DHS ORS CSS GWMO

10/94

IN THE ________________________ DISTRICT COURT

 

___________________________ COUNTY,STATE OF UTAH

 

 

 

 

______________________________________

 

vs.

 

______________________________________

 

WORKSHEET TO DETERMINE MOTHER'S

†††††††††† OBLIGATION TO CHILDREN IN HER

††††† PRESENT HOME

 

 

CivilNo. ______________________

 

 

 

 

OTHER PARENT NAME _____________________________

 

MOTHER

 

OTHER

PARENT

 

COMBINED

 

1.

 

Enter the # of natural and adopted children of the mother and the other parent.

 

 

 

 

 

 

 

2a.

 

Enter the mother's and other parent's gross monthly income. Refer to Instructions for definition.

 

$

 

$

 

 

 

2b.

 

Enter previously ordered alimony that is actually paid. (Do not enter alimony ordered for this case).

 

_

 

_

 

 

 

2c.

 

Enter pre-existing ordered child support. (Do not enter obligations ordered for the children in this case).

 

_

 

_

 

 

 

3.

 

Subtract Lines 2b and 2c, from 2a. This is the Adjusted Monthly Gross Income for child support purposes.

 

$

 

$

 

$

 

4.

 

Take the COMBINED figure in Line 3 and the number of children in Line 1 to the Support Table. Find the Combined Support Obligation. Enter it here.

 

 

 

 

 

$

 

5.

 

Divide each parent's adjusted monthly gross in Line 3 by the COMBINED adjusted monthly gross in Line 3.

 

%

 

%

 

 

 

6.

 

Multiply Line 4 by Line 5 for each parent to obtain each parent's share of the Base Support Obligation.

 

$

 

$

 

 

 

7.

 

Enter the amount of the children's portion of the insurance premium actually paid.

 

 

 

 

 

$

 

8.

 

Enter the monthly work or training related child care expense for the children in Line 1.

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

MOTHER'S SHARE OF BASE CHILD SUPPORT AWARD FOR THE CHILDREN IN LINE 1. Enter the amount for the mother from line 6.

$

 

 

10.

 

MOTHER'S SHARE OF CHILDREN'S INSURANCEFOR THE CHILDREN IN LINE 1. Multiply Line 7 by .50, and enter the result here.

 

$

 

11.

 

MOTHER'S SHARE OF WORK OR TRAINING RELATED CHILD CARE EXPENSESFOR THE CHILDREN IN LINE 1. Multiply Line 8 by .50, and enter the result here.

 

$

 

12.

 

MOTHER'S SHARE OF TOTAL CHILD SUPPORT OBLIGATION TO THE CHILDREN IN LINE 1. Add lines 9,10, and 11. This amount may be used to adjust the mother's gross income on the sole, split, or joint custody worksheets.

 

$

 

 

10/94



INSTRUCTIONS FOR CHILDREN IN THE MOTHER'S HOME WORKSHEET

 

Use this worksheet to determine the mother's obligation for natural or adopted children who live in her home and who are not children of the father listed on the Sole, Split, or Joint Custody Worksheets (primary worksheet). The mother may use this worksheet in modifying an existing child support award, or setting a paternity award, or other appropriate circumstances where the mother has child support obligations for other children.

 

Line 1. Enter the number of natural or adopted children of the mother and the other parent named on this worksheet. The other parent may be a current spouse, partner, or and ex-husband of the mother listed on the primary worksheet.If the mother has children in her home by more than one father, complete a separate worksheet for the children of each other parent.

 

Line 2a. Enter the mother's and other parents gross monthly income. Definition of gross monthly income ‑ prospective income from any source, salaries, wages, commissions, royalties, bonuses, rents, gifts, prizes, dividends, severance pay, pensions, interest, trust income, alimony from previous marriages, annuities, capital gains, social security benefits, workers' compensation benefits, unemployment compensation, disability insurance benefits and payments for "non‑means‑tested" government programs. Income from earned sources is limited to the equivalent of one full time job. For self‑employed parents, see UCA 78‑45‑7.5(4)(a) and (b).

 

The guidelines do not provide for imputing income to the other parent.Therefore, use the other parentís actual earnings.The mother may be the custodial parent of children in her home from a previous marriage.If the divorce decree form her previous marriage was entered prior to July 1, 1989, it is unlikely that a worksheet exists showing the proportion each parent should provide for the support of the children.Therefore, in these kinds of situations, use only the motherís income to take to the Table.Assign the mother 100% of the Table amount in Line 5.

 

Excluded from gross income are: cash assistance provided under Title 35A, Chapter 3, Family Employment Program, benefits from: the housing subsidy program, the Job Training Partnership Act, S.S.I., S.S.D.I., Medicaid, Food Stamps, General Assistance, and other "means‑tested" benefits received by a parent; earnings or benefits of a child who is subject to this award.

 

All income must be verified. Verification includes: year to date pay stubs, employer statements or records, the last year's tax return and documentation of non‑earned income appropriate to the source.

 

Line 2b. In the MOTHER'S column, enter the monthly alimony amount she is paying to a parent other than the one listed on this worksheet or the primary worksheet. In the other parents column enter the monthly alimony that father is paying to someone other than the mother listed on this worksheet.

 

Line 2c. In the MOTHER'S column, enter the court ordered child support she is ordered to pay for children other than the children listed on the primary worksheet. In the other parent's column, list the amount that father is ordered to pay for children other than those listed on this worksheet.

 

Line 7. In the combined column, enter the children's portion of insurance premium that is actually paid. To determine the children's portion divide the total premium by the number of persons covered by the policy and then multiply that number by the number of children listed on this worksheet that are covered by the policy.

 

Line 8. Enter the amount of work‑related, reasonable, child care expenses for up to a full-time work week or training schedule.

 

Line 10. The guideline evaluation committee determined that the non-routine uninsured medical expenses should be evenly split between the mother and the other parent, unless a judge or presiding administrative authority determines otherwise.

 

Line 12. Enter the amount on this line on Line 2d of the Sole Custody, Line 3d of the Split Custody or Line 4d of the Joint Custody Worksheets.