Child Support Worksheet {DRS12f}

251 Superior Court of Arizona in Maricopa County Page 1 of 2 DRS12f- 020519 ALL RIGHTS RESERVED PWC Person Filing: (1) Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY(2) CHILD SUPPORT WORKSHEET (3) Petitioner: (4) Case No. (3) Respondent: (4) ATLAS : No. (5) Total Number of Children: (6) Parent with Primary Physical Custody : P arty A P arty B (7) Parent who is filing this form: Father Mother (8) Gross Income figures for the OTHER PARENT are: ACTUAL, ESTIMATED, bas ed 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 Guid elines 5e ). P ARTY A P ARTY B Gross Income (Pre - Tax Income. Before deductio ns.) $ (9) $ $ $ $ Spousal Maintenance Paid SpousalMaintenance Received $ - (10) $ - Spousal Maintenance Received $ + (11) $ + Child Support Paid/Contributed $ - (12) $ - Other Support of Children Paid $ - (13) $ - Adju sted Gross Income $ (14) ( $ Combined Adjusted Gross Income (15) $ Basic Child Support Obligation (16) $ Plus Costs for: Medical/Dental/Vision Insurance $ (17) $ Childcare $ (18) $ Education Expenses $ (19) $ Extraordinary/Special Needs Child Expenses $ (20) $ No. of Children Age 12 or Over Adjustment % % (21) $ Total Adjustments for Costs (22) $ Total Child Support Obligation $ (23) $ American LegalNet, Inc. www.FormsWorkFlow.com 251 Superior Court of Arizona in Maricopa County Page 2 of 2 DRS12f- 020519 ALL RIGHTS RESERVED PWC Case No. Father Mother P ARTY A P ARTY B Each % (24) % Each Support Obligation $ ( 25) $ d Costs Associated w ith Parenting Time Using Table A Table B $ (26) $ No. of Days = % Adjustment (from table) x Line (16) $ (Basic Child Support Obligation) $ (27) $ Medical/Dental/Vision Insurance* $ (28) $ Childcare* $ (29) $ Education Expenses* $ (30) $ Extraordinary/Special Needs Child Expenses* $ (31) $ * Subtract here ONLY if ADDED - IN it ems 17 - 20 above Adjustments Subtotal $ (32) $ Preliminary Child Support Amount $ (33) $ Self Support Reserve Test for Parent Who Will Pay Amount from Line (14) (Adj. Gross Inc.) Minus Reserve Amount - $ 1, 4 56 .00 Total = $ (34) $ Child Support to be Paid by: P arty A P arty B $ (35) $ Share of Travel Expenses Related to Parenting Time* % (36) % * Only for expenses related to travel ove r 100 miles, one way. Share of Medical/Dental/Vision Costs Not Paid by Insurance % (37) % es-MXI declare under penalty of perjury that the foregoing is true and correct. Executed on: es-MX Date Signature of Parent es-MX American LegalNet, Inc. www.FormsWorkFlow.com