Parents Worksheet for Child Support

Use the instructions in the following link: https://www.dshs.wa.gov/sites/default/files/ESA/dcs/documents/15AZ%20Worksheets%20Instructions.pdf or INSTRUCTIONS PARENTS WORKSHEET FOR CHILD SUPPORT AMOUNT before you complete and submit the PARENTS WORKSHEET FOR CHILD SUPPORT.

Extracted Text for Proper Search

© Superior Court of Arizona in Maricopa County                                          	
   DRS12f-0113	 
ALL RIGHTS RESERVED	
                                                Page  1 of  2	 	
PWC	      	
SUPERIOR COURT OF ARIZONA  
IN MARICOPA	
(2)	  COUNTY  	
 	
PARENT’S WORKSHEET FOR CHILD SUPPORT  	
 
(3)	
 Petitioner    (4)	 Case No.  	
 	 	(3) Respondent	 	 	(4)	 ATLAS 
 	
 	
 (5)  Total Number of Children:  	      	
 (6) Parent with Primary Legal Decision- Making Authority 
(Custody) :    Father 	
    Mother 	 	 	 	
 (7) Parent who is filing this form:    Father  	    Mother 	   	
 	 	(8)  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). 	
  	FATHER	 	 	MOTHER	 	
 	 	 	Gross Income	 (Pre	-Tax Income. Before deductions.) 	 	$  	(9)  
 
 	
$ 
 
   	
 	 	 	 	 	 	 	Spousal Maintenance Paid   	
  	 	
$ - 	(10)
 	
$ 
 	
- 	
 	Spousal Maintenance Received  	$ + 	(11) 	$ 
 	
+ 	
 	Child Support Paid/Contributed	 	
 	
$ - 	(12)  	$ 
 	
- 	
 	Other Support of Children Paid  	$ - 	(13) 	$ 
 	
- 	
 	 	 	 	 	 	 	Adjusted 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) 	$     	
             	For Clerk’s Use Only  	
(1) Name of Person Filing :   
Phone Number(s):    /   
In this case I am 	  Petitioner  or 	  Respondent  Or  	 represented by Attorney  	
(IF) Attorney, Name: 	 	Bar No.: 	 	
Atty. Em ail: 	 	Atty. Phone:

© Superior Court of Arizona in Maricopa County                                          	
   DRS12f-0113	 
ALL RIGHTS RESERVED	
                                                Page  2 of  2	 	
PWC	      	
          
 
 	
Case No.      	
 
 
 	 	 	 	 	
 	 	 	 	
 	 	
 	FATHER	 	MOTHER	 	
Each Parent’s % of Combined Income	     % 	 (24)  	 % 	
 	Each  Parent’s  Share of Tot. Support Obligation	 	$ 	(25)  	
 	
$ 	 	
 	 	 	 	 	Adjustment for Non Custodial Parent’s	 Costs Associated with Parenting Time 	 	 	
 Using Table A 	 Table B 	                                 	(26)	 	 	 	 	
 	  No. of Days            =           % Adjustment  (from table)	                                                                                            	    	 	
  x Line  (16) $                (Basic Child Support Obligation)  	 $ 	
 
(27) 	
 $ 	
 
 	Less Noncustodial Parent’s Costs for:	 	
 	  Medical/Dental/Vision Insurance*  	$ 	(28) 	$ 	
  	 	Childcare*	 	$ 	(29)	 	$ 	
 	 	Education Expenses*	 	$ 	(30)	 	$ 	
 
 Extraordinary/Special Needs Child Expenses*  	$ 	(31) 	$ 	
 	 	     	*Subtract here ONLY  if ADDED-IN 	items 	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  	- $903.00	 	 	 	 	 	 	
  Total 	 	 	= 	$ 	 	(34)	 	$  	
  	 	 	 	 	 	 	 	
 	 	
Child Support to be	 Paid	 by:   Father 	     	Mother 	 	$ 	 	(35)	 	$  	
 	 	 	 	 	 	
Share of Travel Expenses Related to Parenting Time*   	 	% 	(36) 	 	% 	
   *Only	 for expenses related to travel over 100 miles, one way.	 	
Share of Medical/Dental/Vision Costs Not  Paid by Insurance 	 	% 	(37) 	 	% 	
 
 
 
I declare under penalty of perjury that the foregoing is true and correct.    
 
 
Executed on:             
      Date                                                    Signature of Parent