residential schedules and child support: non … schedules and child support: non-parent custody |...

3116EN | September 2017

Residential Schedules and Child Support:

Non-Parent Custody Cases

Forms and Instructions

3116EN | September 2017

Table of Contents | Page - 1

Table of Contents

Section 1: Introduction ............................................................................................... 1

A. Is this packet for me? ...................................................................................... 1

B. What if I have questions that this packet does not answer? ........................... 2

Section 2: List of Forms in this Packet ..................................................................... 2

Section 3: Using the Forms ........................................................................................ 2

Section 4: Instructions for the Forms in this Packet ................................................ 4

A. Child Support Worksheets, Schedule and Instructions ................................... 4

B. Financial Declaration of: – FL All Family 131 .................................................. 7

C. Sealed Financial Source Documents (Cover Sheet) – FL All Family 011 ....... 8

D. Child Support Order - FL All Family 130 ......................................................... 9

E. Residential Schedule – FL Non-Parent 405 .................................................. 16

Section 5: Blank Forms ............................................................................................ 23

This publication provides general information concerning your rights and responsibilities. It is not a substitute for specific legal advice.

This information is current as of September 2017.

© 2017 Northwest Justice Project — 1-888-201-1014.

(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-commercial use only.)

Residential Schedules and Child Support: Non-Parent Custody | Page - 1

Section 1: Introduction

A. Is this packet for me?

Any party to a non-parent custody case may use this packet to fill out

Child Support Worksheets

Financial Declarations

Sealed Financial Records Cover Sheet to go with private financial records

Child Support Orders

Proposed, Temporary, and/or Final Residential Schedules

This packet has only some of the forms for a non-parent custody case. You should also use our packets Filing a Non-Parent Custody Case (for petitioners), OR Responding to a Non-Parent Custody Petition (for respondents), OR Finalizing Your Non-Parent Custody Case.

This packet has no forms or instructions for filing and serving the papers or for preparing for or going to hearings. The other packets listed above have information on these issues.

Do not use this packet for divorce and parentage cases.

This packet has no legal information about the standards for:

getting legal custody

writing a Residential Schedule

calculating child support

Talk with a lawyer. Our publication Non-Parent Custody: Frequently Asked Questions and Answers has very basic info.

You will see footnotes in this packet. They tell the law or court case supporting the footnoted statement, or give special tips, links to websites, or other information. Use the footnotes to look up the law at your local law library, or to tell the court when you are trying to make a legal argument. CR is the Civil Rules of Washington. GR stands for General Rules. RCW stands for Revised Code of Washington, the law of Washington State. Court cases have names, such as In re Custody of Child. The references to the law are up to date as of the date we published this packet. The law sometimes changes before we can update the packet.

Try to talk with a lawyer. Even if you do not hire one to represent you, a one-time meeting can give you important information. If you are low-income, see the next section.

http://www.washingtonlawhelp.org/resource/filing-a-nonparental-custody-case?ref=LWbVW

http://www.washingtonlawhelp.org/resource/responding-to-a-petition-for-nonparental-cust?ref=KmQBi


http://www.washingtonlawhelp.org/resource/finishing-your-nonparental-custody-case?ref=tXW0D


http://www.washingtonlawhelp.org/resource/nonparental-custody-of-a-child-frequently-ask?ref=HQvjP

http://www.washingtonlawhelp.org/resource/nonparental-custody-of-a-child-frequently-ask?ref=HQvjP

http://www.courts.wa.gov/court_rules/?fa=court_rules.list&group=sup&set=CR

http://www.courts.wa.gov/court_rules/?fa=court_rules.list&group=ga&set=GR

http://apps.leg.wa.gov/RCW/default.aspx?cite=4.28.210


B. What if I have questions that this packet does not answer?

Talk to a lawyer familiar with family law before filing anything with the court. Many counties have family law facilitators who can help you fill out forms or free legal clinics where you may get legal advice about your case.

Do you live in King County? Call 211. 211 is open Monday through Friday between 8:00 a.m. and 6:00 p.m. From a pay/public phone, call 1-800-621-4636. 211 will identify and refer you to the appropriate legal aid provider.

Apply online with CLEAR*Online - https://nwjustice.org/get-legal-help

Call the CLEAR Legal Hotline at 1-888-201-1014.

Section 2: List of Forms in this Packet

Form Name Form Number Child Support Worksheets and Instructions

Financial Declaration of: FL All Family 131

Sealed Financial Records Cover Sheet FL All Family 011

Child Support Order FL All Family 130

Residential Schedule (Non-Parent Custody) FL Non-Parent 405

Section 3: Using the Forms

Use the child support worksheets:

at the start of the case

if the judge enters temporary family law orders placing the child with petitioner and orders one or both parent/s to pay temporary child support

at the end of the case, if the nonparent wins custody and the parent(s) will pay child support

The judge will set child support according to the Washington State Child Support Schedule, based mostly on the parent’s incomes. Each party needs to fill out, file, and serve child support worksheets. If the court orders child support, it will approve one set of worksheets (either one that a party has prepared or one that the court directs a party to prepare).

If an administrative proceeding or parentage action has already set child support, a non-parent custody petitioner may not need to fill out child support worksheets. Get advice from a lawyer in this situation.

Attach a sealed financial records cover sheet to your financial documents:

https://nwjustice.org/get-legal-help

https://nwjustice.org/get-legal-help


To keep personal financial information you file with the court out of the public file.

When filing private financial information listed on the form.

The financial declaration goes with the child support worksheets. You also use it when a party asks for financial relief, such as attorney fees or Guardian ad Litem fees.

The child support order sets the amount of support the parent(s) will pay if the nonparent gets temporary or permanent custody.

The residential schedule is a detailed plan for when the child/ren will spend time with each party. Many local courts require it. 1 Even where not locally required, you may find it useful, especially where the nonparent will have custody but one or both parents will have substantial contact with the child.

Petitioner: If you do not use the residential schedule, you must explain custody and the exact visitation between parent(s) and child in detail in your petition and, if you win custody, in the relevant court orders. These include the temporary non-parent custody order and/or, at the end of the case, the findings and conclusions and non-parent final custody order.

Respondent: If you do not use the residential schedule, you should detail your requests for time with the child in Response and, for any temporary orders, in motions, responses, and declarations.

Parents: The Residential Schedule assumes the nonparent will have custody. If this is not your wish, make it clear in writing that you do not agree Petitioner should get custody, and you want the schedule only if Petitioner wins custody despite your objection. Instructions with the form suggest language for making this objection.

You can use the same blank form for the residential schedule as proposed, temporary or final.

Try to find out how your court uses the residential schedule. Some counties do not always use it. Others may expect its use. If you think you might finalize your case by default against a respondent, and you want the court to enter a Residential Schedule as part of your final orders, you should serve a proposed Residential Schedule with your petition (even if your county does not require it). Then the respondents are less likely to challenge any default orders you later get for lack of proper notice.

You should serve child support worksheets with the petition if you want the court to set child support.

1 The parties must use mandatory court forms, RCW 26.10.015. See also Mecum v. Pomiak, 119 Wn. App. 415, 421, 81 P.3d 154 (2003), where the court decided it is improper to enter an order of default against a respondent for not filing a proposed parenting plan in a non-parent custody case.



Section 4: Instructions for the Forms in this Packet

Use the general instructions found in the packets Filing a Non-Parent Custody Case, Responding to a Non-Parent Custody Petition, or Finalizing Your Non-Parent Custody Case for information on filling out the caption and forms in general.

A. Child Support Worksheets, Schedule and Instructions

When child support is an issue, each party should fill out a set of child support worksheets. Use the instructions and schedule that come with the worksheets. You will usually file and serve the completed worksheets with the petition or Response, and new worksheets with motions involving child support if needed to update info. YOU SHOULD FILL OUT THE WORKSHEETS BEFORE FILLING OUT ANY PROPOSED CHILD SUPPORT ORDER.

The judge will sign a set of worksheets s/he approves when entering a child support order. The judge may sign worksheets one party has already prepared, or may ask a party to fill out a new set of worksheets with the specific income, expense, and child support amounts the judge announced at hearing/trial.

The instructions in this packet only cover a few special issues.

The instructions and worksheets in this packet are current as of July 2015. Use these instructions with the Washington State Child Support Schedule published by the Administrative Office of the Courts. Also, read our publication called Understanding the Washington State Child Support Schedule and How Child Support is set in Washington.

The instructions are for filling out the worksheets based on the income, child support amounts, and expense figures you propose at the start of the case and/or before a hearing or trial.

If the parties all agree on the income, child support amounts, and expense figures, you must fill out the worksheets using the figures you agree to. You may still need to show the judge that those amounts are correct.

If you are filling in these worksheets after the judge has announced a decision, you must use the income, child support amounts, expenses, and other info the judge announced, even if you disagree with them and/or they are different from what you proposed.

Use the Division of Child Support’s (DCS) online Child Support Estimator, https://fortress.wa.gov/dshs/dcs/SSGen/Home/QuickEstimator for help

estimating the amount of support the judge might order in your case

preparing proposed child support worksheets

filling out your Worksheets online

http://www.washingtonlawhelp.org/resource/filing-a-nonparental-custody-case?ref=LWbVW



http://www.washingtonlawhelp.org/resource/understanding-the-wa-state-child-support-sche?ref=vazDn

http://www.washingtonlawhelp.org/resource/understanding-the-wa-state-child-support-sche?ref=vazDn

https://fortress.wa.gov/dshs/csips/ssgen

https://fortress.wa.gov/dshs/dcs/SSGen/Home/QuickEstimator


The Estimator may not work if you are asking for a “deviation” from the standard child support calculation. (Examples of when you might ask for a deviation: the parents spend a lot of residential time with the children; there are children from other relationships; each parent has custody of one of the children.)

To fill out the worksheets, follow the instructions in the Washington State Child Support Schedule (WSCSS). They explain:

the meaning of gross and net income

how to list your income

how/when to impute income to the other party

how to fill out the rest of the financial info

Put info about the parents’ incomes in the two columns. There is one for each parent.

Our instructions address gaps in the WSCSS instructions:

1. Above the caption, check the box to show whether these worksheets are proposed or an order signed by the judge. If they are proposed, check the box showing who is proposing them and put your name.

2. Caption your worksheets: At the top of worksheet page 1, put your county, the case number, the parents’ and children’s names, and the children’s ages in the appropriate spaces.

3. If you are a parent, put your own information on the Worksheet. If any party gets SSI, TANF, or Food Stamps, list that income on line 22(f), “Income from Assistance Programs,” and not line 1, “Gross Monthly Income.” You should list income from other common programs such as social security, worker’s compensation, unemployment benefits, and pension or retirement benefits on line 1(e), “Other Income.”

4. If you are the petitioner, put info for the parent/s if you know or can estimate their income and expenses. Write on the form if you have used estimates. If you have any income information for the parents, even an estimate, use that information. Explain in the “Other Factors for Consideration” at Line 26 any income information or estimates you listed which you did not base on wage stubs or tax returns. The parents will have a chance to correct any incorrect information.

5. If you are the petitioner and you cannot get accurate income information about the parents or estimate their income based on what you know, or if you believe a parent is voluntarily unemployed or underemployed, follow the instructions for imputing income to the parent. (See the WSCSS Definitions and Standards, INCOME STANDARD #6, on page 1.)


6. Health Care Expenses (Part III): You should only include here expenses you pay regularly (such as a monthly health insurance premium) in this section. Do not include doctor bills that may change over time. If you are listing health care expenses for a parent on lines 10a and 10b, you should also list monthly payments that parent actually made for those expenses on line 16a, Monthly Health Care Expenses Credit.

7. You can Include Daycare, Education & Travel Expenses: In section 11, put your daycare, tuition or other special childcare expense if you want that amount included in the transfer payment. Then mark the first box in section 21 of the Child Support Order Support under Other shared expenses: “Does not apply. The monthly amount covers all expenses, except health care expenses.” If you are listing day care or other special expenses in part III of the Worksheets, you must also list monthly payments that parent actually made for those expenses on line 16b, Day Care and Special Expenses Credit.

In most cases, you should not list your daycare, education and travel expenses here. Instead, you should list them in section 21 of the Child Support Order under Other shared expenses, after checking the parents will share the cost for the expenses listed below. This allows for changes in these expenses that may take place over time. Then you may not need to change your support order in the future. The downside of putting these expenses in the Order (instead of the Worksheets) is that it may be harder to collect payment from the other parent for these expenses. DCS will help compute and collect day care and other special expenses.

8. The “Other Factors for Consideration” part of the Worksheet. This is where you explain how you calculated income and expenses, and show factors that may allow “deviation” from the “standard calculation.” If there are special circumstances, you should list this information on the worksheet. See the “Limitation Standards” and the "Deviation Standards" on pages 3 - 4 of the Definitions and Standards section of the Washington State Child Support Schedule to decide what information to put.

You can also explain how you calculated the support amount. State how you calculated each parent’s income. If the income you put for a parent is imputed or estimated, put how you figured out the income amount. If you believe support should be less than the standard calculation, state how much it should be and why.

If a parent gets disability benefits like Social Security and the child is eligible for them on the parent’s account, you must report both parent’s and child’s shares under “net income.” You should then explain in the “Other factors for Consideration” box the child’s share of the benefit, who is currently getting the child’s benefit, and that the parent should get credit against his/her support obligation as long as the child’s benefit continues.

Fill out the Worksheet Completely. It takes time and patience to the worksheet out accurately. The judge decides the child support payment based on the info in this worksheet.

9. Signature: Sign where indicated on the last page. Put the date and place (city) you signed.


B. Financial Declaration of: – FL All Family 131

You must fill this out if you are:

A respondent/parent. (You must also fill out child support worksheets.)

A petitioner asking for GAL fees or attorney fees.

Caption. Fill out the caption, including your name.

1. Your personal information. Give the info requested. Check yes if you are currently working and put your hire date. Check no if you are not currently working and give the info provided.

2. Summary of your financial information. Skip this section. Come back to it after filling out the rest of the form.

3. Income.

If you do not know how much a party’s income is, give your best estimate, or use the support schedule’s instructions for imputing income.

Use the You column for your information. Use the column titled other party for the other parent. Put the income information and income deduction information requested. Make sure you use the correct column for each party.

Income from Benefits: If a parent gets Social Security Disability (SSDI) or workers’ compensation (L&I, or other disability benefits from an employer), put that amount in “Other Income.”

Work-Related Disability Benefits: If a parent gets SSDI, L&I and some employer-paid disability benefits or Social Security retirement, and the child/ren get dependent benefits as a result, the payments they get directly count as income to that parent even if the money actually goes to the other parent or custodian. You should add those amounts under 3A to income of the parent getting benefits. Those benefits should also be credited as child support paid by the parent. The paying parent’s support should go down dollar for dollar by the amount of dependent benefits his/her children get directly for current child support. See RCW 26.18.190; In re Marriage of Maples, 78 Wash. App. 696 (1995).

Deductions from Income: If you include any deductions from income other than income tax, FICA, and L&I payments, you must provide documents proving each deduction.2 Paystubs may show union and pension plan deductions. You must have extra documents (such as pages from a collective bargaining agreement or employee handbook, or a letter from the employer) showing these deductions are required. If pension deductions are voluntary, show documents proving you have had the deduction taken for at least two years, or the court may not allow it. If the other parent disputes your claims, be ready to present business records and receipts showing any business expenses you are claiming. Follow the instructions at the end of the Financial Declaration Form. Attach private financial information to the Financial Source Documents Cover Sheet.

4. Other Income and Household Income.

2 RCW 26.19.071(5).




A. Other income. In the blanks, put the name and amount of any other income (including TANF, SSI, and/or food stamps) a parent gets regularly.

B. Household Income. List the gross monthly income of other adults in the household. That income is not included in calculating the basic child support obligation. The court might consider it if someone asks for a deviation from the standard child support amount.

5. Disputed income. If you think anyone will dispute a parent’s income, state what you believe is the correct amount of that parent’s income. Explain why you believe that is the true amount.

6. Available Assets. List your assets - cash, and things that you own that could easily be sold for cash. (Examples: stocks, bonds, and so on.)

7. Monthly Expenses after Separation. Put your monthly household expenses. Put your best estimate of each expense. Many expenses are not monthly. For those, take the actual amount you pay. Calculate the monthly average. Example: If you pay your car insurance every six months, take the amount you pay, divide it by 6, and put that amount in the blank under 7F.

Your total monthly expenses may end up being more than your net monthly household income. This is especially common for people who are low-income. You may put off paying a certain bill or make other cutbacks in your expenses. Your monthly expenses do not need to be equal to or less than your income. But if your expenses are far more than your income, the court might ask how you are meeting your expenses. Be ready to show how you are doing it.

8. & 9. Section 8 is for giving more details about expenses you already listed in 7.

11. Attorney Fees. If you hire a lawyer for this case, put those expenses here.

Signed at: Put the city/town and state where you are signing this form, and the date. Sign and print where it says to.

C. Sealed Financial Source Documents (Cover Sheet) – FL All Family 011

You must use this form when filing private financial documents with the court. Keep a blank copy of this form in case you need to file more financial documents later. You may attach one form to a stack of documents.

