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Commission For Child Support Guidelines JD-FM=220 - Connecticut
| Commission For Child Support Guidelines Form. This is a Connecticut form and can be used in Family Statewide . |
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JD-FM-220 (New 3-12) CCSG-1 Rev. 8-05 C.G.S. §46b-215a §46b-215a-5b, Regulations of Connecticut State Agencies STATE OF CONNECTICUT COMMISSION FOR CHILD SUPPORT GUIDELINES WORKSHEET for the Connecticut Child Support and Arrearage Guidelines MOTHER FATHER CUSTODIAN MOTHER COURT D.N./CASE NO. FATHER OTHER: NUMBER OF CHILDREN CHILD'S NAME DATE OF BIRTH CHILD'S NAME DATE OF BIRTH CHILD'S NAME DATE OF BIRTH All money amounts in this worksheet may be rounded to the nearest dollar I. NET INCOME (Weekly amounts) 1. Gross income (attach verification) 1a. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Number of hours used in calculation $ $ $ $ $ $ $ $ $ $ $ $ MOTHER $ FATHER Federal income tax (based on all allowable exemptions, deductions and credits) Social security tax or mandatory retirement Medicare tax State and local income tax (based on all allowable exemptions, deductions and credits) Medical/hospital/dental insurance premiums (including Husky) for parent and all legal dependents Court-ordered life insurance for benefit of child Court-ordered disability insurance Mandatory union dues or fees (if deducted by employer) Mandatory uniforms and tools (if deducted by employer) Non-arrearage payments on court-ordered alimony and child support awards (for other than child) Imputed support obligation for qualified child (line 12d below times the number of qualified children) MOTHER FATHER Number of qualified children 12a. 12b. 12c. Sum of lines 2-11 Line 1 minus line 12a Current support amount for the parent's qualified children plus all children for whom support is being determined (based on line 12b for claiming parent only) Line 12c divided by number of children used in line 12c $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12d. 13. 14. $ $ $ $ $ $ Sum of lines 2-12 Net income (line 1 minus line 13) II. CURRENT SUPPORT 15. 16. 17. Combined net weekly income (rounded to the nearest $10) Basic child support obligation (from Schedule of Basic Child Support Obligations) Each parent's percentage share of line 15 (line 14 for each parent divided by line 15, times 100%) $ $ % % (If noncustodial parent is a low-income obligor, skip this line and enter line 16 amount in noncustodial parent's column on line 18.) 18. 19. 