Free Form 03EN005E - Oklahoma

IN THE _____________________________________ STATE OF OKLAHOMA

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Dist. Ct. Case No. OAH Case No: OK IV-D FGN: Obligor: Custodial Person:

CHILD SUPPORT COMPUTATION Calculation for number of children Obligor (noncustodial parent) is (Enter "mother" or "father") A 1 2 3 4 5 Base monthly obligation Gross monthly income All sources, except child support received and means-tested public assistance Less court-ordered optional monthly adjustment for marital debt Less court-ordered monthly child support and support alimony actually paid for others Adjusted gross monthly income Line 1 minus Line 2 and/or Line 3, if used Percentage share of income Line 4 for each parent divided by Line 4 combined Base monthly obligation Apply Line 4 combined to Child Support Guideline Schedule and insert in Line 6 combined; then, Line 6 combined X Line 5 for each parent. Shared parenting adjustment, if used Number of overnights with each parent If less than 121 for obligor, skip to C. Percentage with each parent Line 7 for each parent divided by 365 Father Mother Combined

%

%

100%

6

B 7 8

Father

Mother

Combined 365

%

%

100%

OKDHS revised 04-20-2007

03EN005E

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B 9 10 11 12

13

Shared parenting adjustment, if used Shared parenting base obligation Line 6 combined X 1.5 Each parent's share Line 9 combined X Line 5 for each parent Amount retained by each parent Line 10 for each parent X Line 8 for each parent Offset amount Line 10 minus Line 11 for each parent Adjusted base monthly obligation Subtract smaller amount from larger amount on Line 12. If custodial person amount is larger than obligor amount, enter $0 for obligor. Health insurance premium Monthly health insurance premium Actual monthly premium amount for each parent, for child(ren) included in this calculation. If none, enter $0 and skip to Line 17. Monthly health insurance premium share Line 14 combined premium amount X Line 5 for each parent Adjusted premium share paid by obligor Leave custodial person amount blank. Subtract obligor Line 14 from obligor Line 15. Amount may be negative. Work and education-related child care expenses Monthly child care expenses for each parent, for child(ren) included in this calculation. Skip to line 18 if OKDHS child care subsidy case. OKDHS child care subsidy Line 18f X Line 18b divided by Line 18a a. Total children in custodial person's child care subsidy case b. Number of children of these parents in custodial person's child care subsidy case c. Custodial person's actual gross monthly income 03EN005E

Father

Mother

Combined

C

Father

Mother

Combined

14

15

16

D

Father

Mother

Combined

17

18

OKDHS revised 04-20-2007

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D

19

20

21

Work and education-related child care expenses d. Obligor base monthly obligation amount e. Amount treated as custodial person's OKDHS household income - Line 18c plus Line 18d f. Amount treated as custodial person's family share co-payment from OKDHS Appendix C-4, page 2 Child care expense share Line 17 combined or custodial person Line 18, X Line 5 for each parent Adjusted child care contribution paid by obligor. Leave custodial person amount blank. Subtract obligor Line 17 or 18 from obligor Line 19. Amount may be negative. Total monthly child support obligation Add obligor Line 6 or Line 13 and Lines 16 and 20, if positive amounts. Subtract Lines 16 and 20, if negative amounts from obligor Line 6 or Line 13. Other contributions, if agreed or ordered Recurring monthly medical expenses Line 22 combined X Line 5 for each parent Other medical expenses percentage share - Line 5 Visitation transportation costs Line 24 combined X Line 5 for each parent

Father

Mother

Combined

E 22 23 24

Father

Mother

Combined

%

%

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03EN005E

OKDHS revised 04-20-2007

Payments shall commence on the day of are due on the same date of each month thereafter. Guidelines were followed.

,

,

and

Deviation from child support guidelines by Court-Specific findings of Court supporting each deviation:

Dated this

day of

,

. JUDGE

APPROVED AS TO FORM: Printed name Address Address Phone Attorney for OBA# Address Address Phone State's Attorney, CSE, OKDHS Address Address Printed name Address Address Phone Attorney for OBA# Address Address Phone OBA# Phone

OKDHS revised 04-20-2007

03EN005E

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