Caption. Fill out the caption.

Check the boxes next to each type of paper you are filing. If you are submitting child support worksheets, the instructions to the child support worksheets say which documents you must file.

If you are afraid for your safety or the children’s safety, you may block out information identifying your location on the copies you file with the court and deliver to the other parties.

Submitted by: Check the box showing which party you are. Sign and print your name.


D. Child Support Order - FL All Family 130

This form sets the amount of child support the parents will pay if the nonparent custodian gets temporary or permanent custody.

The judge3 will sign child support order(s) only if the nonparent wins temporary or permanent custody.

You must prepare a separate order for each parent. If you are filling this out after the judge has made a decision, attach the child support worksheets the judge has approved. 4 If this is a proposed order, attach the child support worksheets you want the judge to approve.

If you want a Default Order, or already have one against the parent this order covers, use the worksheets filed and served with the petition. If you are filling out this form after trial, use the income figures and child support amount the judge ordered.

If any child gets or has gotten public assistance, or is in foster care or out-of-home placement, the attorney for the State of Washington (usually the prosecuting attorney's office) also must sign the child support order(s) and worksheets before the judge will sign them.

Caption. Fill out the caption. Mark whether this order is temporary (entered before your case is over) or final (entered with other final orders at the end of the case).

1. Judgment Summary. Check the first box and skip to 2 if you do not want a judgment for back child support or attorney’s fees5 (or the judge did not award a judgment for back support or attorney fees after hearing).

Check the second box and fill out the table if:

You will use this as a final order with your Non-Parent Final Custody Order OR

One or both parents owes back child support or attorney fees (for temporary or final orders)

Other: Use this blank if you are asking for attorney fees or the court awards them at your hearing/trial,6 or any costs of your legal case (filing fee, service fees, and so on).

Findings and Order.

2. Check the box showing whether this is a temporary or final order.

3 & 4. Read these. Do not make any changes to either section.

3 Court commissioners, not judges, make many decisions in family law cases. In this packet, we just say “judge.” 4 The judge will sign the worksheets s/he approves. 5 Our packet called Filing for Attorney Fees in a Divorce Case has more information, forms and instructions. 6 This packet does not explain how to request attorney’s fees or when the court might allow them. Our packet called Filing for Attorney Fees in a Divorce Case has more information, forms and instructions.

http://www.washingtonlawhelp.org/resource/filing-a-motion-for-attorney-fees-in-a-dissol?ref=FUQ3S

http://www.washingtonlawhelp.org/resource/filing-a-motion-for-attorney-fees-in-a-dissol?ref=FUQ3S


5. Parents’ Income. Put all the info you can. Each parent gets their own column. Use the same numbers as the Child Support Schedule Worksheets.

If a parent has no income, or you do not know what it is, you must impute income to them, unless there is a reason not to. Examples: do not impute income to a parent who is in prison or a long-term drug treatment. Check imputed to this parent and skip to 6 if you impute income.

If this order is based on the judge’s decision at your trial or hearing: Put the income information the judge announced for each parent. Check the box showing whether the judge found this amount was the parent’s imputed or actual income.

6. Imputed Income. Check the first box for a parent and skip to 7 if you are NOT imputing income.

Check This parent’s monthly net income is imputed because and then the boxes below that show why you are imputing income. Pages 2 and 5 of the Washington State Child Support Schedule Definitions and Standards have more information about imputing income.

7. Limits affecting the monthly child support amount. Check the first box and skip to 8 if the following are true:

The child support amount will be 45% of the paying parent’s income or less.

The paying parent’s monthly income is more than 125% of the federal poverty guidelines.

The parents’ combined net income is less than $12,000.

Check the second box and then:

low-income limits if in any of lines 8 of the worksheets, you put that a parent will pay $50 monthly.

the 45% net income limit if the child support amount is more than 45% of the paying parent’s net income.

Combined Monthly Net Income over $12,000 if that is true. Check the box immediately under if the paying parent will pay the advisory amount. Fill out the blank if it is more than the amount the economic table advises.


There are special rules for setting child support when the parents’ combined monthly net income is over $12,000. This packet does not explain those rules. A parent in this situation can probably afford a lawyer. The Washington State Child Support Schedule at page 3 has more information.

8. Standard Calculation. Most people will check all children living together. If this is a proposed order, put in the blank who you want to have custody. Then put the amount listed at line 15(a) or (e) of the worksheets you propose, even if that is not the amount of the transfer payment. If this is an order after hearing/trial, put in the blank who the judge awarded custody. Then put the figure on line 15 (a) or (e) of the worksheets the judge approved.

Residential split: You will not check this box in non-parent custody cases.

9. Deviation from standard calculation. Check No if there will not be a deviation. Then check the reason underneath why there will not be a deviation. Fill out any blanks as needed.

Check yes if you want a deviation or the judge ordered one. Check underneath all the reasons for a deviation. If you check A parent or parents in this case has or The children in this case, you must also check the appropriate indent boxes underneath.

You might check other reasons in the case of, for example, a parent's temporary unemployment to get schooling or training.

10. Monthly child support amount (transfer payment).

Most people will check the first box and put the paying parent’s name in the first blank and the party with the children in the second. You then list the children’s names and ages. If you can calculate the amount of support for each child, list those amounts and the total at the bottom. Otherwise, just put the Total Monthly Transfer Amount on the last line.

If support will be the standard calculation child support amount (not a deviation), the total support amount will be the amount listed at line 17 of the child support worksheets for the party/parties this order covers.

o If there are no special expenses or credits in lines 10-16 of the Worksheets, you can figure out the child support for each child. Multiply the basic support obligation for each child (in the left-hand box at line 5 on the child support worksheets) by the paying person’s


share of income (line 6 of the worksheets). The amounts for each child must add up to the Total Monthly Transfer Amount on the last line.

If there are special expenses or credits in lines 10-16 of the Worksheets, you may not be able to figure out the amount per child.

If you are agreeing to a deviation or the judge ordered one after hearing, write in the blank the amount a parent will pay, after applying the deviation.

11. Starting date and payment schedule. In the blank, put when child support under this order will start. (Usually, the earliest that a new Support Order can become effective is the date the petition was filed and served.) Check the box showing the schedule. Fill out the blanks where needed.

12. Step Increase. Most people will check Does not apply. Check Approved and fill out the blanks if:

this order changes an earlier support order AND

the child support payment will go up by more than 30% AND

you want the payments to go up gradually or agree to this or the judge ordered it

Check Denied if you do not want a gradual increase, or the judge denied the request for a gradual increase.

13. Periodic Adjustment. Most people will check the first box. Then you may adjust or modify this order according to Washington law.

Check the second box if you want the child support amount adjusted periodically, such as every year due to small changes in income (or the judge ordered this). Then check the box/es underneath showing when adjustments should take place. (You must still go back to court to get the adjustment. It will not automatically happen.)

14. Payment Method. Check the first box if

the child has ever gotten public assistance OR

you want the DCS to help collect support

Having DCS collect can be good. If DCS collects for you, it must help you if the parent paying support pays late or stops paying. DCS will have documented proof of the dates and amounts of all payments.

For more information about the differences between enforcement and payment processing services, contact your local DCS office.

DCS Enforcement: Check the boxes that apply.


Other parent or non-parent custodian by: Check this if this is what you want or what the judge ordered after hearing. Check the first box if you want payment made by mail, and put the address where the paying parent should mail payment. Check the second box if you do not want payment by mail, and put in the blank how you want payments made.

If you are concerned about your home address being in a public record, list an address where you can get your legal mail on a regular basis even after the case is finished. If you change your address for legal mail, also give your new address to DCS, the other party and to the court as soon as possible by filing a Notice of Address Change (available at http://www.courts.wa.gov/forms/). If you do not update your address information with the court, the other party, and DCS, you could be served with legal papers at the address you filled in on this form, and orders could be entered without notice to you.

15. Enforcement through income withholding (garnishment). The usual rule is that child support is deducted from the paying parent’s wages and sent to the support registry. Most people will check the first box.

Check the second box and the boxes after it that apply if you want (or the court orders) a special exception. The court must find good cause not to order wage withholding.

You should not be fired because your paycheck is being garnished for child support.7 If your employer threatens to fire you if you are garnished, contact DCS, a lawyer, your local legal services office, or CLEAR at 1-888-201-1014.

16. End date for support. Check the first box if this is a temporary order.

If this is a final order: Most people will check the second box if the children are not yet in high school and are not disabled, , unless the judge has ordered otherwise.

Check the third box if you also checked Reserved or Granted in 17, or the judge ordered one of those after hearing.

Check the fourth box if a child is disabled and will need support even after age 18. In the blank, put the child’s name. Check the box immediately underneath showing when support should end. Fill out the blanks as appropriate.

Child support usually ends when the child turns 18 years old or completes secondary (high school) education, whichever happens later. Check other if you want child support to end at some other time, or the court orders this. Write in when support will end.

17. Post-secondary educational support (for college or vocational school).

7 RCW 26.18.110(8).

http://www.courts.wa.gov/forms/



Check Reserved if you want the court to decide later, but before the child support obligation ends, whether a parent should pay post-secondary support, or the judge reserved this decision after hearing. You might want to do this if, for example, the child is too young for you to know what her needs after high school will be, or the child’s plans are not yet certain.

Check Granted if you want a parent to pay post-secondary support, or the judge ordered this. Check the first box immediately underneath if you want the judge to decide the amount later, or the judge decided to do this later. (Example: You want the judge to order both parents to pay for college but the child is not going to college soon.)

Check the second box immediately underneath if you want the court to decide the amount now. In the blank, put the amount you want or that the judge ordered.

Check Denied if someone asked for post-secondary support but you do not want the court to order it, OR the court denied the request.

Check Other to describe any agreement you and the other parent have made about post-secondary support, or to add specifics from the judge’s ruling.

18. Claiming children as dependents on tax forms. If you are the non-parent custodian, you should ask for and expect to be awarded the tax exemption for the children, unless you want to make other arrangements with the other parties. Check the second box, and then the first box immediately underneath. In the first blank, put your name. In the second blank, put the children’s names.

If you want a noncustodial parent to claim the exemptions part of the time, you should still check the second box. Then check the boxes showing what arrangement you want. Check other. In the blank, put “a parent may claim an exemption at the times stated above only if the s/he has fully paid all child support, daycare, and uninsured medical expenses that are owed as of December 31st of the relevant tax year.” That way, if s/he does not pay support payments on time, s/he cannot take the exemption.

Parents: If you do not have custody, you must sign an IRS form 8332 saying who gets the tax exemptions.

19. Health Insurance. Check the first box and skip to 20 if true in your case.

Otherwise, check the second box. Put the name of the parent who you want to or agree will pay the premium, or who the judge ordered will do so. Put the name of the parent who you want to or agree will pay the premium, or who the judge ordered will do so. Then check the boxes underneath and fill out blanks where needed showing what the other parent’s insurance obligation is.

20. Health insurance if circumstances change or court has not ordered. Do not make any changes to this section.

21. Children’s expenses not included in the monthly child support amount.


Uninsured medical expenses: In each blank at the top of the chart, put a parent’s name. Then check proportional share and put that parent’s share of uninsured expenses from the worksheets at line 6 in the blank, unless the court orders a different amount. If that happens, check the box under proportional share and put what the judge ordered.

Other shared expenses: Check does not apply if that is what you want, or what the judge ordered. Otherwise, check the second box. In the chart, check the children’s expenses for whatever you want the order to cover or whatever the judge ordered. Then follow the instructions in uninsured medical expenses above for filling out the chart.

22. Past due child support, medical support and other expenses. Check the first box and skip to 23 if you do not want the judge to decide about pas child support or interest.

Check the second box if you want an order stating that neither parent owes any back amounts, or the judge ordered this. Then put the date the judge will sign this order, and check all the boxes that apply.

Check the second box only if you know a paying parent owes no back child support, or the judge ordered this. If you check the first box, a paying parent could be excused from paying any back support owed.

Check money judgments if you want the judge to award back support OR the judge did this after hearing. Then fill out the chart with the info requested.

In from and to, put the dates the support is owed for.

23. Overpayment caused by change. Check does not apply and skip to 24 if this is true in your case, or the judge ordered this.

Check the second box if you are asking for a custody order that would cause someone to have overpaid child support, or the judge made an order that did this. Fill out the rest of the section with the info requested.

24. Other Orders. The judge may use this.

Ordered. LEAVE THIS FOR THE JUDGE.

Petitioner and Respondent or their lawyers fill out below: You should check presented by me in the column for you (Petitioner or Respondent). You should also check whichever other boxes in your column apply to you. You should sign and print your name and the date where indicated.

If any parent or child received government assistance: You must have an assistant prosecutor who handles support cases in this county fill out and sign this section.8

8 If the child has ever gotten public assistance (TANF) or Medicaid, or is in foster care or out-of-home placement,

and the lawyer for DCS will not sign the child support order, you must schedule a court hearing to present the order

to the judge for signature. Give the other parties advance notice of the hearing. This packet does not explain how to

do that.


Parent or Non-Parent Custodian applies for DCS enforcement services: Check this, and sign and print your name and the date if you want this. Having DCS collect can be good. If DCS collects for you, it must help you if the parent paying support pays late or stops paying. DCS will have documented proof of the dates and amounts of all payments.

For more information about the differences between enforcement and payment processing services, contact your local DCS office.

E. Residential Schedule – FL Non-Parent 405

Re-read the intro to Section 3 about when to use a residential schedule, and the warning to respondents.

Before you start, make extra copies of the Residential Schedule form. You may need three or more versions of your residential schedule. You may need:

a proposed final residential schedule to file with your petition or your Response

a proposed temporary residential schedule to file with a motion for temporary or immediate restraining orders or with your response to the motion

a final residential schedule to file with other final documents to finish the case

If you plan to ask for the same residential schedule as a proposed temporary residential schedule and a proposed final residential schedule, save yourself some work. Make copies of the form after filling most of it out. Fill out the entire residential schedule, except for section 1. Do not sign the residential schedule until you have made copies and added the missing information. Make several copies. Then check the appropriate boxes under the title and caption.

If this is a proposed residential schedule (either temporary or final), fill out the schedule the way you want the judge to order it. Your proposed residential schedule may not become a court order. It depends how the case goes. You may agree to a different residential schedule in order to reach an agreement with the other parties. The case may go to trial and the court may order a different residential schedule.

Read the instructions carefully. Take your time. If you need hands-on help, your county may have a family law facilitator who can give more information or help with problem spots in the forms.

Caption. Fill out the caption.

Read through the instructions. Use only the instructions that apply to you.

1. This Residential Schedule is. Check Proposal if you are filing this residential schedule with your Petition or Response. In the blank, put your name.

Check Court order if this is an order the court will sign. Then check the box showing whether it is a temporary or final residential schedule.


2. Custody. Put the name(s) and age(s) of the minor child/ren whose custody the court is deciding.

3. Reasons for limiting a parent’s visitation. If you are a Petitioner: Use this section to show whether the judge should limit or restrict a parent’s time with the child/ren, and why.

In (a), at (parent’s name), put one parent’s name.

Check the first box and skip to 3b if neither that parent nor a person living with him/her has any of the problems listed in (a).This shows there is no reason to restrict or prohibit that parent’s time with the children.

Check the second box if that parent or someone living with him/her has done any of the behavior listed in (a), and you believe that behavior is harmful to the child/ren (or the court found it was). Check all the boxes underneath that apply. If you check other, put the other reasons that parent’s contact with the children should be limited.

Use (b) to put the info about the other parent.

If you are a parent, use (a) for yourself and (b) for the other parent. At (parent’s name), put your name. Check the first box if there is no reason to restrict or prohibit your contact with the child/ren. Use (b) for the other parent.

4. Limitations on visitation.

Some people find this section confusing. Try to talk to a lawyer or your family law facilitator for help with this section.

If you checked boxes in section 3 showing why the court should limit a parent’s time with the child/ren, the residential schedule usually should show those restrictions for that parent. This is where you will put any specific conditions or limitations on a parent’s time with the children needed for the children’s safety. This part of the schedule is very specific. You do not have to be that specific, but a specific schedule helps stability and planning.

a. Put the name of the same parent as 3a. Check the first box and skip to 4b if you did not check anything in 3a for this parent.

Check the second box if you checked anything in 3a. Then check the boxes underneath that apply.

If you check limited visitation as shown in the parents’ visitation schedule (5 – 8) below, you must fill out 5 - 8, too.

If you check limited visitation as follows, fill out the blank and then skip 5 – 8.

Check supervised visitation if you want it (or the judge ordered this). In the blank, put who will pay supervision costs. Usually this will be one or both of the parties getting the supervised visits. Check the box showing whether it will be a professional or non-professional supervisor. In either case, in the blank following, put the supervisor’s name. The supervisor must be someone who will protect the children’s safety. Examples: a trusted adult, or a professional visitation supervisor.

The court will not appoint someone who does not want to supervise.


