                       CHILD SUPPORT GUIDELINES WORKSHEET
                                        

Docket No:                                Dependents: 

Noncustodial Parent Income:               Custodial Parent Income:         
 
Name:                                     Name: 
________________________________________________________________________________
Method(s) Used to Determine Income        Method(s) Used to Determine Income
( )  Parent's Financial Statement         ( )  Parent's Financial Statement
( )  Other Sources (Net)                  ( )  Other Sources (Net)

Total Gross Monthly Income:               Total Gross Monthly Income:      
                                           
Deductions:                               Deductions:
  Federal Income Tax:                     Federal Income Tax:               

  State Income Tax:                       State Income Tax:                 

  Social Security:                        Social Security:                  

  Union Dues:                             Union Dues:                       

  Mandatory Pension:                      Mandatory Pension:                

  Dependent Health Insurance:             Dependent Health Insurance:       

  Individual Health Coverage              Individual Health Coverage
  or Expense Deductions (not              or Expense Deductions (not
  to exceed $25.00/month):                to exceed $25.00/month):          

  Prior Court-Ordered Child               Prior Court-Ordered Child
  Support or Alimony                      Support or Alimony
  Obligation (if paid):                   Obligation (if paid):             

  Prior Court-Ordered Medical             Prior Court-Ordered Medical
  Support (if paid):                      Support (if paid):                

  Qualified Additional                    Actual Child Care Expense
  Dependents Deduction:                   Due to Employment (less the
                                          appropriate inc. tax credit):     

                                          Qualified Additional
                                          Dependents Deduction:             

  Earned Income Credit:                   Earned Income Credit:            

Total Net Monthly Income:                 Total Net Monthly Income:        

I.   Noncustodial Parent's Total Net Monthly Income:         

     Custodial Parent's Total Net Monthly Income:            

II.  Number of Children for Whom Support is Sought: 

III. Guidelines Percentage/Specified Dollar Amount:         
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                  CHILD SUPPORT GUIDELINES WORKSHEET (continued)

    IV.       %        X                        =    
         Percentage        Noncustodial Parent's     Guideline Amount
                           Net Monthly Income        of Child Support

    V.   Deviations: 

    VI.  Recommended Amount of Support: 

    VII. Changes in Support Obligation as Number of Children Entitled
         to Support Changes (Based on present income guidelines):

         Number of children:        Guideline Percentage:      %

              %     X                      =         
         Percentage        Noncustodial Parent's     Guideline Amount
                           Net Monthly Income        of Child Support

         Number of children:        Guideline Percentage:      %

              %         X                  =         
         Percentage        Noncustodial Parent's     Guideline Amount
                           Net Monthly Income        of Child Support


    VIII. Qualified Dependent Deduction:






    STATE OF IOWA, COUNTY OF                  :  ss:


       I,                 , do hereby swear or affirm that the foregoing
    statement is true, complete and correct as I verily believe from all
    information available to me at this time.


    Date:  ________________________   _______________________________________
                          
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                  CHILD SUPPORT GUIDELINES WORKSHEET (continued)


    The undersigned attorney for the                 hereby certifies the
  foregoing Child Support Guidelines Worksheets were prepared by me or at
  my direction in good faith reliance upon information available to me at
  this time.


  Date: _____________________     ____________________________________




  Prepared by:


  _______________________________       Date: ________________________


  _______________________________       Date: ________________________


  **Child Support Recovery Unit is not required to obtain signatures
