Father
Mother
Father
Mother
Overtime, Bonus and Commisions For the Past 3 Years
*Year 1 is the Most Recent*
*Number of children times Federal Income Tax Exemption ($3,700) less child support received. Not to exceed the federal tax exemption*
(Tax Credit will be deducted for you upon form submission)
Yes
No
(Contributing cost of private family health insurance, minus the contributing cost of private single health insurance, divided by the total number of dependants covered by the plan, including the children subject of the support order, times the number of children subject of the support order.)