Under the dates and times of supervised contact will be, check the first box and then fill out 5 – 8 if you want a detailed visitation schedule, or the judge has ordered one. Otherwise, check the second box and put the time s and length of visitations. Those times and lengths must be consistent with availability of a supervisor. (Example: a visit that lasts an entire weekend is hard to supervise.) Check other limitations if you want a respondent to follow certain rules for the visit to happen, or if the judge ordered this. See our section called some suggested restrictions below.

Evaluation or treatment required. Check the box next to this if it applies. Then check all the boxes immediately underneath that apply. See our section called “some suggestions for restrictions” below.

No limitations despite reasons. Check this if you want it or the judge ordered it. Then underneath check the reason you do not want it or the judge ordered it.

If a problem must be addressed before a respondent can have visitation or no restrictions, explain what is needed to prove that the need for the restriction has ended and who makes that decision. Example: The judge restricts visitation because a mental health problem affecting parenting. Respondent will have supervised visitation until addressing the problem. What happens if Respondent gives Petitioner a letter from her provider stating she has successfully completed treatment? If the custodian believes the problem still exists, or is not sure, who decides if the reason for the restriction has ended?

Some suggested restrictions: Here are some areas of possible restrictions on visitation. This list is not complete. You can change or add to the items here based on the child/ren’s needs and the parties’ circumstances.

Drug and Alcohol Abuse: The judge may require a parent to successfully complete drug and alcohol treatment to address a substance abuse problem before unsupervised – or, in some cases, any - visits happen. You could specify the nature of the treatment program required, such as “approved and certified by the State of Washington,” or name a specific treatment program. You could just put “a drug/alcohol treatment program approved by the court.” The court might make a parent show continuing regular participation in a twelve-step program a condition of visitation. The court could require a parent to have random urinalyses or other appropriate drug tests. You could end or make visitation supervised if a parent tests positive for drug/alcohol use. The court could order a parent not to consume alcohol/non-prescription drugs within 24 hours before a visit, and/or at any time during a visit. The court could order other restrictions, such as prohibiting that parent from driving with the children.

Neglect: You could ask for supervised visits until a parent has successfully completed a parenting skills program before asking the court to lift the supervision requirement. You could specify a certain parenting program, or you could make the parent get advance court approval for a program. You could require a professional visitation supervisor to report to the court after a certain number of visits have taken place, so the court can determine whether unsupervised visits can begin.

Domestic Violence: The judge could order a parent to have supervised no visits unless s/he is appropriately evaluated for and, if recommended, successfully completes a state-certified


batterer’s treatment program. The judge could require the parent to follow all the batterer’s treatment program recommendations and to provide the custodian and court written updates of progress. The judge may order the immediate suspension of any unsupervised visits if a parent commits further acts or threats of domestic violence.

Mental health issues: The judge could order that, as a condition to visitation, a parent must continue mental health treatment, and that the parent’s counselor send Petitioner a letter every six months stating whether the parent is keeping up treatment.

Conditions to Lift Restrictions: After stating restrictions, you can explain conditions for reducing or ending the restrictions. Here are some alternatives:

1. The restrictions are in place until a parent provides Petitioner sufficient written proof of successful completion of the requirements in the residential schedule (examples: certified batterer’s treatment program, drug treatment program).

2. A parent who wants to go back to court to ask for changes in visitation or a reduction in restrictions must have completed the required treatment and provided the custodian and court verification of completion. S/he must also show the judge the requested changes are in the children’s best interests.

3. The judge could order that a parent’s counseling/mental health treatment provider or a counselor chosen by the petitioner recommend what visitation is in the children’s best interests.

Criminal charges: The judge could order that a parent who has been convicted of domestic violence or substance abuse complete all terms and conditions of any sentence or pre-release conditions before asking for changes in visitation. A court could order the suspension of visits for a parent who violates parole/probation conditions.

Removal of Child/ren from the State: You could put section 4 that a respondent may not remove the child/ren from the State of Washington without written the nonparent custodian’s consent. Example of an exception: if the parties already agree that the respondent will be taking the child to another state for an annual family reunion.

Abusive Use of Conflict: You could prohibit a parent from discussing the case with the child/ren, questioning the child/ren about the other parties or their activities, or trying to get information to find another party (if that address is confidential).

Phone Visitation: In cases where in-person visitation is not safe (even when supervised) or where a parent lives too far away for regular travel, you could schedule phone visitation. Write in why phone visitation is more appropriate than in-person visitation. Write in the phone schedule and who will make the calls. If in-person visitation is unsafe, write that the phone visitation is the only contact allowed between this parent and the child/ren. For phone visits, make sure any times you list in section 4 are consistent with the reasonable length of phone conversations.

Parents’ Visitation Schedule

Check the first box under this title and skip to 10 if the parents will not have visitation. Otherwise, check the second box.


5. School Schedule.

(a) Children under School-Age: Check the first box and skip to “b” if all the children are in school already.

Check the second box if any of the children are not yet in school (usually age birth through five years) AND you want it to be the same as the schedule in “b” for school-age children.

Check the third box if any of the children are not yet in school AND you want a different schedule for them than the schedule in “b” for school-age children. Fill out this section. Put the first parent’s name in the first Parent (name) blank. Then check all the boxes underneath that apply and fill out blanks where needed. Fill out the second section that starts with Parent (name) for the other parent.

“Every other week” is not the same as the “first and third week.” There are sometimes five weeks in a month.

If you do not know exact days and times of visitation yet because of circumstances imposed by restrictions listed in section 4, check the “other” box. Write in, “as provided in Section 4. Example: you put in section 4 a set length for visits, but also that visits will be supervised and take place at times a professional supervisor is available.

(b) School-Age Children:

You must fill out this section even if none of the children is yet in school. You will use it when they are school age.

Check the boxes showing when the school schedule will start. Then follow the instructions for (a) for showing what visitation each parent will have.

6. Summer Schedule:

This section generally is for children who have started school. To apply it to younger children, check The Summer Schedule is different than the School Schedule. Then check the boxes showing when you want it to start.

Check “The Summer Schedule is the same as the school schedule” to follow the same schedule in the summer as during the school year.

Check “The Summer Schedule is the same as the school schedule except that” if you do not want to put specific dates for the summer schedule in this order. You can use this section to propose that one or both respondents notify the Non-Parent custodian by a certain date of the time they request for that summer.

Check “The Summer Schedule is different than the School Schedule” if you will have a summer schedule that is different from school year visitation. Check the boxes showing when this schedule will start.

Fill out each section that starts with Parent (name) using the instructions for 5(a) for showing what visitation each parent will have.


Other: You can use this section to provide for phone contact with the custodian during long times with a respondent. Example: You can state that the children shall have phone contact with the custodian at least twice a week during vacations spent with the father.

7. Holiday Schedule.

You do not need to give specific time on the holidays. You can if you want to. Examples: Christmas Day often begins early in the morning. On the 4th of July, a party might watch the fireworks late at night with the child.

Check the first box if the holiday schedule will be the same as the school schedule Skip to 8.

Check the second box if there will be a Holiday Schedule. Check the box showing which children it will apply to. Then fill out the table. Put each parent’s name in a Children with (name) column. Check the boxes showing which parent has the children which holidays, when, for how long, and whatever else applies.

Use the last boxes, Other occasion important to the family, if there are special religious or cultural holidays you want to include.

You may rotate years (specify “even” or “odd”) or keep the same schedule for every year, depending on the case and the needs of the children, and any reason for limiting/restricting/prohibiting contact.

You may be specific about the times of day. You may also change this from holiday to holiday. Example: “New Year’s Day with Non-Parent custodian, except with mother from 10 a.m. until 4 p.m.”

8. Conflicts in Scheduling. This governs what happens when parts of the residential schedule conflict, like when a holiday visit conflicts with a weekend visit. Check all the boxes showing what you want. Check other box to write your own priorities OR if the parents’ visitation is so restricted that it does not conflict with the time the child/ren will be with the Non-Parent custodian.

9. Transportation Arrangements. In the first section, check the box showing where you will exchange the children for visits. In the second section, check the box showing who will drive the children back and forth for visits with each respondent.

Use the other section to

List anyone who cannot drive the children.

Require any person providing transportation for visits to have a valid driver’s license and current and adequate insurance, and to show the custodian proof of both if requested.

Require that the child/ren be transported using age-appropriate safety restraints in the vehicle as required by law.


State a neutral place to drop the child/ren off and pick them up. This is usually a public place, like a local McDonalds or park. Courts often order this in cases of conflict.

You should write any arrangements for the cost of transportation in the Child Support Order.

10. Moving with the Children (Relocation). This section explains the laws that apply when a child’s custodian wants to relocate (move) with the child. Do not make any changes to this section.

11. Other. Put any other rules here you would like but did not list earlier, or that the judge ordered. Examples: denying access to school or medical records, being able to go to or get notice of school or extra-curricular events (sports, church events, music recitals, and so on), or phone contact. Other items may include:

Suspending visitation for lack of participation: The residential schedule could state that a parent who does not go to a certain number of visits in a row without reasonable explanation could lose visitation until further court order.

Reintegration: In cases of no or restricted visitation, the residential schedule could state that any future increases in visitation or any reduction of restrictions would be gradually phased in over months, taking into effect the children’s needs and comfort level.

Location of visits: The residential schedule could require a parent to keep petitioner informed of the location of the visits.

If you are a parent writing a proposed residential schedule and you object to Petitioner having custody, put in this section, “I ask the court to deny Petitioner’s request for custody. I propose this Residential Schedule only if the court awards Petitioner custody over my objection.”

Here is some sample language for still other rules:

Phone Calls: Each parent may call the children at reasonable times.

Address and Phone Numbers: The parties will keep each other advised of their current addresses and phone numbers.

School and Activities: All parties may attend school, sports, and other activities of the children, even if the event is not during that party’s usual residential time.

Canceling Visits or Scheduling Make-up Visits: You may require a party to notify the other several hours in advance if a visit cannot take place. You may write in a plan for make-up visitation in the event of a legitimately missed visit. You may state how long the child/ren and custodian need to wait if a parent does not arrive on time for a visit.

Ending the Non-Parent Final Custody Order: The judge may order or the parties may agree that the child will return to a parent’s custody if certain events happen. Any such provision should go in this part of the residential schedule.


When you have finished filling out the residential schedule, read through it several times. Make sure you understand it. If it is your proposed residential schedule, make sure it includes everything you want the court to order. If it is the residential schedule that is ordered by the court after a hearing or trial, make sure it includes everything that the judge ordered.

12. Proposal. Check the first box and skip to 13 if you are writing this residential schedule as a court order.

Check the second box if this is a proposed residential schedule. Sign and put the date and place.

13. Court Order. Check the first box if this is a proposed order.

Check the second box if you are writing this residential schedule as a court order. LEAVE THE REST OF THIS S FOR THE JUDGE.

If this is a court order, the parties and/or their lawyers and any GAL sign below:

You should check is presented by me in the appropriate column (Petitioner on the left, Respondent on the right). Then you should sign and print your name, and put the date.

If you are a respondent, you would not normally prepare a final residential schedule (or a temporary residential schedule after hearing), because the schedule places the child with the non-parent custodian. If you resolve the case by agreement for the petitioner to have custody, the petitioner should prepare the final residential schedule. The only time you, as a respondent, might prepare a final residential schedule is if there was a trial, the court awarded custody to the nonparent, and now you have a dispute with the petitioner about exactly what visitation, contact, or information the judge ordered you to have with the child/ren. Then you would fill out this schedule as an alternative to the nonparent custodian’s proposed schedule for the judge.

If you go to trial and the judge denies the petition, you do not use the residential schedule in finalizing the case. See the packet Finalizing Your Non-Parent Custody Case.

Section 5: Blank Forms

The rest of this packet has blank forms for you to complete using the instructions and sample form. Make a copy of each form so that you have an extra in case your first draft needs lots of changes. You will need forms from other packets. You may not need all the forms in this packet.




The Washington Administrative Office of the Courts also has Microsoft Word and PDF versions of many of these forms available on their web site at http://www.courts.wa.gov/forms/.

http://www.courts.wa.gov/forms/

WSCSS-Worksheets - Mandatory (CSW/CSWP) 05/2016 Page 1 of 5

Washington State Child Support Schedule Worksheets

Proposed by (name) ___________________ State of WA Other _______________. (CSWP) Or, Signed by the Judicial/Reviewing Officer. (CSW)

County Case No.

Child/ren and Age/s:

Parents’ names: (Column 1) (Column 2)

Column 1 Column 2

Part I: Income (see Instructions, page 6)

1. Gross Monthly Income

a. Wages and Salaries $ $

b. Interest and Dividend Income $ $

c. Business Income $ $

d. Maintenance Received $ $

e. Other Income $ $

f. Imputed Income $ $

g. Total Gross Monthly Income (add lines 1a through 1f) $ $

2. Monthly Deductions from Gross Income a. Income Taxes (Federal and State) $ $

b. FICA (Soc. Sec.+ Medicare)/Self-Employment Taxes $ $

c. State Industrial Insurance Deductions $ $

d. Mandatory Union/Professional Dues $ $

e. Mandatory Pension Plan Payments $ $

f. Voluntary Retirement Contributions $ $

g. Maintenance Paid $ $

h. Normal Business Expenses $ $

i. Total Deductions from Gross Income (add lines 2a through 2h)

$

$

3. Monthly Net Income (line 1g minus 2i) $ $

4. Combined Monthly Net Income (add both parents’ monthly net incomes from line 3)

$

5. Basic Child Support Obligation (enter total amount in box )

Child #1 _________ Child #3 __________ Child #5 __________ Child #2 _________ Child #4 __________

$


Column 1 Column 2

6. Proportional Share of Income (divide line 3 by line 4 for each parent)

.

.

Part II: Basic Child Support Obligation (see Instructions, page 7)

7. Each Parent’s Basic Child Support Obligation without consideration of low income limitations. (Multiply each number on line 6 by line 5.)

$

$

8. Calculating low income limitations: Fill in only those that apply.

Self-Support Reserve: (125% of the Federal Poverty Guideline.) $

a. Is Combined Net Income Less Than $1,000? If yes, for each parent enter the presumptive $50 per child. $ $

b. Is Monthly Net Income Less Than Self-Support Reserve? If yes, for that parent enter the presumptive $50 per child. $ $

c. Is Monthly Net Income equal to or more than Self-Support Reserve? If yes, for each parent subtract the self-support reserve from line 3. If that amount is less than line 7, enter that amount or the presumptive $50 per child, whichever is greater. $ $

9. Each parent’s basic child support obligation after calculating applicable limitations. For each parent, enter the lowest amount from line 7, 8a - 8c, but not less than the presumptive $50 per child. $ $

Part III: Health Care, Day Care, and Special Child Rearing Expenses (see Instructions, page 8)

10. Health Care Expenses

a. Monthly Health Insurance Premiums Paid for Child(ren) $ $

b. Uninsured Monthly Health Care Expenses Paid for Child(ren) $ $

c. Total Monthly Health Care Expenses (line 10a plus line 10b) $ $

d. Combined Monthly Health Care Expenses (add both parents’ totals from line 10c)

$

11. Day Care and Special Expenses

a. Day Care Expenses $ $

b. Education Expenses $ $

c. Long Distance Transportation Expenses $ $

d. Other Special Expenses (describe) $ $

$ $

$ $

$ $

e. Total Day Care and Special Expenses

(add lines 11a through 11d)

$

$

12. Combined Monthly Total Day Care and Special Expenses (add

both parents’ day care and special expenses from line 11e)

$

13. Total Health Care, Day Care, and Special Expenses (line 10d plus line 12)

$

14. Each Parent’s Obligation for Health Care, Day Care, and Special Expenses (multiply each number on line 6 by line 13)

$

$

Part IV: Gross Child Support Obligation

15. Gross Child Support Obligation (line 9 plus line 14) $ $


Column 1 Column 2

Part V: Child Support Credits (see Instructions, page 9)

16. Child Support Credits

a. Monthly Health Care Expenses Credit $ $

b. Day Care and Special Expenses Credit $ $

c. Other Ordinary Expenses Credit (describe)

$

$

d. Total Support Credits (add lines 16a through 16c) $ $

Part VI: Standard Calculation/Presumptive Transfer Payment (see Instructions, page 9)

17. Standard Calculation (line 15 minus line 16d or $50 per child whichever is greater) $ $

Part VII: Additional Informational Calculations

18. 45 % of each parent’s net income from line 3 (.45 x amount from line 3 for each parent) $ $

19. 25% of each parent’s basic support obligation from line 9 (.25 x amount from line 9 for each parent) $ $

Part VIII: Additional Factors for Consideration (see Instructions, page 9)

20. Household Assets (List the estimated present value of all major household assets.)

a. Real Estate $ $

b. Investments $ $

c. Vehicles and Boats $ $

d. Bank Accounts and Cash $ $

e. Retirement Accounts $ $

f. Other (describe) $ $

$ $

21. Household Debt

(List liens against household assets, extraordinary debt.)

