| A | B | C | D | E | |
|---|---|---|---|---|---|
1 | |||||
2 | Child Insurance & Childcare Costs | ||||
3 | |||||
4 | |||||
5 | Insurance Premium Costs | ||||
6 | |||||
7 | Insurance | Employee | Emp+Children | Difference | Notes |
8 | Medical Plan | $0.00 | $0.00 | $0.00 | |
9 | Dental Plan | $0.00 | $0.00 | $0.00 | |
10 | Vision Plan | $0.00 | $0.00 | $0.00 | |
11 | Other Plan | $0.00 | $0.00 | $0.00 | |
12 | Total | $0.00 | $0.00 | $0.00 | |
13 | |||||
14 | # of payments per year | 26 | biweekly | ||
15 | # of Children in this case | 1 | 2 | ||
16 | # Other Dependents covered | 1 | |||
17 | |||||
18 | Total Monthly Cost: | $0.00 | |||
19 | |||||
20 | Child Care Costs | ||||
21 | |||||
22 | Name of Provider | Cost | Frequency of Payments per year | ||
23 | None | $0.00 | 52 | weekly | |
24 | |||||
25 | Total Cost: | $0.00 | |||
26 | |||||
27 | |||||
28 | Copyright 2013 Evan Taylor Law Office, PLLC Personal Use Only | ||||