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Worksheet – Child Support Obligation Each party shall complete that portion of the worksheet that applies to him or her, sign the form and file it with the court. This worksheet is required in all proceedings establishing or modifying child support. IN RE: CASE NO: FATHER: MOTHER: CHILD SUPPORT OBLIGATION WORKSHEET (CSOW) Children DOB Children DOB 1. WEEKLY GROSS INCOME Subsequent Children Multipliers (Circle .935 .903 .878 .863 .854) FATHER MOTHER A. Child Support (Court Order for Prior Born Child(ren) B. Child Support (Legal Duty for Prior Born Child(ren) C. Maintenance Paid D. WEEKLY ADJUSTED INCOME (WAI) Line 1 minus 1A, 1B, and 1C 2. PERCENTAGE SHARE OF TOTAL WAI % % 3. COMBINED WEEKLY ADJUSTED INCOME (Line 1D) 4. BASIC CHILD SUPPORT OBLIGATION Apply CWAI to Guideline Schedules A. Weekly Work-Related Child Care Expense of each parent B. Weekly Premium – Children’s Portion of Health Insurance Only 5. TOTAL CHILD SUPPORT OBLIGATION (Line 4 plus 4A and 4B) 6. PARENT’S CHILD SUPPORT OBLIGATION (Line 2 times Line 5) 7. ADJUSTMENTS ( ) Obligation from Post-Secondary Education Worksheet Line J. ( ) Payment of work-related child care by each parent. (Same amount as Line 4A ) ( ) Child(ren)’s Portion of Weekly Health Insurance Premium $ (This will be a credit to the payor) ( ) Parenting Time Credit $ 8. RECOMMENDED CHILD SUPPORT OBLIGATION EXPLAIN ANY DEVIATION FROM GUIDELINE SCHEDULES IN ORDER/DECREE. I affirm under penalties for perjury that the foregoing representations are true. Father: Dated: Mother: UNINSURED HEALTH CARE EXPENSE CALCULATION A. Custodial Parent Annual Obligation: (CSOW Line 4) + (PSEW § Two, Line I) = x 52 weeks x .06 = $ B. Balance of Annual Expenses to be Paid: (Line 2) % by Father; % by Mother.