$ $

$ $

$ $

$ $

$ $

22. Other Household Income

a. Income Of Current Spouse or Domestic Partner

(if not the other parent of this action)

Name __________________________________________

Name __________________________________________

$

$

$

$

b. Income Of Other Adults In Household

Name __________________________________________

Name __________________________________________

$

$

$

$


Column 1 Column 2

c. Gross income from overtime or from second jobs the party is asking the court to exclude per Instructions, page 8

_________________________________________________

$

$

d. Income Of Child(ren) (if considered extraordinary)

Name __________________________________________

Name __________________________________________

$

$

$

$

e. Income From Child Support

Name __________________________________________

Name __________________________________________

$

$

$

$

f. Income From Assistance Programs

Program ________________________________________

Program ________________________________________

$

$

$

$

g. Other Income (describe)

________________________________________________

________________________________________________

$

$

$

$

23. Non-Recurring Income (describe)

_________________________________________________

_________________________________________________

$

$

$

$

24. Child Support Owed, Monthly, for Biological or Legal Child(ren)

Name/age: _____________________________ Paid [ ] Yes [ ] No $ $



25. Other Child(ren) Living In Each Household

(First name(s) and age(s))

26. Other Factors For Consideration


Other Factors for Consideration (continued) (attach additional pages as necessary)

Signature and Dates

I declare, under penalty of perjury under the laws of the State of Washington, the information contained in these Worksheets is complete, true, and correct.

Parent’s Signature (Column 1) Parent’s Signature (Column 2) Date City Date City

________________________________________ _______________________________________ Judicial/Reviewing Officer Date

This worksheet has been certified by the State of Washington Administrative Office of the Courts.

Photocopying of the worksheet is permitted.

WASHINGTON STATE

CHILD SUPPORT SCHEDULE

Including:

Definitions and Standards

Instructions

Economic Table

Worksheets

Effective Dates:

Definitions & Standards July 24, 2015

Instructions - only August 26, 2013

Economic Table October 1, 2009

Worksheets July 24, 2015

Order forms--voice mail telephone number (360) 705-5328

Internet--download forms: http://www.courts.wa.gov/

Questions about the Instructions or Worksheets? Contact: Merrie Gough

Tel. (360) 357-2128 Fax (360) 956-5794

E-mail [email protected] or [email protected]

Child Support Hotline, State DSHS, 1 (800) 442-KIDS

WSCSS-Schedule 07/2015 Page 1

WASHINGTON STATE CHILD SUPPORT SCHEDULE

DEFINITIONS AND STANDARDS

Definitions Unless the context clearly requires otherwise, these definitions apply to

the standards following this section. RCW 26.19.011.

Basic child support obligation: means the monthly child support

obligation determined from the economic table based on the parties’

combined monthly net income and the number of children for whom

support is owed.

Child support schedule: means the standards, economic table,

worksheets and instructions, as defined in chapter 26.19 RCW.

Court: means a superior court judge, court commissioner, and presiding

and reviewing officers who administratively determine or enforce child

support orders.

Deviation: means a child support amount that differs from the standard

calculation.

Economic table: means the child support table for the basic support

obligation provided in RCW 26.19.020.

Instructions: means the instructions developed by the Administrative

Office of the Courts pursuant to RCW 26.19.050 for use in completing

the worksheets.

Standards: means the standards for determination of child support as

provided in chapter 26.19 RCW.

Standard calculation: means the presumptive amount of child support

owed as determined from the child support schedule before the court

considers any reasons for deviation.

Support transfer payment: means the amount of money the court orders

one parent to pay to another parent or custodian for child support after

determination of the standard calculation and deviations. If certain

expenses or credits are expected to fluctuate and the order states a

formula or percentage to determine the additional amount or credit on an

ongoing basis, the term “support transfer payment” does not mean the

additional amount or credit.

Worksheets: means the forms developed by the Administrative Office of

the Courts pursuant to RCW 26.19.050 for use in determining the

amount of child support.

Application Standards

1. Application of the support schedule: The child support schedule

shall be applied:

a. in each county of the state;

b. in judicial and administrative proceedings under titles 13,

26 and 74 RCW;

c. in all proceedings in which child support is determined or

modified;

d. in setting temporary and permanent support;

e. in automatic modification provisions or decrees entered

pursuant to RCW 26.09.100; and

f. in addition to proceedings in which child support is

determined for minors, to adult children who are

dependent on their parents and for whom support is

ordered pursuant to RCW 26.09.100.

The provisions of RCW 26.19 for determining child support and

reasons for deviation from the standard calculation shall be

applied in the same manner by the court, presiding officers and

reviewing officers. RCW 26.19.035(1).

2. Written findings of fact supported by the evidence: An order for

child support shall be supported by written findings of fact upon

which the support determination is based and shall include

reasons for any deviation from the standard calculation and

reasons for denial of a party’s request for deviation from the

standard calculation. RCW 26.19.035(2).

3. Completion of worksheets: Worksheets in the form developed

by the Administrative Office of the Courts shall be completed

under penalty of perjury and filed in every proceeding in which

child support is determined. The court shall not accept

incomplete worksheets or worksheets that vary from the

worksheets developed by the Administrative Office of the

Courts. RCW 26.19.035(3).

4. Court review of the worksheets and order: The court shall

review the worksheets and the order setting child support for the

adequacy of the reasons set forth for any deviation or denial of

any request for deviation and for the adequacy of the amount of

support ordered. Each order shall state the amount of child

support calculated using the standard calculation and the amount

of child support actually ordered. Worksheets shall be attached

to the decree or order or if filed separately, shall be initialed or

signed by the judge and filed with the order. RCW 26.19.035(4).

Income Standards

1. Consideration of all income: All income and resources of each

parent’s household shall be disclosed and considered by the court

when the court determines the child support obligation of each

parent. Only the income of the parents of the children whose

support is at issue shall be calculated for purposes of calculating

the basic support obligation. Income and resources of any other

person shall not be included in calculating the basic support

obligation. RCW 26.19.071(1).

2. Verification of income: Tax returns for the preceding two years

and current paystubs shall be provided to verify income and

deductions. Other sufficient verification shall be required for

income and deductions which do not appear on tax returns or

paystubs. RCW 26.19.071(2).

3. Income sources included in gross monthly income: Monthly

gross income shall include income from any source, including:

salaries; wages; commissions; deferred compensation; overtime,

except as excluded from income in RCW 26.19.071(4)(h);

contract-related benefits; income from second jobs except as

excluded from income in RCW 26.19.071(4)(h); dividends;

interest; trust income; severance pay; annuities; capital gains;

pension retirement benefits; workers’ compensation;

unemployment benefits; maintenance actually received; bonuses;

social security benefits; disability insurance benefits;


and income from self-employment, rent, royalties, contracts,

proprietorship of a business, or joint ownership of a partnership

or closely held corporation. RCW 26.19.071(3).

Veterans’ disability pensions: Veterans’ disability pensions or

regular compensation for disability incurred in or aggravated by

service in the United States armed forces paid by the Veterans’

Administration shall be disclosed to the court. The court may

consider either type of compensation as disposable income for

purposes of calculating the child support obligation. See RCW

26.19.045.

4. Income sources excluded from gross monthly income: The

following income and resources shall be disclosed but shall not

be included in gross income: income of a new spouse or

domestic partner or income of other adults in the household;

child support received from other relationships; gifts and prizes;

temporary assistance for needy families; Supplemental Security

Income; general assistance; food stamps; and overtime or income

from second jobs beyond forty hours per week averaged over a

twelve-month period worked to provide for a current family’s

needs, to retire past relationship debts, or to retire child support

debt, when the court finds the income will cease when the party

has paid off his or her debts. Receipt of income and resources

from temporary assistance for needy families, Supplemental

Security Income, general assistance and food stamps shall not be

a reason to deviate from the standard calculation. RCW

26.19.071(4).

VA aid and attendant care: Aid and attendant care payments to

prevent hospitalization paid by the Veterans Administration

solely to provide physical home care for a disabled veteran, and

special compensation paid under 38 U.S.C. Sec. 314(k) through

(r) to provide either special care or special aids, or both to assist

with routine daily functions shall be disclosed. The court may

not include either aid or attendant care or special medical

compensation payments in gross income for purposes of

calculating the child support obligation or for purposes of

deviating from the standard calculation. See RCW 26.19.045.

Other aid and attendant care: Payments from any source, other

than veterans’ aid and attendance allowance or special medical

compensation paid under 38 U.S.C. Sec. 314(k) through (r) for

services provided by an attendant in case of a disability when the

disability necessitates the hiring of the services or an attendant

shall be disclosed but shall not be included in gross income and

shall not be a reason to deviate from the standard calculation.

RCW 26.19.055.

5. Determination of net income: The following expenses shall be

disclosed and deducted from gross monthly income to calculate

net monthly income: federal and state income taxes (see the

following paragraph); federal insurance contributions act

deductions (FICA); mandatory pension plan payments;

mandatory union or professional dues; state industrial insurance

premiums; court-ordered maintenance to the extent actually paid;

up to five thousand dollars per year in voluntary retirement

contributions actually made if the contributions show a pattern of

contributions during the one-year period preceding the action

establishing the child support order unless there is a

determination that the contributions were made for the purpose

of reducing child support; and normal business expenses and

self-employment taxes for self-employed persons. Justification

shall be required for any business expense deduction about

which there is a disagreement. Items deducted from gross

income shall not be a reason to deviate from the standard

calculation. RCW 26.19.071(5).

Allocation of tax exemptions: The parties may agree which

parent is entitled to claim the child or children as dependents for

federal income tax exemptions. The court may award the

exemption or exemptions and order a party to sign the federal

income tax dependency exemption waiver. The court may divide

the exemptions between the parties, alternate the exemptions

between the parties or both. RCW 26.19.100.

6. Imputation of income: The court shall impute income to a parent

when the parent is voluntarily unemployed or voluntarily

underemployed. The court shall determine whether the parent is

voluntarily underemployed or voluntarily unemployed based

upon that parent’s work history, education, health and age or any

other relevant factors. A court shall not impute income to a

parent who is gainfully employed on a full-time basis, unless the

court finds that the parent is voluntarily underemployed and finds

that the parent is purposely underemployed to reduce the parent’s

child support obligation. Income shall not be imputed for an

unemployable parent. Income shall not be imputed to a parent to

the extent the parent is unemployed or significantly

underemployed due to the parent’s efforts to comply with court-

ordered reunification efforts under chapter 13.34 RCW or under

a voluntary placement agreement with an agency supervising the

child. In the absence of records of a parent’s actual earnings, the

court shall impute a parent’s income in the following order of

priority:

(a) Full-time earnings at the current rate of pay;

(b) Full-time earnings at the historical rate of pay based on

reliable information, such as employment security

department data;

(c) Full-time earnings at a past rate of pay where information is

incomplete or sporadic;

(d) Full-time earnings at minimum wage in the jurisdiction

where the parent resides if the parent has a recent history of

minimum wage earnings, is recently coming off public

assistance, general assistance-unemployable, supplemental

security income, or disability, has recently been released

from incarceration, or is a high school student;

(e) Median net monthly income of year-round full-time workers

as derived from the United States bureau of census, current

population reports, or such replacement report as published

by the bureau of census. (See “Approximate Median Net

Monthly Income” table on page 6.)

RCW 26.19.071(6).

Allocation Standards

1. Basic child support: The basic child support obligation derived

from the economic table shall be allocated between the parents

based on each parent’s share of the combined monthly net

income. RCW 26.19.080(1).

2. Health care expenses: Health care costs are not included in the

economic table. Monthly health care costs shall be shared by the

parents in the same proportion as the basic support obligation.

Health care costs shall include, but not be limited to, medical,


dental, orthodontia, vision, chiropractic, mental health treatment,

prescription medications, and other similar costs for care and

treatment. RCW 26.19.080(2).

3. Day care and special child rearing expenses: Day care and

special child rearing expenses, such as tuition and long distance

transportation costs to and from the parents for visitation

purposes, are not included in the economic table. These

expenses shall be shared by the parents in the same proportion as

the basic child support obligation. RCW 26.19.080(3).

4. The court may exercise its discretion to determine the necessity

for and the reasonableness of all amounts ordered in excess of

the basic child support obligation. RCW 26.19.080(4).

Limitations Standards

1. Limit at 45 percent of a parent’s net income:

Neither parent’s child support obligation owed for all his or her

biological or legal children may exceed 45 percent of net income

except for good cause shown.

a. Each child is entitled to a pro rata share of the income

available for support, but the court only applies the pro rata

share to the children in the case before the court.

b. Before determining whether to apply the 45 percent

limitation, the court must consider the best interests of the

child(ren) and the circumstances of each parent. Such

circumstances include, but are not limited to, leaving

insufficient funds in the custodial parent’s household to

meet the basic needs of the child(ren), comparative hardship

to the affected households, assets or liabilities, and any

involuntary limits on either parent’s earning capacity

including incarceration, disabilities, or incapacity.

c. Good cause includes, but is not limited to, possession of

substantial wealth, child(ren) with day care expenses,

special medical need, educational need, psychological need,

and larger families. RCW 26.19.065(1).

2. Presumptive minimum support obligation: When a parent’s

monthly net income is below 125% of the federal poverty

guideline, a support order of not less than fifty dollars per child

per month shall be entered unless the obligor parent establishes

that it would be unjust to do so in that particular case. The

decision whether there is a sufficient basis to go below the

presumptive minimum payment must take into consideration the

best interests of the child(ren) and circumstances of each parent.

Such circumstances can include leaving insufficient funds in the

custodial parent’s household to meet the basic needs of the

child(ren), comparative hardship to the affected households,

assets or liabilities, and earning capacity. RCW 26.19.065(2)(a).

3. Self-support reserve: The basic support obligation of the parent

making the transfer payment, excluding health care, day care,

and special child-rearing expenses, shall not reduce his or her net

income below the self-support reserve of 125% of the federal

poverty level, except for the presumptive minimum payment of

fifty dollars per child per month or when it would be unjust to

apply the self-support reserve limitation after considering the

best interests of the child(ren) and the circumstances of each

parent. Such circumstances include, but are not limited to,

leaving insufficient funds in the custodial parent’s household to

meet the basic needs of the child(ren), comparative hardship to

the affected households, assets or liabilities, and earning

capacity. This section shall not be construed to require monthly

substantiation of income. (See the Self-Support Reserve

memorandum on the courts’ website www.courts.wa.gov/forms

and at www.WashingtonLawHelp.org.) RCW 26.19.065(2)(b).

4. Income above twelve thousand dollars: The economic table is

presumptive for combined monthly net incomes up to and

including twelve thousand dollars. When combined monthly net

income exceeds twelve thousand dollars, the court may exceed

the maximum presumptive amount of support upon written

findings of fact. RCW 26.19.065(3).

Deviation Standards

1. Reasons for deviation from the standard calculation include but

are not limited to the following:

a. Sources of income and tax planning: The court may deviate

from the standard calculation after consideration of the

following:

i. Income of a new spouse or new domestic partner if the

parent who is married to the new spouse or the parent

who is in a domestic partnership with the new

domestic partner is asking for a deviation based on any

other reason. Income of a new spouse or domestic

partner is not, by itself, a sufficient reason for

deviation;

ii. Income of other adults in the household if the parent

who is living with the other adult is asking for a

deviation based on any other reason. Income of the

other adults in the household is not, by itself, a

sufficient reason for deviation;

iii. Child support actually received from other

relationships;

iv. Gifts;

v. Prizes;

vi. Possession of wealth, including but not limited to

savings, investments, real estate holdings and business

interests, vehicles, boats, pensions, bank accounts,

insurance plans or other assets;

vii. Extraordinary income of a child; or

viii. Tax planning considerations. A deviation for tax

planning may be granted only if child(ren) would not

receive a lesser economic benefit due to the tax

planning;

ix. Income that has been excluded under RCW

26.19.071(4)(h) if the person earning that income asks

for a deviation for any other reason.

RCW 26.19.075(1)(a)

b. Nonrecurring income: The court may deviate from the

standard calculation based on a finding that a particular

source of income included in the calculation of the basic

support obligation is not a recurring source of income.

Depending on the circumstances, nonrecurring income may

include overtime, contract-related benefits, bonuses or

income from second jobs. Deviations for nonrecurring

income shall be based on a review of the nonrecurring

income received in the previous two calendar years.

RCW 26.19.075(1)(b).

http://www.courts.wa.gov/forms

http://www.washingtonlawhelp.org/


c. Debt and high expenses: The court may deviate from the

standard calculation after consideration of the following

expenses:

i. Extraordinary debt not voluntarily incurred;

ii. A significant disparity in the living costs of the parents

due to conditions beyond their control;

iii. Special needs of disabled child(ren); or

iv. Special medical, educational or psychological needs of

the child(ren).

v. Costs anticipated to be incurred by the parents in

compliance with court-ordered reunification efforts

under chapter 13.34 RCW or under a voluntary

placement agreement with an agency supervising the

child. RCW 26.19.075(1)(c).

d. Residential schedule: The court may deviate from the

standard calculation if the child(ren) spend(s) a significant

amount of time with the parent who is obligated to make a

support transfer payment. The court may not deviate on

that basis if the deviation will result in insufficient funds in

the household receiving the support to meet the basic needs

of the child or if the child is receiving temporary assistance

for needy families. When determining the amount of the

deviation, the court shall consider evidence concerning the

increased expenses to a parent making support transfer

payments resulting from the significant amount of time

spent with that parent and shall consider the decreased

expenses, if any, to the party receiving the support resulting

from the significant amount of time the child spends with

the parent making the support transfer payment.

