Free SUPERIOR COURT OF ARIZONA - Arizona

(1)Your Name: Your Mailing Address: Your City, State, ZIP: Your Telephone No: Attorney's Bar No:
Representing Self (Without Attorney) OR Attorney for Petitioner Respondent

SUPERIOR COURT OF ARIZONA IN (2) PINAL COUNTY PARENT'S WORKSHEET FOR CHILD SUPPORT
(3) Petitioner (3) Respondent (5) Total Number of Children: (6) Parent with Primary Custody: (7) Parent who is filing this form: Father Father Mother Mother (4) Case No. (4) ATLAS No.

DO 2

(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 4e).

FATHER
Gross Income (Pre-Tax Income. Before deductions.) Spousal Maintenance Paid Spousal Maintenance Received Child Support Paid/Contributed Support of Other Children Paid Adjusted Gross Income Combined Adjusted Gross Income Basic Child Support Obligation Plus Costs for: Medical/Dental/Vision Insurance Childcare Education Expenses Extraordinary/Special Needs Child Expenses No. of Children Age 12 or Over Total Adjustments for Costs Total Child Support Obligation Adjustment

MOTHER
(9)

$ $ $ $ $ $
(15) (16)

$ $ $ $ $ $ + -

+ -

(10) (11) (12) (13) (14)

$ $
(17 (18 (19 (20

$ $ $ $ %
(21) (22) (23)

$ $ $ $

$

$

© Superior Court of Arizona in Pinal County December 22, 2005 ALL RIGHTS RESERVED

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Parent Worksheet Use Most Current Form

FATHER
Each Parent's % of Combined Income Each Parent's Share of Tot. Support Obligation $

MOTHER %
(24) (25) $

%

Adjustment for Non Custodial Parent's Costs Associated with Parenting Time Using Table A No. of Days x Line (16) $ Table B = (26) $ (27) $

% Adjustment (from table) (Basic Child Support Obligation)

Less Noncustodial Parent's Costs for: Medical/Dental/Vision Insurance* $ Childcare* $ Education Expenses* $ Extraordinary/Special Needs Child Expenses* $ *Subtract here ONLY if ADDED-IN items 17-20 above Adjustments Subtotal Preliminary Child Support Amount Self Support Reserve Test for Parent Who Will Pay Amount from Line (14) Minus Reserve Amount Total - $775 = $ (Adj. Gross Inc.) $ $

(28) (29) (30) (31)

$ $ $ $

(32) (33)

$ $

(34)

$

Child Support to be Paid by: Father

Mother

$

(35) %

$ (36) %

Share of Travel Expenses Related to Parenting Time* *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

© Superior Court of Arizona in Pinal County December 22, 2005 ALL RIGHTS RESERVED

Page 2 of 2

Parent Worksheet Use Most Current Form