Here is the text we could read:
City, State, Zip
Name
Address
Phone
Email
Check your email. You will receive information and
documents at this email address.
I am [ ] Petitioner
[ ] Respondent
[ ] Respondent’s Attorney (Utah Bar #:__________)
[ ] Petitioner’s Attorney
[ ] Petitioner’s Licensed Paralegal Practitioner
[ ] Respondent’s Licensed Paralegal Practitioner
[ ] Intervenor
[ ] Intervenor’s Attorney
(Utah Bar #:__________)
(Utah Bar #:__________)
In the District Court of Utah
__________ Judicial District ________________ County
Court Address ______________________________________________________
In the Matter of (select one)
[ ] the Marriage of (for a divorce with or
without children, annulment, separate
maintenance, or temporary separation case)
[ ] the Children of (to establish custody,
parent-time or child support)
[ ] the Parentage of the Children of (for a
paternity case)
____________________________________
(name of Petitioner)
and
____________________________________
(name of Respondent)
____________________________________________
Other parties (if any)
Child Support Obligation Worksheet
– Joint Physical Custody
(Utah Code 78B-12-301 and 302)
_______________________________
Case Number
_______________________________
Judge
_______________________________
Commissioner (domestic cases)
Write the names of the parents:
_____________
(name:
PARENT 1)
_____________
(name:
PARENT 2)
COMBINED
1. Enter the # of natural and adopted children of these
parents for whom support is to be awarded.
1020FAJ Approved November 25,
2019 / Revised May 1, 2022
Child Support Obligation Worksheet
Page 1 of 4
– Joint Physical Custody
5. Divide each parent’s adjusted monthly gross in Line 3
by the COMBINED adjusted monthly gross in Line 3.
%
%
6. Multiply Line 4 by Line 5 for each parent to obtain each
parent’s share of the Base Support Obligation.
$
$
$
$
365
$
-
-
-
$
(Name of parent with lesser number of
overnights)
2a. Enter the parents’ gross monthly income. Refer to
Instructions for definition of income.
2b. Enter previously ordered alimony that is actually paid.
(Do not enter alimony ordered for this case.)
2c. Enter previously ordered child support. (Do not enter
obligations ordered for the children in Line 1.)
2d. OPTIONAL: Enter the amount from Line 12 of the
Children in Present Home Worksheet for either parent.
3. Subtract Lines 2b, 2c, and 2d from 2a. This is the
Adjusted Gross Income for child support purposes.
$
-
-
-
$
4. Take the COMBINED figure in Line 3 and the number of
children in Line 1 to the Support Table (U.C.A. 78B-12-
301). Enter the Combined Support Obligation here.
7. Enter the number of overnights the children will spend
with each parent. (They must total 365). Each parent
must have at least 111 overnights to qualify for Joint
Physical Custody (U.C.A. 78B-12-208).
7b. Identify the parent who has the child the lesser number
of overnights, and continue the rest of the calculation for
them. You will be making adjustments to the net amount
owed by this parent.
8a. For the parent who has the child the lesser number of
overnights multiply the number of overnights that are
greater than 110 but less than 131 by .0027 to obtain a
resulting figure and enter in the space to the right.
8b. Multiply the result on Line 8a by the Combined Support
Obligation on Line 4 for this parent and enter the
number in the space to the right.
8c. Subtract the respective dollar amount on Line 8b from
this parent’s share of the Base Support Obligation found
in the column for this parent on Line 6 to determine the
amount as indicated by U.C.A. 78B-12-208 (3)(a) and
enter the amount in the space to the right.
$
$
9a. Additional calculation necessary if both parents have the
child for 131 overnights or more (Otherwise go to Line
10): For the parent who has the child the lesser number
of overnights multiply the number of overnights that
exceed 130 (131 overnights or more) by .0084 to obtain a
resulting figure and enter it in the space to the right.
1020FAJ Approved November 25,
2019 / Revised May 1, 2022
Child Support Obligation Worksheet
Page 2 of 4
– Joint Physical Custody
[ ] Parent 1
[ ] Parent 2
[ ] Both
[ ] Yes [ ] No
12.
Is the support award the same as the guideline amount in Line 10?
If YES, you are done with this section. Complete the Certificate of Service.
If NO, enter the amount ordered:
[ ] Parent 1 $_______________
[ ] Parent 2 $_______________
13. What were the reasons stated by the court for the deviation?
[ ]
[ ]
[ ]
[ ]
property settlement
excessive debts of the marriage
absence of need of the parent to receive child support
other: ______________________________________
1020FAJ Approved November 25,
2019 / Revised May 1, 2022
Child Support Obligation Worksheet
Page 3 of 4
– Joint Physical Custody
9b. Multiply the result on Line 9a by the Combined Support
Obligation on Line 4 for this parent and enter each in
the space to the right.
9c. Subtract this parent’s dollar amount on Line 9b from
their respective amount as identified on Line 8c to
determine the amount as indicated by U.C.A. 78B-12-
208 (3)(b) and enter the amount in the space to the
right. Go to Line 10.
10. BASE CHILD SUPPORT AWARD: If the result in Line
9c. is > 0, then this parent is the one who must pay child
support(and the other parent is entitled to receive child
support). Enter the amount in Line 9c here. This is the
amount owed by this parent to the receiving parent all
12 months of the year. If the result in Line 9c is < 0,
then this parent is the one who must pay child
support(and the other parent is entitled to receive child
support). Enter the absolute value of the result in Line
9c here. This is the amount owed to this parent by the
paying parent all 12 months of the year.
