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| A | B | C | D | E | F | G | H | I | J | K | L | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Child Support Worksheet | |||||||||||
2 | Case Caption Information | County | Child Support Summary | Income Calculators | ||||||||
3 | In the District Court of | Cleveland | Summary | Father | Mother | Wage Calculaion | Reg Hours | Overtime | Wage | |||
4 | Plaintiff's Name | Case Number | Base Child Support | $222.50 | $0.00 | Father | 40 | 0 | $7.25 | |||
5 | John Doe | Child Care | $0.00 | $0.00 | Mother | 40 | 0 | $7.25 | ||||
6 | Defendant's Name | FGN | Insurance Premiums | $0.00 | $0.00 | Annual | YTD | |||||
7 | Jane Doe | Cash Medical | $0.00 | $0.00 | Father | $0.00 | ||||||
8 | Monthly Obligation | $222.50 | $0.00 | Mother | $0.00 | |||||||
9 | Data Field Entry | The obligor is: | Father | Multi Year Average | Father | Mother | ||||||
10 | Year 1 | $0.00 | Year 1 | $0.00 | ||||||||
11 | Year 2 | Year 2 | ||||||||||
12 | Number of Minor Children | 1 | Year 3 | Year 3 | ||||||||
13 | Father | Mother | Year 4 | Year 4 | ||||||||
14 | Gross Monthly Income | $1,256.67 | $1,256.67 | Year 5 | Year 5 | |||||||
15 | Excluded Self-Employment Income | $0.00 | $0.00 | |||||||||
16 | Income Percentages | 50.00% | 50.00% | Last Paycheck Method | ||||||||
17 | SSA Title II benefits to Children | $0.00 | $0.00 | Father | Mother | |||||||
18 | Court-Ordered Support Alimony | $0.00 | $0.00 | Gross Monthly Income | $3,552.31 | $0.00 | ||||||
19 | Court-Ordered Marital Debt Adjustment | $0.00 | $0.00 | Paycheck Method | Period Pay | Start Date | End Date | Days | % | |||
20 | Court-Ordered Monthly child support | $0.00 | $0.00 | Father | $32,000.00 | 1/1/2013 | 10/1/2013 | 274 | 75.07% | |||
21 | In-home Children Deduction | Father | Mother | Mother | $0.00 | 1/1/2013 | 12/31/2013 | 365 | 100.00% | |||
22 | Number of qualified in-home children | 0 | 0 | |||||||||
23 | Number of Overnights | 120 | 245 | Income Results | Father | Mother | ||||||
24 | Wage Calculaion | $1,256.67 | $1,256.67 | |||||||||
25 | Child Expenses | Father | Mother | Other Custodian | Annual Method | $0.00 | $0.00 | |||||
26 | Visitation Transportation Costs | $0.00 | $0.00 | $0.00 | Multi Year Average | $0.00 | $0.00 | |||||
27 | Child Care Expenses | $0.00 | $0.00 | $0.00 | ||||||||
28 | On-going Medical Expenses | $0.00 | $0.00 | $0.00 | ||||||||
29 | Medical/Dental Insurance Premiums | $0.00 | $0.00 | $0.00 | ||||||||
30 | ||||||||||||
31 | DHS Assistance Data | |||||||||||
32 | OKDHS Childcare Subsidy Worksheet | Father | Mother | |||||||||
33 | Total Children receiving subsidy | 0 | 0 | |||||||||
34 | Number of Children from this order | 0 | 0 | |||||||||
35 | Family Size for DHS Subsidy | None | None | |||||||||
36 | State Medical Insurance | |||||||||||
37 | Number of Children (no insurance) | 0 | ||||||||||
38 | Who is the Soonercare Applicant? | None | ||||||||||
39 | Guidelines & Effective Date | |||||||||||
40 | Date Child Support Starts | per JE | ||||||||||
41 | Guidelines were followed? | Yes | ||||||||||
42 | ||||||||||||
43 | Income Assignment Calculations | |||||||||||
44 | Weekly Pay Period | $51.35 | ||||||||||
45 | Biweekly Pay Period | $102.69 | ||||||||||
46 | Semimonthly Pay Period | $111.25 | ||||||||||
47 | Monthly Pay Period | $222.50 | ||||||||||
48 | ||||||||||||
49 | Copyright 2013 Evan Taylor Law Office, PLLC Personal Use Only | |||||||||||
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