RCW 26.19.075(1)(d).

e. Children from other relationships: The court may deviate

from the standard calculation when either or both of the

parents before the court have children from other

relationships to whom the parent owes a duty of support.

i. The child support schedule shall be applied to the

parents and children of the family before the court to

determine the presumptive amount of support.

ii. Children from other relationships shall not be counted

in the number of children for purposes of determining

the basic support obligation and the standard

calculation.

iii. When considering a deviation from the standard

calculation for children from other relationships, the

court may consider only other children to whom the

parent owes a duty of support. The court may

consider court-ordered payments of child support for

children from other relationships only to the extent

that the support is actually paid.

iv. When the court has determined that either or both

parents have children from other relationships,

deviations under this section shall be based on

consideration of the total circumstances of both

households. All child support obligations paid,

received, and owed for all children shall be disclosed

and considered. RCW 26.19.075(1)(e).

2. All income and resources of the parties before the court, new

spouses or domestic partners, and other adults in the household

shall be disclosed and considered as provided. The presumptive

amount of support shall be determined according to the child

support schedule. Unless specific reasons for deviation are set

forth in the written findings of fact and are supported by the

evidence, the court shall order each parent to pay the amount of

support determined by using the standard calculation.

RCW 26.19.075(2).

access to the post-secondary education records as provided by

statute (RCW 26.09.225). RCW 26.19.090(4).

3. The court shall enter findings that specify reasons for any

deviation or any denial of a party’s request for any deviation

from the standard calculation made by the court. The court shall

not consider reasons for deviation until the court determines the

standard calculation for each parent. RCW 26.19.075(3).

4. When reasons exist for deviation, the court shall exercise

discretion in considering the extent to which the factors would

affect the support obligation. RCW 26.19.075(4).

5. Agreement of the parties is not by itself adequate reason for any

deviations from the standard calculations. RCW 26.19.075(5).

Benefits paid that apply toward a person’s child support obligation If an injured worker, person with disabilities, deceased person, retired

person, or veteran who owes a child support obligation receives one of

these benefits:

Department of Labor and Industries payments

Self-Insurer’s payment

Social Security Administration:

o Social Security disability dependency benefits

o Retirement benefits

o Survivors insurance benefits

Veteran’s Administration benefits

and shows that the child or the child’s household receives a payment

from those benefits, then, the amount of the payment made on behalf of

the child or on account of the child applies toward the person’s child

support obligation for the same period covered by the benefit.

Post-Secondary Education Standards

1. The child support schedule shall be advisory and not mandatory

for post-secondary educational support. RCW 26.19.090(1)

2. When considering whether to order support for post-secondary

educational expenses, the court shall determine whether the child

is in fact dependent and is relying upon the parents for the

reasonable necessities of life. The court shall exercise its

discretion when determining whether and for how long to award

post-secondary educational support based upon consideration of

factors that include but are not limited to the following: age of

the child; the child’s needs; the expectations of the parties for

their child(ren) when the parents were together; the child(ren)’s

prospects, desires, aptitudes, abilities or disabilities; the nature of

the post-secondary education sought and the parent’s level of

education, standard of living and current and future resources.

Also to be considered are the amount and type of support that the

child would have been afforded if the parents had stayed

together. RCW 26.19.090(2).

3. The child must enroll in an accredited academic or vocational

school, must be actively pursuing a course of study

commensurate with the child’s vocational goals and must be in

good academic standing as defined by the institution. The court-

ordered post-secondary educational support shall be

automatically suspended during the period or periods the child

fails to comply with these conditions. RCW 26.19.090(3).

4. The child shall also make available all academic records and

grades to both parents as a condition of receiving post-secondary

educational support. Each parent shall have full and equal


5. The court shall not order the payment of post-secondary

educational expenses beyond the child’s twenty-third birthday,

except for exceptional circumstances, such as mental, physical or

emotional disabilities. RCW 26.19.090(5).

6. The court shall direct that either or both parents’ payments for

post-secondary educational expenses are made directly to the

educational institution if feasible. If direct payments are not

feasible, then the court in its discretion may order that either or

both parents’ payments are made directly to the child if the child

does not reside with either parent. If the child resides with one

of the parents, the court may direct that the parent making the

support transfer payments make the payments to the child or to

the parent who has been receiving the support transfer payments.

RCW 26.19.090(6).

WSCSS-Instructions 08/2013 Page 6

WASHINGTON STATE CHILD SUPPORT SCHEDULE

INSTRUCTIONS FOR WORKSHEETS

Worksheets:

Fill in the names and ages of only those children whose

support is at issue.

Part I: Income

Pursuant to INCOME STANDARD #1: Consideration of all

income, “only the income of the parents of the child(ren)

whose support is at issue shall be calculated for purposes of

calculating the basic support obligation.” (See page 1.) Pursuant to INCOME STANDARD #2: Verification of

income, “tax returns for the preceding two years and current

paystubs are required for income verification purposes. Other

sufficient verification shall be required for income and

deductions which do not appear on tax returns or paystubs.”

(See page 1.)

Gross Monthly Income

Gross monthly income is defined under INCOME

STANDARD #3: Income sources included in gross monthly

income. (See page 1.)

Income exclusions are defined under INCOME STANDARD

#4: Income sources excluded from gross monthly income.

(See page 2.) Excluded income must be disclosed and listed

in Part VIII of the worksheets.

Monthly Average of Income:

If income varies during the year, divide the annual total

of the income by 12.

If paid weekly, multiply the weekly income by 52 and

divide by 12.

If paid every other week, multiply the two-week

income by 26 and divide by 12.

If paid twice a month (bi-monthly), multiply the bi-

monthly income by 24 and divide by 12.

LINE 1a, Wages and Salaries: Enter the average

monthly total of all salaries, wages, contract-related

benefits, bonuses, and income from overtime and second

jobs that is not excluded from income by RCW

26.19.071(4)(h).

LINE 1b, Interest and Dividend Income: Enter the

average monthly total of dividends and interest income.

LINE 1c, Business Income: Enter the average monthly

income from self-employment, rent, royalties, contracts,

proprietorship of a business, or joint ownership of a

partnership or closely held corporation.

LINE 1d, Maintenance Received: Enter the monthly

amount of maintenance actually received.

LINE 1e, Other Income: Enter the average monthly total

of other income. (Other income includes, but is not limited

to: trust income, severance pay, annuities, capital gains,

pension retirement benefits, workers compensation,

unemployment benefits, social security benefits and disability

insurance benefits.)

LINE 1f, Imputed Income: Enter the imputed gross

monthly income for a parent who is voluntarily

unemployed, underemployed or if you do not have records

of a parent’s actual earnings. Refer to “INCOME

STANDARD #6: Imputation of income.” (See page 2.)

Impute income using the first method possible based on the

information you have in the following order:

Calculate full-time earnings using either:

1. Current rate of pay;

2. Historical rate of pay based on reliable information;

3. Past rate of pay, if current information is incomplete or

sporadic; or

4. Minimum wage where the parent lives when the parent

has a history of minimum wage or government assistance

is recently released from incarceration or is a high school

student.

Historical rate of pay information may be available from the

Division of Child Support. Use form 18-701: “Request for

Income Information for Purposes of Entering a Child Support

Order”, available online at:

http://www.dshs.wa.gov/dcs/Resources/Forms.asp

If you impute income using one of the four methods, above,

enter the amount in line 1f. Also, in line 26 of the

Worksheets, explain which method you used to impute

income and how you calculated the amount of imputed

income.

If you cannot use any of the above methods, impute the

parent’s net monthly income using the table below, and enter

the appropriate amount for the parent’s age and gender on

line 1f and on line 3. The table, below, shows net income,

after deductions. So if you impute using this table, you will

not enter any deductions on the worksheet under line 2.

Leave lines 2a through 2i blank. For this parent, go to line 4.

Also, in line 26 of the Worksheets, explain that net income

was imputed using the Approximate Median Net Monthly

Income Table.


Approximate Median Net Monthly Income

MALE age FEMALE

$1,832 15-24 $1,632

$2,804 25-34 $2,446

$3,448 35-44 $2,693

$3,569 45-54 $2,714

$3,735 55-64 $2,814

$4,084 65 + $2,960

U.S. Census Bureau, Current Population Survey, 2009 Annual

Social and Economic Supplement, Table PINC-01. Selected

Characteristics of People 15 Years Old and Over by Total

Money Income in 2008, Work Experience in 2008, Race,

Hispanic Origin, and Sex, Worked Full Time, Year Round.

[Net income has been determined by subtracting FICA (7.65

percent) and the tax liability for a single person (one

withholding allowance).]

LINE 1g, Total Gross Monthly Income: Add the monthly

income amounts for each parent (lines 1a through 1f) and

enter the totals on line 1g.

Monthly Deductions from Gross Income

Allowable monthly deductions from gross income are defined

under INCOME STANDARD #5: Determination of net

income. (See page 2.)

Monthly Average of Deductions: If a deduction is annual or

varies during the year, divide the annual total of the deduction

by 12 to determine a monthly amount.

LINE 2a, Income Taxes: Enter the monthly amount

actually owed for state and federal income taxes. (The

amount of income tax withheld on a paycheck may not be the

actual amount of income tax owed due to tax refund, etc. It is

appropriate to consider tax returns from prior years as

indicating the actual amount of income tax owed if income

has not changed.)

LINE 2b, FICA/Self Employment Taxes: Enter the total

monthly amount of FICA, Social Security, Medicare and

Self-employment taxes owed.

LINE 2c, State Industrial Insurance Deductions: Enter

the monthly amount of state industrial insurance

deductions.

LINE 2d, Mandatory Union/Professional Dues: Enter the

monthly cost of mandatory union or professional dues.

LINE 2e, Mandatory Pension Plan Payments: Enter the

monthly cost of mandatory pension plan payments

amount.

LINE2f, Voluntary Retirement Contributions: Enter the

monthly cost of voluntary Retirement Contributions.

Divide the amount of the voluntary retirement contribution,

up to $5,000 per year, by 12 to calculate the monthly cost.

(For more information regarding limitations on the allowable

deduction of voluntary retirement contributions, refer to

INCOME STANDARD #5: Determination of net income.

See page 2.)

LINE 2g, Maintenance Paid: Enter the monthly amount

of maintenance actually paid pursuant to a court order.

LINE 2h, Normal Business Expenses: If self-employed,

enter the amount of normal business expenses. (Pursuant

to INCOME STANDARD #5: Determination of net income,

“justification shall be required for any business expense

deduction about which there is a disagreement.” See page 2.)

LINE 2i, Total Deductions From Gross Income: Add the

monthly deductions for each parent (lines 2a through 2h)

and enter the totals on line 2i.

LINE 3, Monthly Net Income: For each parent, subtract

total deductions (line 2i) from total gross monthly income

(line 1g) and enter these amounts on line 3.

LINE 4, Combined Monthly Net Income: Add the

parents’ monthly net incomes (line 3) and enter the total

on line 4.

LINE 5, Basic Child Support Obligation: In the work

area provided on line 5, enter the basic support obligation

amount determined for each child. Add these amounts

together and enter the total in the box on line 5. (To

determine a per child basic support obligation, see the

following economic table instructions.)

Economic Table Instructions

To use the Economic Table to determine an individual

support amount for each child:

Locate in the left-hand column the combined

monthly net income amount closest to the amount

entered on line 4 of Worksheet (round up when the

combined monthly net income falls halfway between the

two amounts in the left-hand column);

Locate on the top row the family size for the number

of children for whom child support is being

determined (when determining family size for the

required worksheets, do not include child(ren) from

other relationships); and

circle the two numbers in the columns listed below the

family size that are across from the net income. The

amount in the “A” column is the basic support amount for

a child up to age 11. The amount in the “B” column is

the basic support amount for a child 12 years of age or

older.


LINE 6, Proportional Share of Income: Divide the

monthly net income for each parent (line 3) by the

combined monthly net income (line 4) and enter these

amounts on line 6. (The entries on line 6 when added

together should equal 1.00.)

Part II: Basic Child Support Obligation

LINE 7, Each Parent’s Basic Child Support Obligation

without consideration of low income limitations: Multiply

the total basic child support obligation (amount in box on

line 5) by the income share proportion for each parent

(line 6) and enter these amounts on line 7. (The amounts

entered on line 7 added together should equal the amount

entered on line 5.)

LINE 8, Calculating low income limitations: Fill in only

those that apply:

To calculate the low-income limitation standards in lines 8b

and 8c, you will need to know the self-support reserve

amount, which is 125 % of the current federal poverty

guideline. As of January 20, 2011, self-support reserve is

$1,134. The guideline and self-support reserve change

roughly annually. To check the current self-support reserve

amount go to the courts’ web site at: www.courts.wa.gov, or

go to www.WashingtonLawHelp.org. Enter the self-support

reserve amount in the space provided in line 8. (For more

information, see Limitation Standard #2 on page 3 of the

Definitions and Standards.)

8a. Is combined net income less than $1,000? If combined

net monthly income on line 4 is less than $1,000, enter each

parent’s presumptive support obligation of $50 per child. Do

not enter an amount on line 8a if combined income on line

4 is more than $1,000.

8b. Is monthly net income less than self-support reserve? For each parent whose monthly net income on line 3 is less

than the self support reserve, enter the parent’s presumptive

support obligation of $50 per child. Do not use this box for

a parent whose net income on line 3 is greater than the

self-support reserve.

8c. Is monthly net income equal to or more than self-

support reserve? Subtract the self-support reserve from line

3 and enter this amount or enter $50 per child whichever is

greater. Do not use this box if the amount is greater than

the amount in line 7.

LINE 9, Each parent’s basic child support obligation after

calculating applicable limitations: For each parent, enter

the lowest amount from line 7, 8a – 8c, but not less than the

presumptive $50 per child.

Part III: Health Care, Day Care, and Special Child Rearing Expenses

Pursuant to ALLOCATION STANDARD #4: “the court may

exercise its discretion to determine the necessity for and the

reasonableness of all amounts ordered in excess of the basic

child support obligation.” (See page 2.)

Pursuant to ALLOCATION STANDARD #2: Health care

expenses and #3: Day care and special child rearing expenses,

health care, day care, and special child rearing expenses shall

be shared by the parents in the same proportion as the basic

support obligation. (See page 2.) NOTE: The court order

should reflect that health care, day care and special child

rearing expenses not listed should be apportioned by the same

percentage as the basic child support obligation.

Monthly Average of Expenses: If a health care, day care, or

special child rearing expense is annual or varies during the

year, divide the annual total of the expense by 12 to determine

a monthly amount.

Health Care Expenses

LINE 10a, Monthly Health Insurance Premiums Paid For

Child(ren): List the monthly amount paid by each parent

for health care insurance for the child(ren) of the

relationship. (When determining an insurance premium

amount, do not include the portion of the premium paid by an

employer or other third party and/or the portion of the

premium that covers the parent or other household members.)

LINE 10b, Uninsured Monthly Health Care Expenses

Paid For Child(ren): List the monthly amount paid by

each parent for the child(ren)’s health care expenses not

reimbursed by insurance.

LINE 10c, Total Monthly Health Care Expenses: For

each parent add the health insurance premium payments

(line 10a) to the uninsured health care payments (line 10b)

and enter these amounts on line 10c.

LINE 10d, Combined Monthly Health Care Expenses:

Add the parents’ total health care payments (line 10c) and

enter this amount on line 10d.

Day Care and Special Expenses

LINE 11a, Day Care Expenses: Enter average monthly

day care costs.

LINE 11b, Education Expenses: Enter the average

monthly costs of tuition and other related educational

expenses.

LINE 11c, Long Distance Transportation Expenses: Enter

the average monthly costs of long distance travel incurred

pursuant to the residential or visitation schedule.

http://www.courts.wa.gov/



LINE 11d, Other Special Expenses: Identify any other

special expenses and enter the average monthly cost of

each.

LINE 11e, Total Day Care and Special Expenses: Add the

monthly expenses for each parent (lines 11a through 11d)

and enter these totals on line 11e.

LINE 12, Combined Monthly Total of Day Care and

Special Expenses: Add the parents’ total expenses (line

11e) and enter this total on line 12.

LINE 13, Total Health Care, Day Care and Special

Expenses: Add the health care expenses (line 10d) to the

combined monthly total of day care and special expenses

(line 12) and enter this amount on line 13.

LINE 14, Each Parent’s Obligation For Health Care, Day

Care And Special Expenses: Multiply the total health

care, day care, and special expense amount (line 13) by the

income proportion for each parent (line 6) and enter these

amounts on line 14.

LINE 15, Gross Child Support Obligation: For each

parent, add the basic child support obligation (line 9) to

the obligation for extraordinary health care, day care and

special expenses (line 14). Enter these amounts on line 15.

Part V: Child Support Credits

Child support credits are provided in cases where parents

make direct payments to third parties for the cost of goods

and services which are included in the standard calculation

support obligation (e.g., payments to an insurance company or

a day care provider).

