APPENDIX V Income Tax Considerations Section A

Completed Sample Child Support Worksheet
APPENDIX VII
IN THE
JUDICIAL DISTRICT
COUNTY, KANSAS
IN THE MATTER OF:
and
CASE NO.
CHILD SUPPORT WORKSHEET OF
(name)
A. INCOME COMPUTATION – WAGE EARNER MOTHER FATHER
1. Domestic Gross Income $ 893 $
(Insert on Line C.1. below)*
B. INCOME COMPUTATION – SELF-EMPLOYED
†1. Self-Employment Gross Income* 3,000
†2. Reasonable Business Expenses (-) 1,232
†3. Domestic Gross Income 1,768
(Insert on Line C.1. below)
C. ADJUSTMENTS TO DOMESTIC GROSS INCOME
†1. Domestic Gross Income 893 1,768
2. Court-Ordered Child Support Paid (-) 0 0
3. Court-Ordered Maintenance Paid (-) 0 0
4. Court-Ordered Maintenance Received (+) 0 0
†5. Child Support Income 893 1,768
(Insert on Line D.1. below)
D. COMPUTATION OF CHILD SUPPORT
†1. Child Support Income 893 + 1,768
= 2,661
†2. Proportionate Shares of Combined Income 33.5 % 66.5 %
(Each parent’s income divided by combined income)
†3. Gross Child Support Obligation**
(Using the combined income from Line D.1.
find amount for each child and enter total for
all children)
Age of Children 0-5 6-11 12-18 Total
Number Per-Age Category 1 1 0
Total Amount 283 + 320 + 0 = 603
† Examples provided in Appendix VIII
* Interstate Pay Differential Adjustment? Yes X No
**Multiple Family Application? Yes X No
Admin. Order #216, Rev. 11/16/09