Client Intake Form – Marriage

    Form Part II Child Custody and Child Support

    Security


    Today's Date:

    Email of person completing this form (required)



    Children


    NoneOneTwoThreeFourFive































































    Shared Residential Arangement




    Enter the annual income of the Husband's, Wife's and then the combined Income of both.  Use the income from the last tax return, most recent paystub deducting of 7.65% for (FICA) but not less than the 2017 self-support reserve of $16,281, unless a party is disabled. Also see: CSSA Guidelines Chart



    Annual Combined Support Obligation

    Weekly Combined Support Obligation

    Husband's Percentage of Comdined CSSA Support Obligation and uninsured medical expenses

    Husband's Weekly Child Support Obligation

    Wife's Percentage of Comdined CSSA Support Obligation and uninsured medical expenses

    Wifes's Weekly Child Support Obligation

    The parties have agreed to OPT-INOPT-OUT