Exceptional Circumstances Form

STATE OF HAWAI'I FAMILY COURT OF THE __________ CIRCUIT Payor Parent: EXCEPTIONAL CIRCUMSTANCES FORM to be attached to CHILD SUPPORT GUIDELINES WORKSHEET (CSGW) CASE NUMBER: FC-_ No. _________ This form requires information from your completed CSGW, and you must mark it as an attachment at the bottom of the CSGW. No. of children in this case: CS amount from Line 14: The court should deviate from the Total Child Support Obligation as calculated on Line 14 of the Child Support Guidelines Worksheet (CSGW) because of the following exceptional circumstance(s): EXCEPTION REQUESTED BECAUSE CALCULATED CHILD SUPPORT EXCEEDS 70% OF NET INCOME Payor's total child support obligation as calculated on Line 14 of the CSGW (___________) exceeds the minimum support amount of $77 per child and is greater than 70% of Payor's net income from the Table of Incomes (___________). I request a finding that an exceptional circumstance exists and that Payor's total child support obligation on Line 14 of the CSGW be limited to either 70% of Payor's net income or $77 per child, whichever is greater. Using the higher of the two numbers the total support for the ___ children in this case would be ___________ per month. After deductions for monthly child care expenses listed on Line 15 (________) and health insurance costs listed on Line 16 (________), which are paid directly by Payor, the remaining child support obligation of Payor will be ___________ per month EXCEPTION REQUESTED BECAUSE PAYOR SUPPORTS ADDITIONAL CHILD(REN) A) Payor's total child support obligation as calculated on Line 14 of the CSGW (___________), divided by the number of children to be supported on Line 4 of the CSGW (___), equals ___________ per child. Is this amount per child greater than $77 per child (the minimum support amount)? Yes No B) Payor supports ___ additional child(ren). If all of Payor's Net Income on Line 2 of the CSGW (___________) is divided by the total number of children Payor is required to support (___), each child would receive ___________. Is this amount per child less than the amount per child calculated on line A) above? No Yes If the answers to both questions above is 'Yes,' you may request that the Court make the following finding: Due to Payor's obligation to support (and Payor's actual support of) additional children, I request a finding that an exceptional circumstance exists and that the support per child in this case be limited to the greater of the amount per child shown in line B) above, ___________, or the State minimum per child of $77. Using the higher of the two numbers the total support for the ___ children in this case would be ___________ per month. After deductions for monthly child care expense listed on Line 15 (________) and health insurance/cash medical cost listed on Line 16 (________), which are paid directly by Payor, the remaining child support obligation of Payor will be ___________ per month. EXCEPTION REQUESTED DUE TO OTHER CIRCUMSTANCES SUMMARY OF CHILD SUPPORT PAYMENTS (IF EXCEPTION IS GRANTED) to other parent, Parent (A) Parent (B) pays monthly child support of per child per mo. Parent (B) pays child care expense. Parent (A) Parent (B) pays health insurance/cash medical. Parent (A) Appendix C-1 American LegalNet, Inc. www.FormsWorkFlow.com SAMPLE WORKSHEET EXCEPTIONAL CIRCUMSTANCES 70% OF NET INCOME STATE OF HAWAI'I FAMILY COURT OF THE FIRST CIRCUIT JOHN MIDDLE ALOHA Plaintiff/Petitioner/Parent (A) vs. JANE ALOHA Defendant/Respondent/Parent (B) Name: Address: City,St,Zip: Phone No: CHILD SUPPORT GUIDELINES WORKSHEET Attorney for: CASE NUMBER: FC-D No. 14-1-0000 This worksheet, and any attachments, was prepared by: Parent (A) X Parent (B) JANE ALOHA 1111 Mahalo Street Honolulu, Hawaii 96813 (808) 555-5555 Parent (A) $2,500 $946 61% + Parent (B) $2,000 $597 39% = TOTAL (C) $1,543 PARENTS' INCOMES 1. Monthly Gross Income from all sources . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Monthly Net Income (from Table of Incomes) . . . . . . . . . . . . . . . . . . . . . 3. Percentage of Total Net Income on Line 2 from each parent . . . . . . . . . . CHILD SUPPORT NEED 4. Base Primary Support: Round to nearest % [Line 2(A) ÷ 2(C)] x 100 [Line 2(B) ÷ 2(C)] x 100 ($385) x 3 TOTAL (C) (# of children) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .=. . . . . . $1,155 + + = $400 $200 $1,755 5. Plus Monthly Child Care Expense (to allow custodial parent to work or attend voc. ed. or training) . . . . . . . . . . . . 6. Plus Monthly Health Insurance Expense (for the child(ren) and paid by parents). If no insurance, use Cash Medical support amount (10% of Net Income on Line 2) $95 $60 7. PRIMARY CHILD SUPPORT NEED (add Lines 4, 5 & 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parent (A) Parent (B) TOTAL (C) STANDARD OF LIVING ADJUSTMENT (SOLA) = 8. SOLA Income (from Table of Incomes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,349 + $849 $2,198 $1,755 9. Less PRIMARY CHILD SUPPORT NEED (copy from Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Remaining SOLA Income (Line 8(c) - Line 9; but if result is negative enter 0 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .= . . . . . . . .$443 . . . . . . . . . . . . .... 11. SOLA Percentage (10% per child, up to 30% maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x 30% $133 12. SOLA Amount (Line 10 x Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =. . . . . 13. CHILD SUPPORT CALCULATION (Line 7 + Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .= . . . . . . $1,888 . .. Parent (A) CHILD SUPPORT OBLIGATIONS / CREDITS $946 14. Total Support Obligation for each parent (Line 13 x % in Line 3) . . . . . Minimum: $77 per child. Maximum: The Total Support Obligation for a parent should not exceed that parent's Net Income on Line 2, if the Net Income exceeds $77 per child. 15. Credit for Child Care Expense (for parent who pays) . . . . . . . . . . . . . . 16. Credit for Health Ins./Cash Medical amount (for parent who pays) . . . . . . . . . . . - . . 17. REMAINING CHILD SUPPORT OBLIGATION AFTER CREDITS . . . = SUMMARY OF CHILD SUPPORT PAYMENTS X Parent (A) Parent (B) pays monthly child supp