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 
[  ]  Intervenor  
[  ]  Intervenor’s Attorney  

 

 

 

(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) 

Child Support Obligation Worksheet 
– Split Custody 
(Utah Code 78B-12-301 and 302) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner (domestic cases) 

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

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. 

 

 

 

1022FAJ Approved November 25, 
2019 / Revised May 1, 2022 

Child Support Obligation Worksheet  

Page 1 of 4 

– Split Custody 

and  

 

 

 

% 

%  

$ 

- 

- 

- 

$ 

 

% 

$ 

 

$ 

 

 

 

 

$ 

  $ 

%  

 

 

 

2. Divide the number of children with each parent by the 

combined number of children listed in Line 1. 

3a. Enter the parent’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 (U.C.A. 78B-12-
301). 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 parent 1’s Line 7 by parent 2’s Line 2. This 

is parent 1’s obligation to parent 2 

9. Multiply parent 2’s Line 7 by parent 1’s Line 2. This is 

parent 2’s obligation to parent 1. 

10. BASE CHILD SUPPORT AWARD: Subtract the lesser 
amount from the greater amount of Lines 8 and 9. This 
is the amount the parent who must pay child support 
pays to the parent who receives child support all 12 
months of the year. 

$ 

- 

- 

- 

$ 

$ 

$ 

 

$ 

11.  Who must pay child support? 

[  ]  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:  

1022FAJ Approved November 25, 
2019 / Revised May 1, 2022 

Child Support Obligation Worksheet  

Page 2 of 4 

– Split Custody 

 

[  ]  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: ______________________________________ 

 

1022FAJ Approved November 25, 
2019 / Revised May 1, 2022 

 

Child Support Obligation Worksheet  

Page 3 of 4 

– Split Custody 

 

 

 

 

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 

 

 

1022FAJ Approved November 25, 
2019 / Revised May 1, 2022 

 

Child Support Obligation Worksheet  

Page 4 of 4 

– Split Custody 

 

INSTRUCTIONS FOR THE SPLIT 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 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 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 3b.  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. 

1022FAJ Approved November 25, 2019 / Revised 
November 22, 2021 

Child Support Obligation Worksheet  

– Split Custody 

 

 

 

 

 

Line 3c.  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 3d.  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 4.   Complete the calculation as directed. 

Line 5.   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 children. 

Line 6.   Calculate each parent's share of the amount in Line 5 as a percentage figure. 

Line 7.   Calculate each parent's share of the amount in Line 5 as a dollar amount. 

Line 8.   Complete the calculation as directed. This is Parent 1’s obligation to Parent 2. 

Line 9.   Complete the calculation as directed. This is Parent 2’s obligation to Parent 1. 

Line 10.  The Base Child Support Award is the amount the parent who must pay child 

support pays to the parent who receives child support 

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. 

1022FAJ Approved November 25, 2019 / Revised 
November 22, 2021 

Child Support Obligation Worksheet  

– Split Custody 

 

 

 

Line 13.   Complete Line 13 if the parent who must pay child support will not be ordered 
to pay the guideline amount from either the "Combined Child Support 
Obligation Table” or the "Low Income Table." 

 

 

 

1022FAJ Approved November 25, 2019 / Revised 
November 22, 2021 

Child Support Obligation Worksheet  

– Split Custody