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<br />200600921 <br /> <br />WORKSHEETS 1 (Basic), 4 (No. of Children), & 5 (Deviations) <br />2 = # of Children MOTHER COMBINED <br />000-00-0000 <br /> <br />:;::;:::::::i:;:ii:::::i:,:::;g.&~:,. <br />..' FATHER <br />000-00-0000 <br /> <br />MONTHLY INCOME: <br />1 Salary <br />2 Self-employment <br />3 Other Taxable <br />4 Fringe Benefits <br />5 Total Monthly Income <br />DEDUCTIONS: (child exemptions) <br />6 Federal <br />7 State <br />8 Taxes <br />9 FICA <br />10 CHILD(REN)'S Health Insurance <br />11 Retirement <br />12 Child Support Previously Ordered <br />13 Regular Support for Other Children <br />14 Total deductions <br />15 MONTHLY NET INCOME <br />16 PERCENT CONTRIBUTION <br /> <br />891.00 <br />0.00 <br />0.00 <br />0,00 <br />891.00 <br />(2) <br />0.00 <br />0.00 <br />0.00 <br />68,16 <br />0,00 <br />0.00 <br />0.00 <br />0.00 <br />68.16 <br />822.84 <br />43.25% <br /> <br />1,902.64 <br /> <br />1,255.00 <br />0.00 <br />0.00 <br />0,00 <br />1,255.00 <br />o <br />59.25 <br />19.94 <br />79.19 <br />96,01 <br />0,00 <br />0.00 <br />0.00 <br />0,00 <br />175.20 <br />1,079.80 <br />56.75% <br /> <br /> <br />23 Guideline R Limitation 82.28 331.80 <br />24 Guildeline S Limitation 0.00 0.00 <br />25 Guideline T Limitation 0.00 0.00 <br /> DEVIATIONS: <br />26 Deviation for One Child 0.00 0.00 <br />27 Deviation for Two Children 0.00 0.00 <br />28 Deviation for Three Children 0.00 0.00 <br />29 Deviation for Four Children 0,00 0.00 <br />30 Deviation for Five Children 0.00 0,00 <br />31 Deviation for Six Children 0.00 0.00 <br /> MONTHL Y SUPPORT AFTER DEVIA TIONS/LlMIT A TIONS: <br /> Name 0/0/6 SSN <br />32 One Child Marleny M, 8a6m 01/01/96 82.28 111-11-1111 274.00 <br />33 Two Children 2nd youngest Isaaxc Saenz 82.28 222-22-2222 331.80 <br />34 Three Childrer #N/A #N/A #N/A #N/A #N/A <br />35 Four Children #N/A #N/A #N/A #N/A #N/A <br />36 Five Children #N/A #N/A #N/A #N/A #N/A <br />37 Six Children #N/A #N/A #N/A #N/A #N/A <br /> <br />CHILD CARE EXPENSES: <br />38 Max. Monthly Amt. by NONCUSTODIA <br />39 Monthly Tax Credit (other party earning <br /> <br />#N/A <br />#N/A <br /> <br />#N/A <br />#N/A <br /> <br />APPENDIX "B" <br /> <br />saenz <br /> <br />Hall County Case No. CI 05-763 <br /> <br />'" <br />~ <br />'" <br />~ <br />'" <br />'" <br />'" <br />~ <br />~ <br /> <br />EXHIBIT <br /> <br />I <br /> <br />/1'1_7 ...<J~ <br />