Child Support Guideline Worksheet {DR-30}

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT CHILD SUPPORT GUIDELINE WORKSHEET COUNTY PLAINTIFF PLAINTIFF SOC. SEC. NO. CIVIL ACTION-FILE NO. VS. DEFENDANT DEFENDANT SOC. SEC. NO. To be filed with complaints on divorce, bed & board, miscellaneous complaints and when answer or modification is filed. Plaintiff Number of Children: 1. Monthly Gross Income $ 2. Required Deductions: a. Preexisting Child Support Payments b. Health Insurance Premiums or Medical Cash Contributions: c. Additional Minor Dependants 3. Optional Adjustments in the Discretion of the Court a. Pension/Retirement Payments b. Life Insurance Premium Payments c. Parent's Extraordinary Medical Exp. ± d. Income Tax Exemptions Adjustment e. Payments of Assigned Marital Debts 4. Monthly Adjusted Gross Income (line 1minus lines 2 and 3) $ 5. Percentage Share of Income (line 4 parent's income divided by line 4 combined income) 6. Basic Child Support Obligation (apply line 4 combined income to child support table) 7. Work-Related Child Care Costs (actual costs minus federal tax credit) 8. Total Child Support Obligation (add lines 6 and 7) 9. Parent's Child Support Obligation (for each parent, line 5 percentage X line 8) $ 10. Recommended Child Support Order (enter line 9 amount for non-custodial parent l leave other column blank) $ 11. Basic Child Support Amount Ordered: $ 12. Cash Medical Ordered $ 13. TOTAL AMOUNT ORDERED: $ (add lines 11 and 12) $ ± $ $ 100% XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Defendant Combined XXX XXX XXX $ % $ XXX per $ $ $ $ wl./bi-wk./mo. XXX DATE Prepared and presented by/for plaintiff: by/for defendant: Prepared and presented by Office of Child Support Enforcement (if applicable) Approved and presented DR-30 (Rev. 7/07) Enter Page 1 of 2 DATE DATE American LegalNet, Inc. www.FormsWorkFlow.com FINDING OF FACTS AND JUDGE'S COMMENTS: DR-30 (Rev. 7/07) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com