Form C Child Support Obligation Guidelines Worksheet
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1CHILD SUPPORT OBLIGATION
Form C
GUIDELINES WORKSHEET A
__________________________________
NO: __________________ DIV. ______
(
)
PETITIONER
THE FAMILY COURT
VERSUS
PARISH OF EAST BATON ROUGE
__________________________________
STATE OF LOUISIANA
(
)
DEFENDANT
Children’s Names
Children’s Names
Dates of Birth
Dates of Birth
__________________________ ______________
__________________________ ______________
__________________________ ______________
__________________________ ______________
__________________________ ______________
__________________________ ______________
Petitioner
Defendant
Combined
1
MONTHLY GROSS INCOME
$
$
−
−
a. Preexisting child support payment
−
−
b. Preexisting spousal support payment
2
MONTHLY ADJUSTED GROSS INCOME
$
$
(line 1 minus 1a and 1b)
3
COMBINED MONTHLY ADJUSTED
GROSS INCOME (line 2 column A plus line 2
$
column B) La. R.S. § 9:315.2(c)
4
PERCENTAGE SHARE OF INCOME (line 2
%
%
divided by line 3) La. R.S. § 9:315.2(c)
5
BASIC CHILD SUPPORT OBLIGATION
(compare line 3 to Child Support Schedule) La.
$
R.S. § 9:315.2(d)
a. Net child care costs (costs less Federal Tax
+
Credit)
b. Child’s health insurance premium cost
+
c. Extraordinary medical expenses (uninsured
+
only; agreed to by parties or by court order)
d. Extraordinary expenses (agreed to by parties
+
or by court order)
e. Optional, minus extraordinary adjustments
−
(child’s income if applicable)
6
TOTAL CHILD SUPPORT OBLIGATION
$
(add lines 5, 5a, 5b, 5c, & 5d; subtract line 5e)
EACH PARTY’S CHILD SUPPORT
7
$
$
OBLIGATION (multiply line 4 times line 6)
8
DIRECT PAYMENTS made by noncustodial
parent on behalf of the child for work-related
net child care costs, health insurance
$
premiums, extraordinary medical expenses, or
extraordinary expenses
9
RECOMMENDED CHILD SUPPORT
$
ORDER (subtract line 8 from line 7)
Comments: __________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________
_____________________
PREPARER SIGNATURE
DATE
THE FAMILY COURT
FORM C
REVISED: NOV 2013
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