LINE 16a, Monthly Health Care Expenses Credit: Enter

the total monthly health care expenses amounts from line

10c for each parent.

LINE 16b, Day Care And Special Expenses Credit: Enter

the total day care and special expenses amounts from line

11e for each parent.

LINE 16c, Other Ordinary Expense Credit: If approval of

another ordinary expense credit is being requested, in the

space provided, specify the expense and enter the average

monthly cost in the column of the parent to receive the

credit. (It is generally assumed that ordinary expenses are

paid in accordance with the child(ren)’s residence. If payment

of a specific ordinary expense does not follow this

assumption, the parent paying for this expense may request

approval of an ordinary expense credit. This credit is

discretionary with the court.)

LINE 16d, Total Support Credits: For each parent, add

the entries on lines 16 a through c and enter the totals on

line 16d.

Part VI: Standard Calculation/Presumptive Transfer Payment

LINE 17, For Each Parent: subtract the total support

credits (line 16d) from the gross child support obligation

(line 15) and enter the resulting amounts on line 17. If the

amount is less than $50 per child for either parent, then

enter the presumptive minimum support obligation of $50

per child, instead of the lower amount.

Part VII: Additional Informational Calculations

LINE 18, 45% of Each Parent’s Net Income From Line 3:

For each parent, multiply line 3 by .45. Refer to

LIMITATIONS Standards #1: Limit at 45% of a parent’s

net income.

LINE 19, 25% of Each Parent’s Basic Support Obligation

from Line 9: For each parent, multiply line 9 by .25.

Part VIII: Additional Factors for Consideration

Pursuant to INCOME STANDARD #1: Consideration of all

income: “all income and resources of each parent’s household

shall be disclosed and considered by the court when the court

determines the child support obligation of each parent.” (See

page 1.)

LINE 20 a-h, Household Assets: Enter the estimated

present value of assets of the household.

LINE 21, Household Debt: Describe and enter the amount

of liens against assets owned by the household and/or any

extraordinary debt.

Other Household Income

LINE 22a, Income of Current Spouse or Domestic

Partner: If a parent is currently married to or in a

domestic partnership with someone other than the parent

of the child(ren) for whom support is being determined,

list the name and enter the income of the present spouse

or domestic partner.

LINE 22b, Income of Other Adults In The Household:

List the names and enter the incomes of other adults

residing in the household.

LINE 22c, Gross income from overtime or from second

jobs the party is asking the court to exclude per INCOME

STANDARD #4, Income sources excluded from gross

monthly income (see page 2).

LINE 22d, Income of Children: If the amount is

considered to be extraordinary, list the name and enter

the income of children residing in the home.


LINE 22e, Income from Child Support: List the name of

the child(ren) for whom support is received and enter the

amount of the support income. Do not include the

child(ren) for whom support is being determined.

LINE 22f, Income from Assistance Programs: List the

program and enter the amount of any income received

from assistance programs. (Assistance programs include,

but are not limited to: temporary assistance for needy

families, SSI, general assistance, food stamps and aid and

attendance allowances.)

LINE 22g, Other Income: Describe and enter the amount

of any other income of the household. (Include income

from gifts and prizes on this line.)

LINE 23, Nonrecurring Income: Describe and enter the

amount of any income included in the calculation of gross

income (LINE 1g) which is nonrecurring. (Pursuant to

DEVIATION STANDARD #1b: Nonrecurring income,

“depending on the circumstances, nonrecurring income may

include overtime, contract-related benefits, bonuses or income

from second jobs.” See page 3.)

LINE 24, Child Support Owed, Monthly, for Biological or

Legal Child(ren). List the names and ages and enter the

amount of child support owed for other children, (not the

children for whom support is being determined). Is the

support paid? Check [ ] Yes or [ ] No.

LINE 25, Other Child(ren) Living in Each Household:

List the names and ages of children, other than those for

whom support is being determined, who are living in each

household.

LINE 26, Other Factors For Consideration: In the space

provided list any other factors that should be considered

in determining the child support obligation. (For

information regarding other factors for consideration, refer to

DEVIATION STANDARDS. See page 3.) Also use this

space to explain how you calculated the income and

deductions in lines 1 and 2.

Nonparental Custody Cases: When the children do not reside

with either parent, the household income and resources of the

children’s custodian(s) should be listed on line 26.

WSCSS-Economic Table 10/2009

WASHINGTON STATE CHILD SUPPORT SCHEDULE ECONOMIC TABLE

MONTHLY BASIC SUPPORT OBLIGATION PER CHILD (KEY: A = AGE 0-11 B = AGE 12-18)

Combined Monthly Net

One Child Family

Two Children Family

Three Children Family

Four Children Family

Five Children Family

Income A B A B A B A B A B

For income less than $1,000, the obligation is based upon the resources and living expenses of each household. Minimum support shall not be less than $50 per child per month except when allowed by RCW 26.19.065(2). 1000 220 272 171 211 143 177 121 149 105 130 1100 242 299 188 232 157 194 133 164 116 143 1200 264 326 205 253 171 211 144 179 126 156 1300 285 352 221 274 185 228 156 193 136 168 1400 307 379 238 294 199 246 168 208 147 181 1500 327 404 254 313 212 262 179 221 156 193 1600 347 428 269 333 225 278 190 235 166 205 1700 367 453 285 352 238 294 201 248 175 217 1800 387 478 300 371 251 310 212 262 185 228 1900 407 503 316 390 264 326 223 275 194 240 2000 427 527 331 409 277 342 234 289 204 252 2100 447 552 347 429 289 358 245 303 213 264 2200 467 577 362 448 302 374 256 316 223 276 2300 487 601 378 467 315 390 267 330 233 288 2400 506 626 393 486 328 406 278 343 242 299 2500 526 650 408 505 341 421 288 356 251 311 2600 534 661 416 513 346 428 293 362 256 316 2700 542 670 421 520 351 435 298 368 259 321 2800 549 679 427 527 356 440 301 372 262 324 2900 556 686 431 533 360 445 305 376 266 328 3000 561 693 436 538 364 449 308 380 268 331 3100 566 699 439 543 367 453 310 383 270 334 3200 569 704 442 546 369 457 312 386 272 336 3300 573 708 445 549 371 459 314 388 273 339 3400 574 710 446 551 372 460 315 389 274 340 3500 575 711 447 552 373 461 316 390 275 341 3600 577 712 448 553 374 462 317 391 276 342 3700 578 713 449 554 375 463 318 392 277 343 3800 581 719 452 558 377 466 319 394 278 344 3900 596 736 463 572 386 477 326 404 284 352 4000 609 753 473 584 395 488 334 413 291 360 4100 623 770 484 598 404 500 341 422 298 368 4200 638 788 495 611 413 511 350 431 305 377 4300 651 805 506 625 422 522 357 441 311 385 4400 664 821 516 637 431 532 364 449 317 392 4500 677 836 525 649 438 542 371 458 323 400 4600 689 851 535 661 446 552 377 467 329 407 4700 701 866 545 673 455 562 384 475 335 414 4800 713 882 554 685 463 572 391 483 341 422 4900 726 897 564 697 470 581 398 491 347 429 5000 738 912 574 708 479 592 404 500 353 437 5100 751 928 584 720 487 602 411 509 359 443 5200 763 943 593 732 494 611 418 517 365 451 5300 776 959 602 744 503 621 425 525 371 458 5400 788 974 612 756 511 632 432 533 377 466 5500 800 989 622 768 518 641 439 542 383 473 5600 812 1004 632 779 527 651 446 551 389 480 5700 825 1019 641 791 535 661 452 559 395 488 5800 837 1035 650 803 543 671 459 567 401 495 5900 850 1050 660 815 551 681 466 575 407 502 6000 862 1065 670 827 559 691 473 584 413 509 6100 875 1081 680 839 567 701 479 593 418 517 6200 887 1096 689 851 575 710 486 601 424 524 6300 899 1112 699 863 583 721 493 609 430 532 6400 911 1127 709 875 591 731 500 617 436 539 6500 924 1142 718 887 599 740 506 626 442 546 6600 936 1157 728 899 607 750 513 635 448 554 6700 949 1172 737 911 615 761 520 643 454 561 6800 961 1188 747 923 623 770 527 651 460 568 6900 974 1203 757 935 631 780 533 659 466 575 7000 986 1218 767 946 639 790 540 668 472 583 7100 998 1233 776 958 647 800 547 677 478 591 7200 1009 1248 785 971 654 809 554 684 484 598 7300 1021 1262 794 982 662 818 560 693 490 605 7400 1033 1276 803 993 670 828 567 701 496 613 7500 1044 1290 812 1004 677 837 574 709 502 620 7600 1055 1305 821 1015 685 846 581 718 507 627 7700 1067 1319 830 1026 692 855 587 726 513 634 7800 1078 1333 839 1037 700 865 594 734 519 642 7900 1089 1346 848 1048 707 874 601 742 525 649 8000 1100 1360 857 1059 714 883 607 750 531 656

WSCSS-Economic Table 10/2009

8100 1112 1374 865 1069 722 892 614 759 536 663 8200 1123 1387 874 1080 729 901 620 767 542 670 8300 1134 1401 882 1091 736 910 627 775 548 677 8400 1144 1414 891 1101 743 919 633 783 553 684 8500 1155 1428 899 1112 750 928 640 791 559 691 8600 1166 1441 908 1122 758 936 646 799 565 698 8700 1177 1454 916 1133 765 945 653 807 570 705 8800 1187 1467 925 1143 772 954 659 815 576 712 8900 1198 1481 933 1153 779 962 665 822 582 719 9000 1208 1493 941 1163 786 971 672 830 587 726 9100 1219 1506 949 1173 792 980 678 838 593 732 9200 1229 1519 957 1183 799 988 684 846 598 739 9300 1239 1532 966 1193 806 996 691 854 604 746 9400 1250 1545 974 1203 813 1005 697 861 609 753 9500 1260 1557 982 1213 820 1013 703 869 614 759 9600 1270 1570 989 1223 826 1021 709 877 620 766 9700 1280 1582 997 1233 833 1030 716 884 625 773 9800 1290 1594 1005 1242 840 1038 722 892 631 779 9900 1300 1606 1013 1252 846 1046 728 900 636 786 10000 1310 1619 1021 1262 853 1054 734 907 641 793 10100 1319 1631 1028 1271 859 1062 740 915 647 799 10200 1329 1643 1036 1281 866 1070 746 922 652 806 10300 1339 1655 1044 1290 872 1078 752 930 657 812 10400 1348 1666 1051 1299 879 1086 758 937 662 819 10500 1358 1678 1059 1308 885 1094 764 944 668 825 10600 1367 1690 1066 1318 891 1102 770 952 673 832 10700 1377 1701 1073 1327 898 1109 776 959 678 838 10800 1386 1713 1081 1336 904 1117 782 966 683 844 10900 1395 1724 1088 1345 910 1125 788 974 688 851 11000 1404 1736 1095 1354 916 1132 794 981 693 857 11100 1413 1747 1102 1363 922 1140 799 988 698 863 11200 1422 1758 1110 1371 928 1147 805 995 703 869 11300 1431 1769 1117 1380 934 1155 811 1002 708 876 11400 1440 1780 1124 1389 940 1162 817 1009 714 882 11500 1449 1791 1131 1398 946 1170 822 1017 719 888 11600 1458 1802 1138 1406 952 1177 828 1024 723 894 11700 1467 1813 1145 1415 958 1184 834 1031 728 900 11800 1475 1823 1151 1423 964 1191 839 1038 733 906 11900 1484 1834 1158 1431 970 1199 845 1045 738 912 12000 1492 1844 1165 1440 975 1206 851 1051 743 919

The economic table is presumptive for combined monthly net incomes up to and including twelve thousand dollars. When

combined monthly net income exceeds twelve thousand dollars, the court may exceed the maximum presumptive amount of support

upon written findings of fact.

RCW 26.18.220(1) Mandatory Form (05/2016) FL All Family 131

Financial Declaration

p. 1 of 6

Superior Court of Washington, County of

In re custody of:

Children:

Petitioner/s (person/s who started this case):

Respondents (parents and any guardian or custodian):

No.

Financial Declaration of (name):

(FNDCLR)


1. Your personal information

Name:

Highest year of education you completed: Your job/profession is:

Are you working now?

Yes. List the date you were hired (month / year):

No. List the last date you worked (month / year):

What was your monthly pay before taxes: $

Why are you not working now?

2. Summary of your financial information

(Complete this section after filling out the rest of this form.)

1. Total Monthly Net Income (copy from section 3, line C. 3.) $

2. Total Monthly Expenses After Separation (copy from section 7, line I.) $

3. Total Monthly Payments for Other Debts (copy from section 9) $

4. Total Monthly Expenses + Payments for Other Debts (add line 2 and line 3) $



p. 2 of 6

Gross Monthly Income of Other Party (copy from section 3. A.) $

3. Income

List monthly income and deductions below for you and the other person in your case. If your case involves child support, this same information is required on your Child Support Worksheets. If you do not know the other person’s financial information, give an estimate.

Tip: If you do not get paid once a month, calculate your monthly income like this: Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2

A. Gross Monthly Income (before taxes, deductions, or retirement contributions)

You Other Party

Monthly wage / salary

Income from interest / dividends

Income from business

Spousal support / maintenance received

(Paid by: )

Other income

Total Gross Monthly Income (add all lines above)

Total gross income for this year before deductions (starting January 1 of this year until now)

B. Monthly Deductions

You Other Party

Income taxes (federal and state)

FICA (Soc.Sec. + Medicare) or self-employment taxes

State Industrial Insurance (Workers’ Comp.)

Mandatory union or professional dues

Mandatory pension plan payments

Voluntary retirement contributions (up to the limit in RCW 26.19.071(5)(g))

Spousal support / maintenance paid

Normal business expenses

Total Monthly Deductions (add all lines above)

C. Net Monthly Income

You Other Party

1. Total Gross Monthly Income (from A above)



p. 3 of 6

2. Total Monthly Deductions (from B above)

3. Net Monthly Income (Line 1 minus Line 2)

4. Other Income and Household Income

Tip: If this income is not once a month, calculate the monthly amount like this: Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2

A. Other Income (Do not repeat income you already listed on page 2.)

You Other Party

Child support received from other relationships

Other income (From: )

Other income (From: )

Total Other Income (add all lines above)

B. Household Income (Monthly income of other adults living in the home)

Your Home Other Party’s Home

Other adult’s gross income (Name: )

Other adult’s gross income (Name: )

Total Household Income of other adults in the home (add all lines above)

5. Disputed Income – If you disagree with the other party’s statements about anyone’s

income, explain why the other party’s statements are not correct, and your statements are correct:

6. Available Assets

List your liquid assets, like cash, stocks, bonds, that can be easily cashed.

Cash on hand and money in all checking & savings accounts $

Stocks, bonds, CDs and other liquid financial accounts $

Cash value of life insurance $



p. 4 of 6

Other liquid assets $

Total Available Assets (add all lines above)

7. Monthly Expenses After Separation

Tell the court what your monthly expenses are (or will be) after separation. If you have dependent children, your expenses must be based on the parenting plan or schedule you expect to have for the children.

A. Housing Expenses F. Transportation Expenses

Rent / Mortgage Payment Automobile payment (loan or lease)

Property Tax (if not in monthly payment) Auto insurance, license, registration

Homeowner’s or Rental Insurance Gas and auto maintenance

Other mortgage, contract, or debt payments based on equity in your home

Parking, tolls, public transportation

Homeowner’s Association dues or fees Other transportation expenses

Total Housing Expenses Total Transportation Expenses

B. Utilities Expenses G. Personal Expenses (not children’s)

Electricity and heating (gas and oil) Clothes

Water, sewer, garbage Hair care, personal care

Telephone(s) Recreation, clubs, gifts

Cable, Internet Education, books, magazines

Other (specify): Other Personal Expenses

Total Utilities Expenses Total Personal Expenses

C. Food and Household Expenses H. Other Expenses

Groceries for (number of people): _____ Life insurance (not deducted from pay)

Household supplies (cleaning, paper, pets) Other (specify):

Eating out Other (specify):

Other (specify): Other (specify):

Total Food and Household Expenses Total Other Expenses

D. Children’s Expenses List all Total Expenses from above:

Childcare, babysitting A. Total Housing Expenses

Clothes, diapers B. Total Utilities Expenses

Tuition, after-school programs, lessons C. Total Food and Household Expenses

Other expenses for children D. Total Children’s Expenses

Total Children’s Expenses E. Total Health Care Expenses

F. Total Transportation Expenses

E. Health Care Expenses G. Total Personal Expenses

Insurance premium (health, vision, dental) H. Total Other Expenses

Health, vision, dental, orthodontia, mental health expenses not covered by insurance

I. All Total Expenses (add A - H above)



p. 5 of 6

Other health expenses not covered by insurance

Use section 11 below to explain any unusual

expenses, or attach additional pages. Total Health Care Expenses

8. Debts included in Monthly Expenses listed in section 7 above

Debt for what expense (mortgage, car loan, etc.)

