Child Support Worksheet A

MONTHLY CHILD SUPPORT OBLIGATION

WORKSHEET A – BASIC VISITATION

IN THE FAMILY COURT OF THE NAVAJO NATION

DISTRICT OF ____________

________________________________,

Petitioner,

vs.	NO. ____________________

________________________________,

Respondent.

MONTHLY CHILD SUPPORT OBLIGATION

A.	Gross Monthly Income and Percentage
		Custodial Parent		Absent Parent		Combined
1.	Gross Monthly Income	$ _______	+	$ _______	=	$ _______
2.	Percentage of Combined Income (Each parent’s income divided by combined income)	______ %	+	______ %	=	100 %
B.	Computation of Basic Support
3.	Number of Children for Whom Support is Sought					_______
4.	Basic Support for Number of Children					$ _______
C.	Additional Support Costs
5.	Children’s Health and Dental Insurance Premium	$ _______	+	$ _______	=	$ _______
6.	Work-Related Child Care	$ _______	+	$ _______	=	$ _______
7.	Extraordinary Costs	$ _______	+	$ _______	=	$ _______
8.	Total Additional Support Costs	$ _______	+	$ _______	=	$ _______
D.	Calculation of Support Amount
9.	Total Basic and Additional Support Costs (Add Combined Column Figures from Line 4 and Line 8)					$ _______
10.	Each Parent’s Obligation	$ _______		$ _______
11.	Enter Each Parent’s Total Additional Support Costs from Line 8	$ _______		$ _______
12.	Each Parent’s Net Child Support Obligation (Subtract Line 11 from Line 10)	$ _______		$ _______

Absent Parent pays $ ________ each month to Custodial Parent for Child Support Costs.

_________________________________

Custodial Parent’s Signature

_______________

Date

_________________________________

Absent Parent’s Signature

_______________

Date

_________________________________

Child Support Enforcement Officer

_______________

Date