IN THE _____________________________ DISTRICT COURT


________________________________ COUNTY,  STATE OF UTAH













Civil  No. ______________________


           MOTHER       FATHER         COMBINED    


1. Enter the # of natural and adopted children of this mother and father for whom support is to be awarded.








2. Divide the number of children with each parent by the combined number of children listed in Line 1.








3a. Enter the father's and mother's gross monthly income. Refer to Instructions for definition of income.








3b. Enter previously ordered alimony that is actually paid. (Do not enter alimony ordered for this case).








3c. Enter previously ordered child support. (Do not enter obligations ordered for the children in Line 1).








3d. OPTIONAL: Enter the amount from Line 12 of the Children in Present Home Worksheet for either parent.








4. Subtract Lines 3b, 3c, and 3d from 3a. This is the Adjusted Gross Income for child support purposes.








5. Take the COMBINED figure in Line 4 and the number of children in Line 1 to the Support Table. Find the Base Combined Support Obligation. Enter it here.








6. Divide each parent's adjusted monthly gross in Line 4 by the COMBINED adjusted monthly gross in Line 4.








7. Multiply Line 5 by Line 6 for each parent to obtain each parent's share of the Base Support Obligation.








8. Multiply the mother's Line 7 by the father's Line 2. This is the mother's obligation to the father.








9. Multiply the father's Line 7 by the mother's Line 2. This is the father's obligation to the mother.









 10. BASE CHILD SUPPORT AWARD: Subtract the lesser amount (OBLIGEE'S) from the 

 greater amount (OBLIGOR'S) of Lines 8 and 9. This is the amount the OBLIGOR pays to the

 obligee all 12 months of the year.




11.           Which parent is the obligor?                   (   )  Mother                            (   )  Father


12.           Is the support award the same as the guideline amount in line 10?        (   )  Yes                  (   )  No

If NO, enter the amount ordered: $__________________ , and answer number 13.


13.   What were the reasons stated by the court for the deviation?

(   ) property settlement

(   ) excessive debts of the marriage

(   ) absence of need of the custodial parent

(   ) other: _______________________________________________________________________________


Attorney Bar No. _______________ (   ) Electronic Filing     (   ) Manual Filing               10/94



 Line 1. Enter the number of natural and adopted children of the mother and father for support is to be determined. Do not include any children of either parent by another partner this line. If a child for whom support is to be determined is an unemancipated minor who does not live with his parents, use the total number of children, including the unemancipated minor, by that set of parents for Line 1.


Line 2. Complete the computation as directed.


Line 3a. Enter the mother's and father's gross monthly income. Definition of gross monthly income -  prospective income from any source, salaries, wages, commissions, royalties, bonuses, rents, gifts, prizes, dividends, severance pay, pensions, interest, trust income, alimony from previous marriages, annuities, capital gains, social security benefits, workers' compensation benefits, unemployment compensation, disability insurance benefits and payments for "non-means-tested" government programs. Income from earned sources is limited to the equivalent of one full time job. For self-employed parents, see UCA 78-45-7.5(4)(a) and (b).


Excluded from gross income are: cash assistance provided under Title 35A, Chapter 3, Part 3, Family Employment Program, benefits from: the housing subsidy program, the Job Training Partnership Act, S.S.I.,  S.S.D.I., Medicaid, Food Stamps, General Assistance, and other "means-tested" benefits received by a parent; earnings or benefits of a child who is subject to this award.


All income must be verified. Verification includes: year to date pay stubs, employer statements or records, the last year's tax return and documentation of non-earned income appropriate to the source.


Line 3b. Enter the amount of alimony either parent is court ordered to pay and actually pays to another parent. Do not include alimony payments for this case. Alimony payments must be verified. Cancelled checks or a statement from the recipient of the alimony may be accepted as verification.


Line 3c. Enter the amount of support either parent is court ordered to pay for children by another partner. Previously ordered support may include specifically ordered payments toward a child's medical expenses, child care, or child support. A copy of the order is required for verification.


Line 3d. Natural or adoptive children of either parent who live in the home of that parent and are not children in common to both parties, may at the option of either party be taken into account under the guidelines in setting or adjusting a child support award. Use the WORKSHEET TO DETERMINE FATHER'S OBLIGATION TO CHILDREN IN HIS PRESENT HOME and/or the WORKSHEET TO DETERMINE MOTHER'S OBLIGATION TO CHILDREN IN HER PRESENT HOME to compute the obligations of the respective parents for the additional children. Consideration of natural or adoptive children other than those in common to both parties may be applied to lessen an increase to an existing award, but may not be applied to justify a decrease in the award.


Line 4. Complete the calculation as directed.


Line 5. The amount on the "Combined Child Support Obligation Table" shows the amount BOTH parents combined should contribute for the support of their children.


Line 6. Each parent's share of the combined support obligation as a percentage figure.


Line 7. Each parent's share of the combined support obligation as a dollar figure.


Line 8. Complete the calculation as directed. This is the mother's obligation to the father.


Line 9. Complete the calculation as directed. This is the father's obligation to the mother.


Line 10. The Base Child Support Award is the amount the obligor pays to the obligee. See the Insurance Premium and Child Care Adjustment Worksheet to determine how insurance premiums and child care expenses may change the amount the obligor pays to the obligee.


Line 11. Designate which parent must pay support.


Line 12. Complete line 12 to indicate if the amount ordered deviates from the guideline amount in line 10. Complete line 13 if you deviated from the guideline amount.