Who do you owe (Name of creditor)

Amount you owe this creditor now

Last Monthly Payment made

$ Date:

$ Date:

$ Date:

$ Date:

9. Monthly payments for other debts (not included in expenses listed in section 7)

Describe Debt (credit card, loan, etc.)

Who do you owe (Name of creditor)

Amount you owe this creditor now

Last Monthly Payment (Date and Amount)

$ Date: $

$ Date: $

$ Date: $

$ Date: $

$ Date: $

$ Date: $

Total Monthly Payments for Debts

10. Explanation of expenses or debts (if any needed):

11. Lawyer Fees

List your total lawyer fees and costs for this case as of today.

Amount paid $ Source of the money you used to pay these fees and costs:

Amount still owed $

Total Fees/Costs $



p. 6 of 6

I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true.

Signed at (city and state): Date:

Sign here Print name

Financial Records – You must provide financial records as required by statute and state and local court rules. These records may include:

Personal Income Tax Returns

Pay stubs

Partnership or Corporate Income Tax Returns

Other financial records

Important! Do not attach financial records to this form. Financial records should be served on the other party and filed with the court separately using the Sealed Financial Source Documents cover sheet (FL All Family 011). If filed separately using the cover sheet, the records will be sealed to protect your privacy (although they will be available to all parties and lawyers in this case, court personnel and certain state agencies and boards.) See GR 22(c)(2).

GR 22(b)(8), (g) Mandatory Form (05/2016) FL All Family 011

Sealed Financial Source Documents

p. 1 of __


In re custody of:

Children:



No.

Sealed Financial Source Documents (Cover Sheet)

(SEALFN)

Clerk’s action required.

For use in Family Law and Guardianship cases.

Sealed Financial Source Documents

(Cover Sheet)

Use this form as a cover sheet to keep your financial documents private from the public. On the first page of each document, write the word “SEALED” 1 inch from the top of the page.

Check the documents you are attaching to this cover sheet to be sealed:

Income tax records Pay stubs or other proof of earnings

Credit card statements Bank statements

Checks or the equivalent Loan application documents

Check registers Retirement plan orders

Other financial information sealed by court order (specify):

Submitted by: Petitioner or his/her lawyer Respondent or his/her lawyer

Sign here Print name (if lawyer, also provide WSBA #)

Important! The other person and the lawyers in your case can see your sealed documents. If you need to keep your address information private for safety reasons, you may cross out or delete your address information.

RCW 26.09.135; 26.26.132; 26.10.050 Mandatory Form (07/2017) FL All Family 130

Child Support Order

p. 2 of 16


In re:


And Respondent/s (other party/parties):

No.

Child Support Order

Temporary (TMORS)

Final (ORS)

Clerk’s action required.

Child Support Order

1. Money Judgment Summary

No money judgment is ordered.

Summarize any money judgments from section 22 in the table below.

Judgment for Debtor’s name (person who must pay money)

Creditor’s name (person who must be paid)

Amount Interest

Past due child support from to

$ $

Past due medical support from to

$ $

Past due children’s exp. from to

$ $

Other amounts (describe):

$ $

Yearly Interest Rate for child support, medical support, and children’s expenses: 12% . For other judgments: ____% (12% unless otherwise listed)

Lawyer (name): Represents (name):

Lawyer (name): Represents (name):


Child Support Order

p. 3 of 16

Findings and Orders

2. The court orders child support as part of this family law case. This is a (check one):

temporary order. final order.

3. The Child Support Schedule Worksheets attached or filed separately are approved by the court and made part of this Order.

4. Parents’ contact and employment information

Each parent must fill out and file with the court a Confidential Information form (FL All Family 001) including personal identifying information, mailing address, home address, and employer contact information.

Important! If you move or get a new job any time while support is still owed, you must:

Notify the Support Registry, and

Fill out and file an updated Confidential Information form with the court.

Warning! Any notice of a child support action delivered to the last address you provided on the Confidential Information form will be considered adequate notice, if the party trying to serve you has shown diligent efforts to locate you.

5. Parents’ Income

Parent (name): Parent (name):

Net monthly income $ . (line 3 of the Worksheets)

This income is (check one):

imputed to this parent. (Skip to 6.)

this parent’s actual income (after any exclusions approved below).

Net monthly income $ . (line 3 of the Worksheets)

This income is (check one):

imputed to this parent. (Skip to 6.)

this parent’s actual income (after any exclusions approved below).

Does this parent have income from overtime or a 2nd job?

No. (Skip to 6.)

Yes. (Fill out below.)

Should this income be excluded? (check one):

No. The court has included this income in this parent’s gross monthly income on line 1 of the Worksheets.

Yes. This income should be excluded because: This parent worked over 40 hours per week

averaged over 12 months, and That income was earned to pay for

current family needs debts from a past relationship child support debt, and

This parent will stop earning this extra income after paying these debts.

The court has excluded $ from this parent’s gross monthly income on line 1 of the Worksheets.

Does this parent have income from overtime or a 2nd job?

No. (Skip to 6.)

Yes. (Fill out below.)

Should this income be excluded? (check one):

No. The court has included this income in this parent’s gross monthly income on line 1 of the Worksheets.

Yes. This income should be excluded because: This parent worked over 40 hours per week

averaged over 12 months, and That income was earned to pay for

current family needs debts from a past relationship child support debt, and

This parent will stop earning this extra income after paying these debts.

The court has excluded $ from this parent’s gross monthly income on line 1 of the Worksheets.


Child Support Order

p. 4 of 16


Other Findings:

Other Findings:

6. Imputed Income

To calculate child support, the court may impute income to a parent: whose income is unknown, or who the court finds is unemployed or under-employed by choice.

Imputed income is not actual income. It is an assigned amount the court finds a parent could or should be earning. (RCW 26.19.071(6))


Does not apply. This parent’s actual income is

used. (Skip to 7.)

Does not apply. This parent’s actual income is

used. (Skip to 7.)

This parent’s monthly net income is imputed because (check one):

this parent’s income is unknown.

this parent is voluntarily unemployed.

this parent is voluntarily under-employed.

this parent works full-time but is purposely under-employed to reduce child support.

The imputed amount is based on the information below: (Options are listed in order of required priority. The Court used the first option possible based on the information it had.)

Full-time pay at current pay rate.

Full-time pay based on reliable information about past earnings.

Full-time pay based on incomplete or irregular information about past earnings.

Full-time pay at minimum wage in the area where the parent lives because this parent (check all that apply):

is a high school student.

recently worked at minimum wage jobs.

recently stopped receiving public assistance, supplemental security income (SSI), or disability.

was recently incarcerated.

Table of Median Net Monthly Income.

Other (specify):

This parent’s monthly net income is imputed because (check one):

this parent’s income is unknown.

this parent is voluntarily unemployed.

this parent is voluntarily under-employed.

this parent works full-time but is purposely under-employed to reduce child support.

The imputed amount is based on the information below: (Options are listed in order of required priority. The Court used the first option possible based on the information it had.)

Full-time pay at current pay rate.

Full-time pay based on reliable information about past earnings.

Full-time pay based on incomplete or irregular information about past earnings.

Full-time pay at minimum wage in the area where the parent lives because this parent (check all that apply):

is a high school student.

recently worked at minimum wage jobs.

recently stopped receiving public assistance, supplemental security income (SSI), or disability.

was recently incarcerated.

Table of Median Net Monthly Income.

Other (specify):


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7. Limits affecting the monthly child support amount

Does not apply. The monthly amount was not affected by the upper or lower limits in RCW 26.19.065.

The monthly amount has been affected by (check all that apply):

low-income limits. The self-support reserve and presumptive minimum payment have been calculated in the Worksheets, lines 8.a. - c.

the 45% net income limit. The court finds that the paying parent’s child support obligations for his/her biological and legal children are more than 45% of his/her net income (Worksheets, line 18). Based on the children’s best interests and the parents’ circumstances, it is (check one): fair not fair to apply the 45% limit. (Describe both parents’ situations):

Combined Monthly Net Income over $12,000. Together the parents earn more than $12,000 per month (Worksheets line 4). The child support amount (check one):

is the presumptive amount from the economic table.

is more than the presumptive amount from the economic table because (specify):

8. Standard Calculation

Parent Name Standard calculation Worksheets line 17

$

$

Check here if there is a Residential Split– (each parent has at least one of the children from this relationship living with him/her most of the time.)

These children (names and ages):

These children (names and ages):

Live with (parent’s name): Live with (parent’s name):

The standard calculation for the parent paying support is $ . This is from (check one):

The Attachment for Residential Split Adjustment (Arvey calculation), line G (form WSCSS–Attachment for RSA). This Attachment to the Child Support Schedule Worksheets is approved by the court and made part of this order.


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Other calculation (specify method and attach Worksheet/s):

9. Deviation from standard calculation

Should the monthly child support amount be different from the standard calculation?

No – The monthly child support amount ordered in section 10 is the same as the

standard calculation listed in section 8 because (check one):

Neither parent asked for a deviation from the standard calculation. (Skip to 10.)

There is no good reason to approve the deviation requested by (name/s): The facts supporting this decision are (check all that apply):

detailed in the Worksheets, Part VIII, lines 20 through 26.

the parent asking for a deviation:

has a new spouse or domestic partner with income of $ .

lives in a household where other adults have income of $ .

has income from overtime or a 2nd job that was excluded in section 5

above.

other (specify):

Yes – The monthly child support amount ordered in section 10 is different from the

standard calculation listed in section 8 because (check all that apply):

A parent or parents in this case has:

children from other relationships.

paid or received child support for children from other relationships.

gifts, prizes or other assets.

income that is not regular (non-recurring income) such as bonuses, overtime, etc.

unusual unplanned debt (extraordinary debt not voluntarily incurred).

tax planning considerations that will not reduce the economic benefit to the children.

very different living costs, which are beyond their control.

The children in this case:

spend significant time with the parent who owes support. The non-standard amount still gives the other parent’s household enough money for the children’s basic needs. The children do not get public assistance (TANF).

have extraordinary income.

have special needs because of a disability.

have special medical, educational, or psychological needs.

There are (or will be) costs for court-ordered reunification or a voluntary placement agreement.

The parent who owes support has shown it is not fair to have to pay the $50 per child presumptive minimum payment.


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The parent who is owed support has shown it is not fair to apply the self-support reserve (calculated on lines 8.a. – c. of the Worksheets).

Other reasons:

The facts that support the reasons checked above are (check all that apply):

detailed in the Worksheets, Part VIII, lines 20 through 26.

the parent asking for a deviation:

has a new spouse or domestic partner with income of $ .

lives in a household where other adults have income of $ .

has income from overtime or a 2nd job that was excluded in section 5 above.

as follows:

10. Monthly child support amount (transfer payment)

After considering the standard calculation in section 8, and whether or not to apply a

deviation in section 9, the court orders the following monthly child support amount

(transfer payment).

(Name): must pay child support to (name): each month as follows for the children listed below (add lines for additional children if needed):

Child’s Name Age Amount

1. $

2. $

3. $

4. $

5. $

Total monthly child support amount: $

Child turning twelve years old – The monthly amount for (child’s name) will change to $ starting with the month this child turns twelve (month, year): .

Residential Split – Each parent has at least one of the children from this relationship living with him/her most of the time. (Name): must pay child support to (name): each month as follows:

Total monthly child support amount: $


Child Support Order

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11. Starting date and payment schedule

The monthly child support amount must be paid starting (month, year): on the following payment schedule:

in one payment each month by the day of the month.

in two payments each month: ½ by the and ½ by the day of the month.

other (specify):

12. Step Increase (for modifications or adjustments only)

Does not apply.

Approved – The court is changing a final child support order. The monthly child support amount is increasing by more than 30% from the last final child support order. This causes significant financial hardship to the parent who owes support, so the increase will be applied in two equal steps:

For six months from the Starting Date in section 11 above, the monthly child

support amount will be the old monthly amount plus ½ of the increase, for a total of $ each month.

On (date): , six months after the Starting Date in section 11,

the monthly child support amount will be the full amount listed in section 10.

Denied – The court is changing a final child support order (check one):

but the monthly payment increased by less than 30%.

and the monthly payment increased by more than 30%, but this does not cause a significant hardship to the parent who owes support.

13. Periodic Adjustment

Child support may be changed according to state law. The Court is not ordering a specific periodic adjustment schedule below.

Any party may ask the court to adjust child support periodically on the following schedule without showing a substantial change of circumstances:

The Motion to Adjust Child Support Order may be filed:

every months.

on (date/s):

other (describe condition or event):

Important! A party must file a Motion to Adjust Child Support Order (form FL Modify 521), and the court must approve a new Child Support Order for any adjustment to take effect.

Deadlines, if any (for example, deadline to exchange financial information, deadline to file the motion):


Child Support Order

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14. Payment Method (check either Registry or Direct Pay)

Registry – Send payment to the Washington State Support Registry. The Division of Child Support (DCS) will forward the payments to the person owed support and keep records of all payments.

Address for payment: Washington State Support Registry PO Box 45868, Olympia, WA 98504

Phone number/s: 1 (800) 922-4306 or 1 (800) 442-5437

Important! If you are ordered to send your support payments to the Washington State Support Registry, and you pay some other person or organization, you will not get credit for your payment.

DCS Enforcement (check one):

DCS will enforce this order because (check all that apply):

this is a public assistance case.

one of the parties has already asked DCS for services.

one of the parties has asked for DCS services by signing the application statement at the end of this order (above the Warnings).

DCS will not enforce this order unless one of the parties applies for DCS services or the children go on public assistance.

Direct Pay – Send payment to the other parent or on-parent custodian by:

mail to: street address or PO box city state zip

or any new address the person owed support provides to the parent who owes support. (This does not have to be his/her home address.)

other method:

15. Enforcement through income withholding (garnishment)

DCS or the person owed support can collect the support owed from the wages, earnings, assets or benefits of the parent who owes support, and can enforce liens against real or personal property as allowed by any state’s child support laws without notice to the parent who owes the support.

If this order is not being enforced by DCS and the person owed support wants to have support paid directly from the employer, the person owed support must ask the court to sign a separate wage assignment order requiring the employer to withhold wages and make payments. (Chapter 26.18 RCW.)

Income withholding may be delayed until a payment becomes past due if the court finds good reason to delay.

Does not apply. There is no good reason to delay income withholding.

Income withholding will be delayed until a payment becomes past due because (check one):


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the child support payments are enforced by DCS and there are good reasons in the children’s best interest not to withhold income at this time. If this is a case about changing child support, previously ordered child support has been paid on time.

List the good reasons here:

the child support payments are not enforced by DCS and there are good reasons not to withhold income at this time.

List the good reasons here:

the court has approved the parents’ written agreement for a different payment arrangement.

16. End date for support

Support must be paid for each child until (check one):

the court signs a different order, if this is a temporary order.

the child turns 18 or is no longer enrolled in high school, whichever happens last,

unless the court makes a different order in section 17.

the child turns 18 or is otherwise emancipated, unless the court makes a different

order in section 17.

after (child’s name): turns 18. Based on information available to the court, it is expected that this child will be unable to support him/herself and will remain dependent past the age of 18. Support must be paid until (check one):

this child is able to support him/herself and is no longer dependent on the parents.

other:

other (specify):

17. Post-secondary educational support (for college or vocational school)

Reserved – A parent or non-parent custodian may ask the court for post-secondary educational support at a later date without showing a substantial change of circumstances by filing a Petition to Modify Child Support Order (form FL Modify 501).

The Petition must be filed before child support ends as listed in section 16.

Granted – The parents must pay for the children’s post-secondary educational support. Post-secondary educational support may include support for the period after high school and before college or vocational school begins. The amount or percentage each person must pay (check one):

will be decided later. The parties may make a written agreement or ask the court to set the amount or percentage by filing a Petition to Modify Child Support Order (form FL Modify 501).

is as follows (specify):

Denied – The request for post-secondary educational support is denied.


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Other (specify):

18. Claiming children as dependents on tax forms

Does not apply.

The parties have the right to claim the children as their dependents on their tax forms as follows (check one):

Every year – (name): has the right to claim (children’s names): ; and (name): has the right to claim (children’s names): .

Alternating – (name): has the right to claim the children for (check one): even odd years. The other parent has the right to claim the children for the opposite years.

Other (specify):

For tax years when a non-custodial parent has the right to claim the children, the parents must cooperate to fill out and submit IRS Form 8332 in a timely manner.

Warning! Under federal law, the parent who claims a child as a dependent may owe a tax penalty if the child is not covered by health insurance.

19. Health Insurance

Important! Read the Health Insurance Warnings at the end of this order.

The court is not ordering how health insurance must be provided for the children because the court does not have enough information to determine the availability of accessible health insurance for the children (insurance that could be used for the children’s primary care). The law requires every parent to provide or pay for health insurance. The Division of Child Support (DCS) or any parent can enforce this

requirement. (Skip to 20.)

OR

(Name): must pay the premium to provide health insurance coverage for the children. The court has considered the needs of the children, the cost and extent of coverage, and the accessibility of coverage.

The other parent must pay his/her proportional share* of the premium paid. Health insurance premiums (check one):

are included on the Worksheets (line 14). No separate payment is needed.

are not included on the Worksheets. Separate payment is needed. A parent or non-parent custodian may ask DCS or the court to enforce payment for the proportional share.

