Free Worksheet 5 - Nebraska

Worksheet 5 DEVIATIONS TO CHILD SUPPORT GUIDELINES This worksheet may be completed by the court and filed with the clerk in the event of a deviation or deviations under § 4-203 of the child support guidelines. Mother 1. Net income of the parties as computed under worksheet 1 Combined monthly income Percent contribution of each Monthly support for child(ren) from table 1 Health insurance premium Total obligation Each parent's monthly share Each parent's credit for health premium actually paid Each parent's final share of the obligation Further deviations (specify) a. reason 1 ______________ b. reason 2 ______________ c. reason 3 ______________ d. 11. Total _______ % $ _______ $ _______ _______ % Father $ _______

2. 3. 4.

$ _______ $ _______ $ _______ $ _______

$ _______ $ _______ $ _______ $ _______

5. 6. 7. 8.

$ _______ $ _______

$ _______ $ _______

9. 10.

$ _______ $ _______ $ _______ $ _______

$ _______ $ _______ $ _______ $ _______

Each parent's monthly share (line 9 above) (+/-) Line 10d Adjusted child support

$ _______ $ _______ $ _______

$ _______ $ _______ $ _______

12. 13.

Dated: _________________________ Judge
County Case No. CI__-_____

Worksheet 5 adopted Dec. 23, 1992; amended effective Sept. 1, 2002; amended March 18, 2009.