The Parent Designated To Have Custody Or Be Primary Caretaker Under A Shared Parenting Plan: Father Mother Number of Children – Employment Income – Father Mother Annual Gross Income From Employment But Exclude Overtime, Bonuses, Self-Employment Income, Or Commissions: Overtime, Bonus and Commissions For The Past 3 Years: 2012: 2011: 2010: Self Employed – Gross Business Income: Business Expenses: Other Income – Annual Interest & Dividends Income: Annual Unemployment Compensation: Annual Workers Comp/Disability/Other Benefits: Other Income (Put Any Spousal Support Received Here): Deductions* – Adjustment for minor children born to or adopted by either parent and are also living with this parent. Do not include stepchildren. *Number of children times Federal Income Tax Exemption ($3,700) less child support received. Not to exceed the federal tax exemption* Annual Court Ordered Child Support Obligations: Annual Spousal Support Obligation: Annual Local Taxes Paid: Annual Mandatory Work Related Deductions (ex: Union Dues): Annual child care expenses for children who are subject of this order that are employment training or education related: Health Insurance – Is Private Health Insurance Provided : Yes No Annual cost of health insurance premiums to provide heath insurance for the children subject to this order: (Total Cost of insurance to cover kids ONLY. Either contact your employer’s human resources department or guess that it is normally between 30-70% of total insurance cost.) Annual amount of any social security and veteran’s benefits paid to and received by a child or a person on behalf of the child due to death, disability or retirement of the parent: Calculate Payment Reset Form
