting adjustment, if used Father Mother Combined 10 Each parent's share Line 9 combined X Line 5 for each parent 11 Amount retained by each parent Line 10 for each parent X Line 8 for each parent 12 Offset amount Line 10 minus Line 11 for each parent 13 Adjusted base monthly obligation Subtract smaller amount from larger amount on Line 12. If custodi al person amount is larger than obligor am ount, enter for obligor. C Health insurance premium Father Mother Combined 14 Monthly health insurance premium Actual monthly premium amount for each parent, for child(ren) included in this calculation. If none, enter and skip to Line 17. 15 Monthly health insu rance premium share Line 14 combined premium amount X Line 5 for each parent 16 Adjusted premium share paid by obligor Leave custodial person amount blank. Subtract obligor Line 14 from obligor Line 15. Amount may be negative. D Work and education-related child care expenses Father Mother Combined 17 Monthly child care expenses for each parent, for child(ren) included in this calculation. Skip to line 18 if OKDHS child care subsidy case. 18 OKDHS child care subsidy Line 18f X Line 18b divided by Line 18a a. Total children in custodial person's child care subsidy case b. Number of children of these parents in custodial person's child care subsidy case c. Custodial person's actual gross monthly income Page 2 of 4 Revised 7-1-2009 D Work and education-related child care expenses Father Mother Combined d. Obligor base monthly obligation amount e. Amount treated as custodial person's OKDHS household income - Line 18c plus Line 18d f. Amount treated as custodial person's family share co-payment from OKDHS Appendix C-4, page 2 19 Child care expense share Line 17 combined or custodial person Line 18, X Line 5 for each parent 20 Adjusted child care contribution paid by obligor. Leave custodial person amount blank. Subtract obligor Line 17 or 18 from obligor Line 19. Amount may be negative. 21 Total monthly child support obligation Add obligor Line 6 or Line 13 and Lines 16 and 20, if positive amount s. Subtract Lines 16 and 20, if negative amounts from obligor Line 6 or Line 13. E Other contributions, if agreed or ordered Father Mother Combined 22 Recurring monthly medical expenses Line 22 combined X Line 5 for each parent 23 Other medical expenses percentage share - Line 5 % % 24 Visitation transportation costs Line 24 combined X Line 5 for each parent Revised 7-1-2009 Page 3 of 4 Payments shall commence on the day of , , and are due on the same date of each month thereafter. Guidelines were followed. Deviation from child support guidelines by Court-Specific findings of Court supporting each deviation: Dated this day of , JUDGE APPROVED AS TO FORM: Printed name Printed name Address Address Address Address Phone Phone Attorney for Attorney for OBA# OBA# Address Address Address Address Phone Phone State's Attorney, OCSS, OKDHS OBA# Address Phone Address Page 4 of 4 Revised 7-1-2009