Parents Worksheet For Child Support {DRS12F}

(1) Name of Person Filing: Your Address: Your City, State, Zip Code: Your Telephone Number: ATLAS Number (if applicable): Attorney Bar Number (if applicable): Representing: Self (Without an Attorney) Or Attorney for Petitioner For Clerk Use Only Respondent SUPERIOR COURT OF ARIZONA IN (2) _____________________COUNTY PARENT'S WORKSHEET FOR CHILD SUPPORT (3) ___________________________________ Name of Petitioner (4) ___________________________________ Name of Respondent ) ) ) ) ) (5) Case No. _______________________ (6) ATLAS No. _____________________ (7) Name of parent filing: ___________________________________ (8) Date prepared: ___________________________________ (9) In this case, I am the [ ] Petitioner [ ] Respondent [ ] Represented by Attorney (10) Time-sharing arrangement: [ ] Essentially equal [ ] Mostly with Father [ ] Mostly with Mother (11) Child(ren)'s names (First, middle initial, and last name) Date of birth Age Presumptive termination date _________________ Actual termination date _________________ Youngest grade ______ Number of minor children ______ Number of children age 12 or over ______ (12) Gross Income figures for the OTHER PARENT are: [ ] ACTUAL, with proof, such as a recent W2 or pay stub attached, or other party's signed statement. [ ] ESTIMATED, based on facts or knowledge of pay before promotion or of others in similar job. [ ] ATTRIBUTED, based on what other party could and should be earning (see Guidelines 5e). Revised December 2016 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com DRS12F Case No._____________________ Father Gross Monthly Income Spousal maintenance paid Spousal maintenance received Custodial parent of other children subject of court order(s) [ ] Father [ ] Mother Court-ordered child support paid for children of other relationships Other natural or adopted children not subject of court order(s) [ ] Father [ ] Mother Standard deduction Alternate Deduction (only if less than standard deduction) Adjusted Gross Monthly Income Combined Adjusted Gross Income Basic Child Support Obligation for [ Additions: Adjusted for [ ] children over age 12 at [ ] child(ren) ]% (25) (26) (27) (28) (29) (30) (31) (32) ]% (22) (23) (24) $ $ $ $ $ $ $ $ __________% __________% $ $ Table B [ ] (33) (34) (35) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Medical, dental and vision insurance paid Monthly childcare costs for [ Less federal tax credit allowed to custodian at [ Extra education expenses paid Extraordinary (gifted or handicapped) child expenses paid Subtotal Total Adjustments for Costs Total Child Support Obligation Each parent's proportionate percentage of combined income Each parent's proportionate share of the total support obligation Less paying parent's costs Costs associated with parenting time: No. of parenting days ______ Line (21) x adjustment percentage ______% Adjustments subtotal Preliminary Child Support Amount Table A [ ] ] children (13) (14) (15) (16) (17) (18) $ $$+ $$$$$(19) (20) (21) $ $ $ Mother $ $$+ $$$$$$ Revised December 2016 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com DRS12F Case No._____________________ Father Self-Support Reserve Test for Payor Line (19) $ Less paid arrears $ Less $1,115 Child support amount to be paid by: [ ] Father [ ] Mother Travel related to parenting time Medical, dental, and vision costs not paid by insurance (37) (38) (39) $ $ __________% __________% __________% __________% (36) $ $ Mother Revised December 2016 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com DRS12F