20. Each parent's share of the basic child support obligation (line 17 times line 16 for each parent) Social security dependency benefits adjustment Presumptive current support amounts (line 18 minus line 19) (Rounded to the nearest dollar) (Enter noncustodial parent's amount on line 34, unless deviation criteria apply see section VII.) $ $ $ $ $ $ CONTINUED ON REVERSE American LegalNet, Inc. www.FormsWorkFlow.com ,,, 1(7 ',6326$%/( ,1&20( /LQH SOXV OLQH (for custodial parent) OLQH PLQXV OLQH (for noncustodial parent) $PRXQW RI ZHHNO\ DOLPRQ\ LI DQ\ /LQH WLPHV /LQH SOXV OLQH (for recipient of alimony) OLQH PLQXV OLQH (for payer of alimony) 1RQFXVWRGLDO SDUHQW¶V OLQH DPRXQW VRFLDO VHFXULW\ GHSHQGHQF\ EHQHILWV IRU FKLOG /LQH SOXV OLQH (for custodial parent) OLQH PLQXV OLQH (for noncustodial parent) paid by QRQFXVWRGLDO SDUHQW FXVWRGLDO SDUHQW 027+(5 )$7+(5 ,9 815(,0%856(' 0(',&$/ (;3(16( 6XP RI OLQH DPRXQWV FRPELQHG QHW GLVSRVDEOH LQFRPH (DFK SDUHQW¶V SHUFHQWDJH VKDUH RI FRPELQHG QHW GLVSRVDEOH LQFRPH OLQH IRU HDFK SDUHQW GLYLGHG E\ OLQH WLPHV URXQGHG WR WKH QHDUHVW ZKROH SHUFHQWDJH If the noncustodial parent is a low-income obligor, proceed to line 29. If the noncustodial parent is not a low-income obligor, enter these percentages on line 35, unless deviation criteria apply. 8QOHVV GHYLDWLRQ FULWHULD DSSO\ HQWHU RQ OLQH IRU WKH QRQFXVWRGLDO SDUHQW WKH OHVVHU RI WKH QRQFXVWRGLDO SDUHQW¶V OLQH SHUFHQWDJH RU DQG HQWHU RQ OLQH IRU WKH FXVWRGLDO SDUHQW PLQXV WKH SHUFHQWDJH HQWHUHG IRU WKH QRQFXVWRGLDO SDUHQW 9 &+,/' &$5( &2175,%87,21 'HWHUPLQH LI WKH QRQFXVWRGLDO SDUHQW¶V OLQH DPRXQW IDOOV ZLWKLQ WKH GDUNHU VKDGHG DUHD RI WKH VFKHGXOH ,I LW GRHV SURFHHG WR OLQH ,I LW GRHV QRW VNLS OLQH DQG HQWHU WKH QRQFXVWRGLDO SDUHQW¶V OLQH SHUFHQWDJH RQ OLQH XQOHVV GHYLDWLRQ FULWHULD DSSO\ 'HWHUPLQH LI WKH FXVWRGLDO SDUHQW¶V OLQH DPRXQW IDOOV ZLWKLQ WKH GDUNHU VKDGHG DUHD RI WKH VFKHGXOH ,I LW GRHV QRW HQWHU RQ OLQH DV WKH QRQFXVWRGLDO SDUHQW¶V FKLOG FDUH FRQWULEXWLRQ XQOHVV GHYLDWLRQ FULWHULD DSSO\ ,I LW GRHV HQWHU RQ OLQH WKH OHVVHU RI WKH QRQFXVWRGLDO SDUHQW¶V OLQH SHUFHQWDJH RU XQOHVV GHYLDWLRQ FULWHULD DSSO\ 9, $55($5$*( 3$<0(17 (Enter line 32 amount on line 38 unless deviation criteria apply.) RI OLQH OR DPRXQW GHWHUPLQHG LQ $ % & RU ' EHORZ (check box that applies and enter amount here) $ ,I QRQFXVWRGLDO SDUHQW LV D ORZLQFRPH REOLJRU HQWHU WKH JUHDWHU RI RI OLQH RU SHU ZHHN XQOHVV SDUDJUDSK % EHORZ DSSOLHV % ,I WKH FKLOG LV OLYLQJ ZLWK WKH REOLJRU HQWHU SHU ZHHN LI WKH REOLJRU¶V JURVV LQFRPH LV OHVV WKDQ RU HTXDO WR RI SRYHUW\ OHYHO 25 RI DQ LPSXWHG VXSSRUW REOLJDWLRQ IRU WKH FKLOG LI WKH REOLJRU¶V JURVV LQFRPH LV JUHDWHU WKDQ RI SRYHUW\ OHYHO & ,I WKHUH LV QR FXUUHQW VXSSRUW RUGHU DQG SDUDJUDSK % DERYH GRHV QRW DSSO\ HQWHU RI DQ LPSXWHG VXSSRUW REOLJDWLRQ LI WKH FKLOG LV DQ XQHPDQFL SDWHG PLQRU 25 RI DQ LPSXWHG VXSSRUW REOLJDWLRQ LI WKH FKLOG LV GHFHDVHG HPDQFLSDWHG RU RYHU DJH ' ,I SDUDJUDSKV $ % DQG & DERYH GR QRW DSSO\ DQG WKH VXP RI WKH FXUUHQW VXSSRUW DQG DUUHDUDJH SD\PHQWV ZRXOG H[FHHG RI WKH QRQFXVWRGLDO SDUHQW¶V OLQH DPRXQW HQWHU RI WKH QRQFXVWRGLDO SDUHQW¶V OLQH DPRXQW PLQXV WKH OLQH DPRXQW 9,, '(9,$7,21 &5,7(5,$ (Attach additional sheet if necessary.) 5HDVRQV IRU GHYLDWLRQ IURP SUHVXPSWLYH VXSSRUW DPRXQWV (Check all boxes that apply.) 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