Child Support Guidelines Worksheet - Virginia
CHILD SUPPORT GUIDELINES WORKSHEET Case No. ....................................................................................................................................
Commonweal t h of Vir gi nia Va. Co de § 20-108.2
........................................................................................................................................................... v. ................................................................................................................................................... .....................................................
DATE
MOTHER FATHER
1. Monthly Gross Income (see instructions on reverse) $
.......................................... $ ................................................
2. Adjustments for spousal support payments (see instructions on reverse) $
.......................................... $ ................................................
3. Adjustments for support of child(ren) (see instructions on reverse) $ .......................................... $ ................................................
4. Deductions from Monthly Gross Income allowable by law $
.......................................... $ ................................................
(see instructions on reverse)
5. a. Available monthly income $
.......................................... $ ................................................
b. Combined monthly available income
(combine both available monthly income figures from line 5.a.)
$
6. Number of children in the present case for whom support is sought:
7. a. Monthly basic child support obligation
(from schedule — see instructions on reverse) a. $
...................................................
b. Monthly amount allowable for health care coverage b.
$
...................................................
(see instructions on reverse)
c. Monthly amount allowable for employment-related child care expenses c.
$
...................................................
(see instructions on reverse)
8. Total monthly child support obligation (add lines 7.a., 7.b., and 7.c.)
$
MOTHER FATHER
9. Percent obligation of each party (divide “available monthly income” on ...............................................% ................................................ %
line 5.a. by line 5.b.)
10. Monthly child support obligation of each party (multiply line 8 by line 9) $
$
11. Deduction by non-custodial parent for health care coverage when paid directly by
non-custodial parent or non-custodial parent’s spouse (from line 7.b.) $
.......................................... $ ..........................................
MOTHER FATHER
12. Adjustments (if any) to Ch ild Support Guidelines Calculation
(see instructions on reverse)
a. Credit for benefits received by or for the child derived from the parent’s -$
......................................... -$ ..............................................
entitlement to disability insurance benefits to th e extent that such derivative
benefits are included in a parent’s gross income
b.
.................................................................................................................................................................................................... $ .......................................... $ .............................................
c.
................................................................................................................................................................................................... $ .......................................... $ .............................................
13. Each party’s adjusted share
$ $
FORM DC-637 (MASTER, PAGE ONE OF TWO) 07/09
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