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Proposed-Support-Decision

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					GROSS MONEY EARNED PER MONTH
  (1) Gross wages and salary income
  (2) Commissions, tips, and bonuses
  (3) Self-employment income (net of expenses other than
depreciation and tax credits)
  (4) Rental income (net of expenses other than
depreciation)
  (5) All other income actually received

(A) GROSS MONEY EARNED PER MONTH                           0.00

ACTUAL DEDUCTIONS PER MONTH
  (1) Income tax withholding
  (2) FICA (Social Security)
  (3) Medicare
  (4) Health Insurance
  (5) Union Dues
  (6) Other:

(B) TOTAL ACTUAL DEDUCTIONS PER MONTH                      0.00

(C ) ACTUAL NET RESOURCES RECEIVED PER MONTH
(Subtract (B) from (A) )                                   0.00

STATUTORY DEDUCTIONS ALLOWED PER MONTH
  (1) Income tax withholding
  (2) FICA (Social Security)
  (3) Medicare
  (4) Health insurance attributable to the children
  (5) Union Dues

(D) TOTAL STATUTORY DEDUCTIONS ALLOWED PER
MONTH                                                      0.00

(E) STATUTORY NET RESOURCES PER MONTH
(Subtract (D) from (A))                                    0.00

(F) PRESUMED CHILD SUPPORT

(G) TOTAL ACTUAL MONEY REMAINING AFTER
ACTUAL DEDUCTIONS (Subtract (F) from (C ))                 0.00

(H) TOTAL MONEY REMAINING AFTER STATUTORY
DEDUCTIONS AND PAYMENT OF CHILD SUPPORT
(Subtract (F) from (E))                                    0.00
TOTAL MONEY NEEDED PER MONTH BY ME AND MINOR CHILDREN LIVING WITH ME
  (1) Rent or house payment
  (2) Real property taxes (omit if part of house payment)
  (3) Residence maintenance (repairs, yard, etc.)
  (4) Insurance - home or renters (omit if part of house payment)
  (5) Utilities - gas
  (6) Utilities - electric and water
  (7) Utilities - garbage service
  (8) Telephone
  (9) Mobile Phone
  (10) Groceries and household items
  (11) Meals away from home
  (12) School lunches
  (13) Dental and orthodontia
  (14) Medical and prescriptions
  (15) Laundry and dry cleaning
  (16) Car Payment
  (17) Gas and vehicle maintenance
  (18) Clothing and shoes
  (19) Insurance - Auto
  (20) Insurance - Life
  (21) Insurance - Health (omit if payroll deduction)
  (22) Child care
  (23) Children's activities
  (24) Entertainment
  (25) Haircuts
  (26) Cable TV and newspaper
  (27) Total Monthly payments on debts (see list below)
  (28) Support or alimony payments to other persons
  (29) Other (specify):

TOTAL MONEY NEEDED PER MONTH

DIFFERENCE BETWEEN MONEY RECEIVED AND MONEY NEEDED

PRESUMED CHILD SUPPORT
                                                      Amount of
                                         Date Final   Monthly
Description of Debt   Total Balance Owed Payment      Payment




TOTAL PAYMENTS ON
MONTHLY DEBTS

				
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