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STATE OF NEW MEXICO
[ ] JUDICIAL DISTRICT COURT
COUNTY OF [ ]
[ ], Petitioner,
vs.NO [ ]
[ ], Respondent.
MONTHLY CHILD SUPPORT OBLIGATION
Combined
1. Gross Monthly Income + =
2. Percentage of Combined Income % + % = %
3. Number of Children
4. Basic Support from Schedule
5. Children's Health and Dental Insurance Premium + =
6. Work-Related Child Care + =
7. Additional Expenses + =
8. Total Support + =
9. Each Parent's Obligation  
10. Amount for Each Parent from Line 8  
11. Each Parent's Net Obligation  
Combined
PART 1 - BASIC SUPPORT:
1. Gross Monthly Income + =
2. Percentage of Combined Income % + % = %
3. Number of Children
4. Basic Support from Schedule
5. Shared Responsibility Basic Obligation
6. Each Parent's Share
7. Number of 24 Hour Days with Each Parent +    
8. Percentage with Each Parent % + % = %
9. Amount Retained
10. Each Parent's Basic Obligations
11. Amount Transferred  
Part 2 - ADDITIONAL PAYMENTS:
12. Children's Health and Dental Insurance Premium + =
13. Work-Related Child Care + =
14. Additional Expenses + =
15. Total Additional Payments + =
16. Each Parent's Obligation
17. Amount Transferred  
Part 3 - NET AMOUNT TRANSFERRED:
18. Combine Lines 11 and 17 by addition if same parent pays on both lines, otherwise by subtraction.  
 
Self Support Reserve Rates In Use
 

Petitioner's Signature: _________________________________

Respondent's Signature: _________________________________

Date: ________________