IN THE DISTRICT COWRT In the Matter of the Marriage of Pispiers SENERAL Jusispigy TOP Solero Wwxiso4 HALLECK RICHARDSON EKA, KANSAS Qakkme KANSAS! and Division: 2 CLAUDINE DOMBROWSK! CCHILD SUPPORT WORKSHEET (SUBMITTED BY FATHER) MOTHER FATHER GROSS ANNUAL INCOMES: 23,582 26,633, ‘A. INCOME COMPUTATION - WAGE EARNER 1. Domestic Gross income (Wages intrest, et.) 1,965 ° 8, INCOME COMPUTATION - SELF-EMPLOYED 1. Self-Employment Gross Income ° 23388 2. Reasonable Business Expenses (ml. SE tax) o (189) 3. Domestic Grass Income (Selt-Emplayed) o Bae C. ADJUSTMENTS TO DOMESTIC GROSS INCOME 4. Gross income (Total: Monthy) 1,965 2219 Cos of Living Agustment ° ° 2. Other Court Ordered Child Support Paid o ° 3. Maintenance Rec'd (Paid in this case ° ° 4 Maintenance Rec'd (Pai) other cases ° ° 5. Chile Suppor income 7965 Bas 1. COMPUTATION OF CHILD SUPPORT 4. Child Supper Income 4,965 2219 2. Proporionate Shares of Combined Income 47.0% 53.0% 3. Basie Child Suppor Obligation ‘Age of children 06 TS Number per age 7 o ° ‘Amount per chi 486 ° ° TOTALS STRICT CouRE icaeneeeyg) Hie SENERAL Jy ‘ enfin gratatet CIAL DISTRICT. imi Taira SOURE a6 0 3 4 0s PH 'O) 86 0 217 TOTAL 60,215 1.965 2219 4185 100.0%Page2 D. COMPUTATION OF CHILD SUPPORT (Cont) 4. Health and Dental insurance Premium 5. Work Related Child Care Costs ‘Less Child Care Tax Credit (inc. Kansas credit) 6, Parents’ Total Child Support Obligation 7. Each Parents Child Support Obligation 8. Adjustment for Insurance & Chie Care 9. Net Parental Child Support Obligation (Percentage of Parents Gross income) . CHILD SUPPORT ADJUSTMENTS Agreement Past Minority (Overall Financial Condition Applicable Category Yes No 1 %] Long Dist Vistation Costs 2 2] Visitation Adjustment 3. | Income Tax Considerations 4 X| Special Needs 5. x 8 x 7. Total Adjustments F, ADJUSTED CHILD SUPPORT SUMMARY (Deviations from rebuttable presumption amount) 1. Basic Parental Child Support Obligation 2. Total Child Support Adjustments 3. Adjusted Subtotal CChild Support Payable by Mother CChild Support Enforcement Fee Allowance Total Amount Payable Prepared by: Hoffman & Hofman 142 West Seventh - Garden Suite ‘Topeka, Kansas 66603, (785) 283-5887 ‘Attomeys for Petitioner ‘Administrative Order No. 128 Signed: Date: Case No. SN 96D 217 MOTHER FATHER TOTAL ° 81 81 ° 433 429 ° 63 3 ° 46 46H or 44s 502 ° as) wn) ai we 226% 26% “mount Alowed Tioher | _ Father 7 3 0 o ° ° ° ° 3 ° ° ° o 3 ° MOTHER FATHER as 41 ° 0 was a we 445 3 we Prepared: ant $2000 Version 12:1 Copyright 2000 Brady Stare