$
$
$
11. Who must pay child support?
Certificate of Service
I certify that I filed with the court and am serving a copy of this Child Support Obligation Worksheet on the
following people.
Person’s Name
Service Method
Service Address
Service
Date
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Email
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Email
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Email
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)
Date
Signature ►
Printed Name
1020FAJ Approved November 25,
2019 / Revised May 1, 2022
Child Support Obligation Worksheet
Page 4 of 4
– Joint Physical Custody
INSTRUCTIONS FOR THE JOINT PHYSICAL CUSTODY WORKSHEET
See Office of Recovery Services Child Support Calculator for assistance in filling out
this form.
Line 1. Enter the number of natural and adopted children of the parents for whom
support is to be determined. Do not include any children of either parent by
another partner on 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 2a. Enter each parent’s gross monthly income. U.C.A. 78B-12-203(1) states: “As
used in the guidelines, ‘gross income’ includes prospective income from any
source, including earned and nonearned income sources which may include
salaries, wages, commissions, royalties, bonuses, rents, gifts from anyone,
prizes, dividends, severance pay, pensions, interest, trust income, alimony
from previous marriages, annuities, capital gains, Social Security benefits,
workers' compensation benefits, unemployment compensation, income
replacement disability insurance benefits, and payments from ‘nonmeans-
tested’ government programs.”
U.C.A. 78B-12-203(2) states: “Income from earned income sources is limited
to the equivalent of one full-time 40-hour job.” Refer to U.C.A. 78B-12-203 for
additional information about determining gross income.
U.C.A. 78B-12-203(3) says: “specifically excluded from gross income are:
(a) cash assistance provided under Title 35A, Chapter 3, Part 3, Family
Employment Program;
(b) benefits received under a housing subsidy program, the Job Training
Partnership Act, Supplemental Security Income, Social Security Disability
Insurance, Medicaid, SNAP benefits, or General Assistance; and
(c) other similar means-tested welfare benefits received by a parent.
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 2b. Enter the amount of alimony either parent is court ordered to pay and actually
pays to a former spouse [U.C.A. 78B-12-204(1)]. 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.
1020FAJ Approved November 25, 2019 / Revised
November 22, 2021
Child Support Obligation Worksheet
– Joint Physical Custody
Line 2c. Enter the amount of any child support orders either parent is ordered to pay for
children by another partner [(U.C.A. 78B-12-204(1)].
A copy of the order is required for verification.
Line 2d. U.C.A. 78B-12-210(6) states: “(a) 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 a child support award, as provided in Subsection (7); (b)
Additional worksheets shall be prepared that compute the base child support
award of the respective parents for the additional children. The base child
support award shall then be subtracted from the appropriate parent's income
before determining the award in the instant case.
U.C.A. 78B-12-210 (7) states: “In a proceeding to adjust or modify an existing
award, consideration of natural or adoptive children born after entry of the
order and who are not in common to both parties may be applied to mitigate
an increase in the award but may not be applied: (a) for the benefit of the
obligee [the parent who receives child support] if the credit would increase the
support obligation of the obligor [the parent who must pay child support] from
the most recent order; or (b) for the benefit of the obligor [parent who must pay
child support] if the amount of support received by the obligee [the parent who
receives child support] would be decreased from the most recent order.”
Line 3. Complete the calculation as directed.
Line 4. The amount on the "Combined Child Support Obligation Table" (U.C.A. 78B-
12-301) shows the amount BOTH parents combined should contribute for the
support of their child(ren).
Line 5. Calculate each parent's share of the amount in Line 4 as a percentage figure.
Line 6. Calculate each parent’s share of the amount in Line 4 as a dollar amount.
Line 7. This is the total number of overnights the children will have with each parent.
Each parent must have at least 111 overnights to qualify for Joint Physical
Custody (U.C.A. 78-12-208).
Line 7b. The rest of the calculation will be made for the parent who has the child(ren)
the lesser number of overnights. So identify this parent here and continue the
calculation for only this parent.
Line 8a. Complete the calculation as directed. This is the mathematical figure that will
be used to reduce the base support obligation for overnights totaling between
110 and 131 [U.C.A. 78B-12-208 (3) (a)].
1020FAJ Approved November 25, 2019 / Revised
November 22, 2021
Child Support Obligation Worksheet
– Joint Physical Custody
Line 8b. Complete the calculation as directed. This is the combined support obligation
as a dollar figure for this parent.
Line 8c. Complete the calculation as directed. This is this parent’s share of the base
support obligation as a dollar figure.
Line 9a. If both parents have the child for 131 overnights or more, then continue the
calculation as directed. This is the mathematical figure that will be used to
reduce the base support obligation for any overnights greater than 130 that the
child(ren) have with the parent who has the child(ren) the lesser number of
overnights [U.C.A. 78B-12-208 (3) (b)]. Otherwise go to Line 10.
Line 9b. Complete the calculation as directed. This is the combined support obligation
as dollar figure for this parent.
Line 9c. Complete the calculation as directed. This is this parent’s share of the base
support obligation as a dollar figure.
Line 10. Designate which parent must pay support and the support amount by
completing the calculation as directed. The Base Child Support Award is the
amount the paying parent pays to the receiving parent all 12 months of the
year. See the Insurance Premium and Child Care Adjustment Worksheet to
determine how the insurance premiums and child care expenses may change
the amount the paying parent pays to the receiving parent.
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.
Line 13. Complete Line 13 if the paying parent will not be ordered to pay the guideline
amount from either the "Combined Child Support Obligation Table” or the "Low
Income Table."
1020FAJ Approved November 25, 2019 / Revised
November 22, 2021
Child Support Obligation Worksheet
– Joint Physical Custody
