COURT COUNTY OFDR-25 (3/01)MONTGOMERY COUNTY DOMESTIC RELATIONS COURT CHILD SUPPORT COMPUTATION WORKSHEET SPLIT PARENTAL RIGHTS AND RESPONSIBILITIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.Name of Parties Case No. Number of minor children . The following parent was designated as residential parent and legal custodian of the following number of children: mother; father. Father has pay periods annually, Mother has pay periods annually.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Column IColumn IIColumn III FatherMotherCombinedINCOME 1a. Annual gross income from employment or, when determined appropriate by the court or agency, average annual gross income from employment over a reasonable period of years (Exclude overtime, bonuses, self-employment income, or commissions).............$....$. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .b. Amount of overtime, bonuses and commissions (Yr. 1 representing the most recent year) FatherTHE PEOPLE OF THE STATE OF NEW YORK TOMother Yr. 3 $Yr. 3 $ Three years ago Yr. 2 $Yr. 2 $ Two years ago Yr. 1 $Yr. 1 $ Last calendar yearGREETINGS:Average $$WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,(Include in Col. I and/or Col. II the average of the three years or the year 1 amount, whichever is less, if there exists a reasonable expectation that the total earnings from overtime and/or bonuses during the current calendar year will meet or exceed the amount that is the lower of the average of the three years or the year 1 amount. If, however, there exists a reasonable expectation that the total earnings from overtime/bonuses during the current calendar year will be less than the lower of the average of the 3 years or the year 1 amount, include only the amount reasonably expected to be earned this year).................................................................................$....$located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.2. For Self-Employment Income:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) fora. Gross receipts from business.........................................................$....$ b. Ordinary and necessary business expenses.................................$....$ c. 5.6% of adjusted gross income or the actual marginal difference between the actual rate paid by the self-employed individual and the F.I.C.A. rate.............................................................................$....$ d. Adjusted gross income from self-employment (Subtract the sum of 2b and 2c from 2a) ..................................................................$....$ 3. Annual income from interest and dividends (whether or not taxable)..........................................................................$....$ 4. Annual income from unemployment compensation..........................$....$ 5. Annual income from workers' compensation, disability insurance, or social security disability/retirement benefits..................................$....$ 6. Other annual income (identify) ...........$....$Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OFPage 2/Split Custody WorksheetColumn IColumn IIColumn III Father. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .MotherCombined:::::::Index No.7. Total annual gross income (add lines 1a,1b, 2d, and 3-6).......................$...$Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:ADJUSTMENTS TO INCOME 8. Adjustment for minor children born to or adopted by either parent and another parent who are living with this parent; adjustment does not apply to stepchildren (number of children times federal income tax exemption less child support received, not to exceed federal tax exemption) .................................$....$ 9. Annual court ordered support paid for other children.......................$....$ 10. Annual court-ordered spousal support paid to any spouse or former spouse...................................................... ....................$....$ 11. Amount of local income taxes actually paid or estimated to be paid..$....$ 12. Mandatory work-related deductions such as union dues, uniform fees, etc. (not including taxes, social security, or retirement)... .....$....$ 13. Total gross income adjustments (add lines 8 through 12)......................$....$ 14. Adjusted annual gross income (subtract line 13 from line 7)..................$....$ 15. Combined annual income that is basis for child support order (add line 14, Col. I and Col. II).....................................................................................................$ 16. Percentage parent's income to total income a. Father (divide line 14, Col. I by line 15, Col. III)........% b. Mother (divide line 14, Col. II by line 15, Col. III).... +% = 100% 17. Basic combined child support obligation (Refer to schedule, first column, locate the amount nearest to the amount on line 15, Col. III, then refer to column for number of children with this parent. If the income of the parents is more than one sum but less than another, you may calculate the difference)............. For children forWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on w
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