* Proportional share is each parent’s percentage share of the combined net income from line 6 of the Child Support Schedule Worksheets.

The other parent is not ordered to pay for any part of the children’s insurance because (explain):


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A parent has been ordered to pay an amount that is more than 25% of his/her basic support obligation (Worksheets, line 19). The court finds this is in the children’s best interest because:

Neither parent can be ordered to pay an amount towards health insurance premiums that is more than 25% of his/her basic support obligation (Worksheets, line 19) unless the court finds it is in the best interest of the children.

Other (specify):

20. Health insurance if circumstances change or court has not ordered

If the parties’ circumstances change, or if the court is not ordering how health insurance

must be provided for the children in section 19:

A parent, non-parent custodian, or DCS can enforce the medical support requirement.

If a parent does not provide proof of accessible private insurance (insurance that can be used for the children’s primary care), that parent must:

Get (or keep) insurance through his/her work or union, unless the insurance costs more than 25% of his/her basic support obligation (line 19 of the Worksheets),

Pay his/her share of the other parent’s monthly premium up to 25% of his/her basic support obligation (line 19 of the Worksheets), or

Pay his/her share of the monthly cost of any public health care coverage, such as Healthy Kids, BHP, or Medicaid, for which there is an assignment.

21. Children’s expenses not included in the monthly child support amount

Uninsured medical expenses – Each parent is responsible for a share of uninsured medical expenses as ordered below. Uninsured medical expenses include premiums, co-pays, deductibles, and other health care costs not covered by insurance.

Children’s Expenses for:

Parent (name):

pays monthly

Parent (name):

pays monthly

Make payments to:

Person who pays the expense

Service Provider

Uninsured medical expenses

Proportional Share*

%**

Proportional Share*

%**

* Proportional Share is each parent’s percentage share of the combined net income from line 6 of the Child Support Schedule Worksheets.

** If the percentages ordered are different from the Proportional Share, explain why:

Other shared expenses (check one):


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Does not apply. The monthly amount covers all expenses, except health care expenses.

The parents will share the cost for the expenses listed below (check all that apply):

Children’s Expenses for:

Parent (name):

pays monthly

Parent (name):

pays monthly

Make payments to:

Person who pays the expense

Service Provider

Day care:

Proportional Share*

$

%**

Proportional Share*

$

%**

Education:

Proportional Share*

$

%**

Proportional Share*

$

%**

Long-distance transportation:

Proportional Share*

$

%**

Proportional Share*

$

%**

Other (specify):

Proportional Share*

$

%**

Proportional Share*

$

%**

* Proportional Share is each parent’s percentage share of the combined net income from line 6 of the Child Support Schedule Worksheets.

** If any percentages ordered are different from the Proportional Share, explain why:

Other (give more detail about covered expenses here, if needed):

A person receiving support can ask DCS to collect:

expenses owed directly to him/her.

reimbursement for expenses the person providing support was ordered to pay.

an order for a money judgment that s/he got from the court.

22. Past due child support, medical support and other expenses

This order does not address any past due amounts or interest owed.

As of (date): , neither parent owes (check all that apply):

past due child support interest on past due child support

past due medical support interest on past due medical support


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past due other expenses interest on past due other expenses

to (check all that apply): the other parent or non-parent custodian. the state.

The court orders the following money judgments (summarized in section 1 above):

Judgment for Debtor’s name (person who must pay money)

Creditor’s name (person who must be paid)

Amount Interest

Past due child support from to

$ $

Past due medical support (health ins. & health care costs not covered by ins.) from to

$ $

Past due expenses for:

day care

education

long-distance transp.

from to

$ $

Other (describe):

$ $

The interest rate for child support judgments is 12%.

Other (specify):

23. Overpayment caused by change

Does not apply.

The Order signed by the court today or on date: caused an overpayment of $ .

(Name): shall repay this amount to (Name): by (date): .

The overpayment shall be credited against the monthly support amount owed each month at the rate of $ each month until paid off.

Other (specify):


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24. Other Orders

All the Warnings below are required by law and are incorporated and made part of this order.

Other (specify):

Ordered.

Date Judge or Commissioner

Petitioner and Respondent or their lawyers fill out below:

This document (check any that apply): This document (check any that apply): is an agreement of the parties is an agreement of the parties is presented by me is presented by me may be signed by the court without notice to me may be signed by the court without notice to me

Petitioner signs here or lawyer signs here + WSBA # Respondent signs here or lawyer signs here + WSBA #

Print Name Date Print Name Date

If any parent or child received public assistance:

The state Department of Social and Health Services (DSHS) was notified about this order through the Prosecuting Attorney’s office, and has reviewed and approved the following:

child support medical support

past due child support other (specify):

Deputy Prosecutor signs here Print name and WSBA # Date

Parent or Non-Parent Custodian applies for DCS enforcement services:

I ask the Division of Child Support (DCS) to enforce this order. I understand that DCS will keep $25 each year as a fee if DCS collects more than $500, unless I ask to be excused from paying this fee in advance. (You may call DCS at 1-800-442-5437. DCS will not charge a fee if you have ever received TANF, tribal TANF, or AFDC.)

Parent or Non-Parent Custodian signs here Print name Date (lawyer cannot sign for party)

All the warnings below are required by law and are part of the order. Do not remove.

Warnings!

If you don’t follow this child support order…

DOL or other licensing agencies may deny, suspend, or refuse to renew your licenses, including your driver’s license and business or professional licenses, and

Dept. of Fish and Wildlife may suspend or refuse to issue your fishing and hunting licenses and you may not be able to get permits. (RCW 74.20A.320)


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If you receive child support…

You may have to:

Document how that support and any cash received for the children’s health care was spent.

Repay the other parent for any day care or special expenses included in the support if you didn’t actually have those expenses. (RCW 26.19.080)

Health Insurance Warnings!

Both parents must keep the Support Registry informed whether or not they have access to health insurance for the children at a reasonable cost, and provide the policy information for any such insurance.

* * *

If you are ordered to provide children’s health insurance…

You have 20 days from the date of this order to send: proof that the children are covered by insurance, or proof that insurance is not available as ordered. Send your proof to the other parent or to the Support Registry (if your payments go there). If you do not provide proof of insurance: The other parent or the support agency may contact your employer or union, without notifying you, to ask for direct

enforcement of this order (RCW 26.18.170), and The other parent may:

Ask the Division of Child Support (DCS) for help, Ask the court for a contempt order, or File a Petition in court.

Don’t cancel your children’s health insurance without the court’s approval, unless your job ends and you can no longer

get or continue coverage as ordered in section 19 through your job or union. If your insurance coverage for the children

ends, you must notify the other parent and the Support Registry. If an insurer sends you payment for a medical provider’s service: you must send it to the medical provider if the provider has not been paid; or you must send the payment to whoever paid the provider if someone else paid the provider; or you may keep the payment if you paid the provider.

If the children have public health care coverage, the state can make you pay for the cost of the monthly premium. Always inform the Support Registry and other parent if your access to health insurance changes or ends.

RCW 26.10.160 Mandatory Form (05/2016) FL Non-Parent 405

Residential Schedule (Non-Parent Custody)

p. 1 of 14


In re custody of:

Children:



No.


(PRS / TRS / RS)

Clerk’s action required: 1.


1. This residential schedule is a (check one):

Proposal (request) by a party (name/s): . It is not a signed court order. (PRS)

Court order signed by a judge or commissioner. This is a (check one):

Temporary order. (TRS)

Final order. (RS)

This final residential schedule changes the last final residential schedule.

2. Custody – The Petitioner/s is/are granted custody of the following children:

Child’s name Age Child’s name Age

1. 4.

2. 5.

3.

6.



p. 2 of 14

3. Reasons for limiting a parent’s visitation (under RCW 26.10.160)

a. (Parent’s name):

Abandonment, neglect, child abuse, domestic violence, assault, or sex offense.

(If this parent has any of these problems, the court must limit his or her contact with

the children and right to make decisions for the children.)

This parent does not have any of these problems. (Skip to 3.b.)

This parent has one or more of these problems as follows (check all that apply):

Abandonment – S/he intentionally abandoned a child listed in 2 for an

extended time.

Neglect – S/he substantially refused to perform his/her parenting duties for a

child listed in 2.

Child Abuse – S/he (or someone living in his/her home) abused or threatened to abuse a child. The abuse was (check all that apply): physical sexual

repeated emotional abuse.

Domestic Violence – S/he (or someone living in his/her home) has a history of domestic violence as defined in RCW 26.50.010(1).

Assault – S/he (or someone living in his/her home) has assaulted or sexually assaulted someone causing grievous physical harm or fear of such harm.

Sex Offense –

S/he has been convicted of a sex offense as an adult.

Someone living in this parent’s home has been convicted as an adult or adjudicated as a juvenile of a sex offense.

Other (specify):

b. (Parent’s name):

Abandonment, neglect, child abuse, domestic violence, assault, or sex offense.

(If this parent has any of these problems, the court must limit his or her contact with

the children and right to make decisions for the children.)

This parent does not have any of these problems. (Skip to 4.)

This parent has one or more of these problems as follows (check all that apply):

Abandonment – S/he intentionally abandoned a child listed in 2 for an

extended time.

Neglect – S/he substantially refused to perform his/her parenting duties for a

child listed in 2.

Child Abuse – S/he (or someone living in his/her home) abused or threatened to abuse a child. The abuse was (check all that apply): physical sexual

repeated emotional abuse.



p. 3 of 14

Domestic Violence – S/he (or someone living in his/her home) has a history of domestic violence as defined in RCW 26.50.010(1).

Assault – S/he (or someone living in his/her home) has assaulted or sexually assaulted someone causing grievous physical harm or fear of such harm.

Sex Offense –

S/he has been convicted of a sex offense as an adult.

Someone living in this parent’s home has been convicted as an adult or adjudicated as a juvenile of a sex offense.

Other (specify):

4. Limitations on visitation

a. (Parent’s name):

Does not apply. There are no reasons for limitations checked in 3.a. above. (Skip

to 4.b.)

Because of the limiting factors checked in 3.a. above, this parent has visitation as

follows (check all that apply):

No visitation with the children.

Limited visitation as shown in the Parents’ Visitation Schedule (5 – 8) below.

Limited visitation as follows (specify schedule, list all contact here instead of in

a Parents’ Visitation Schedule, skip sections 5 – 8):

Supervised visitation. All visits shall be supervised. Any costs of supervision must be paid by (name):

The supervisor shall be:

a professional supervisor (name):

a non-professional supervisor (name):

The dates and times of supervised contact will be:

as shown in the Parents’ Visitation Schedule (sections 5 – 8) below.

as follows (specify):

(Specific rules for supervision, if any):

Other limitations or conditions during visitation (specify):



p. 4 of 14

Evaluation or treatment required. This parent must:

be evaluated for: .

start (or continue) and comply with treatment:

as recommended by the evaluation.

as follows (specify kind of treatment and any other details):

provide a copy of the evaluation and compliance reports (specify details):

If this parent does not follow the evaluation or treatment requirements above, then

(what happens):

No limitations despite reasons. Despite the limiting factors checked in 3.a.

above, there should be no limitations or conditions on this parent’s visitation because the limiting factors do not involve a sex offense and (check one or more):

the parent’s past conduct checked above did not affect the children.

contact with the children will not cause them physical, sexual, or emotional harm, and it is so unlikely that the parent will behave in a harmful or abusive way again that it is not in the children’s best interest to limit visitation.

b. (Parent’s name):

Does not apply. There are no reasons for limitations checked in 3.b. above. (Skip

to Parents’ Visitation Schedule.)

Because of the limiting factors checked in 3.b. above, this parent has visitation as

follows (check all that apply):

No visitation with the children.

Limited visitation as shown in the Parents’ Visitation Schedule (5 – 8) below.

Limited visitation as follows (specify schedule, list all contact here instead of in

a Parents’ Visitation Schedule, skip sections 5 – 8):

Supervised visitation. All visits shall be supervised. Any costs of supervision must be paid by (name):

The supervisor shall be:

a professional supervisor (name):

a non-professional supervisor (name):



p. 5 of 14

The dates and times of supervised contact will be:

as shown in the Parents’ Visitation Schedule (sections 5 – 8) below.

as follows (specify):

(Specific rules for supervision, if any):

Other limitations or conditions during visitation (specify):

Evaluation or treatment required. This parent must:

be evaluated for: .

start (or continue) and comply with treatment:

as recommended by the evaluation.

as follows (specify kind of treatment and any other details):

provide a copy of the evaluation and compliance reports (specify details):

If this parent does not follow the evaluation or treatment requirements above, then

(what happens):

No limitations despite reasons. Despite the limiting factors checked in 3.b.

above, there should be no limitations or conditions on this parent’s visitation because the limiting factors do not involve a sex offense and (check one or more):

the parent’s past conduct checked above did not affect the children.

contact with the children will not cause them physical, sexual, or emotional harm, and it is so unlikely that the parent will behave in a harmful or abusive way again that it is not in the children’s best interest to limit visitation.

Parents’ Visitation Schedule

Check one:

Skip the parents’ visitation schedule in sections 5 - 8 if both parents have no contact with

the children other than what is described in section 4 – Limitations.

The children live with the Petitioner/s except as described in section 4.

Complete the parents’ visitation schedule in sections 5 - 8.



p. 6 of 14

5. School Schedule

a. Children under School-Age

Does not apply. All children are school-age.

The schedule for children under school-age is the same as for school-age children.

Children under school-age will live with Petitioner/s except when they are scheduled to be with a parent.

Parent (name): ’s visitation schedule is (check all that apply):

WEEKENDS: every week every other week other (specify):

from (day) at : .m. to (day) at : .m.


OTHER (specify):





OTHER (specify):

Other (specify):

b. School-Age Children

This schedule will apply when (check one): the youngest child the oldest child each child begins:

(check one): Kindergarten 1st grade Other:

The children will live with the Petitioner/s except when they are scheduled to be with a parent.





OTHER (specify):



p. 7 of 14





OTHER (specify):

Other (specify):

6. Summer Schedule

Summer begins and ends according to the school calendar. as follows:

.

The Summer Schedule is the same as the School Schedule. (Skip to 7.)

The Summer Schedule is the same as the School Schedule except that (name/s): shall spend weeks of uninterrupted vacation time with the children each summer. The parties shall confirm their vacation schedules in writing by the end of (date) each

year. (Skip to 7.)

The Summer Schedule is different than the School Schedule. The Summer Schedule will begin the summer before: (check one): the youngest child the oldest child each child begins (check one): Kindergarten 1st grade Other:

During the summer the children will live with the Petitioner/s except when they are scheduled to be with a parent.





OTHER (specify):





OTHER (specify):



p. 8 of 14

7. Holiday Schedule (includes school breaks)

The Holiday Schedule is the same as the School and Summer Schedules above for all

holidays and school breaks. (Skip to 8.)

This is the Holiday Schedule for all children school-age children only.

The children will be with the Petitioner/s for all holidays and school breaks except as listed below. (Put one parent’s name in each column and fill out when the children will be with that parent for holidays and school breaks.)

Holiday Children with (name): Children with (name):

Odd Years Even Years Every Yr. Odd Years Even Years Every Yr.

Begin day/time: Begin day/time:

End day/time: End day/time:

With the person who has the children for the attached weekend

Other plan:





Other plan:




Each person has the children for the half of break attached to his/her weekend. The children must be exchanged on Wednesday at (time): .

Other plan:




Each person has the children for the half of break attached to his/her weekend. The children must be exchanged on Wednesday at (time): .

Other plan:






p. 9 of 14


Other plan:





Other plan:




Other plan:




Follow the Summer Schedule in section 6.

Other plan:





Other plan:




Other plan:






p. 10 of 14


Other plan:




Follow the Winter Break schedule above.

Other plan:





Other plan:





Other plan:




Other plan:

All three-day weekends not listed elsewhere

(Federal holidays, school in-service days, etc.)

The children shall spend any unspecified holiday or non-school day with the person who has them for the attached weekend.

Other plan:




Other plan:



p. 11 of 14


Other occasion important to the family:

_________




Other plan:

8. Conflicts in Scheduling

The Holiday Schedule must be observed over all other schedules. If there are conflicts within the Holiday Schedule (check all that apply):

Named holidays shall be followed before school breaks.

Children’s birthdays shall be followed before named holidays and school breaks.

Other (specify):

9. Transportation Arrangements

The children will be exchanged for visitation (picked up and dropped off) at:

each party’s home

school or day care when in session

other location (specify):

Who is responsible for arranging transportation?

The picking up party – The person who is about to start time with the children must arrange to have the children picked up.

The dropping off party – The person whose time is ending must arrange to have the children dropped off.

All transportation will be arranged by (name): .

Other details (if any):

10. Moving with the Children (Relocation)

If the custodian plans to move, s/he must notify every person who has court-ordered time with the children.

Move to a different school district

If the move is to a different school district, the custodian must complete the form Notice of Intent to Move with Children (FL Relocate 701) and deliver it at least 60 days before the intended move.



p. 12 of 14

Exceptions:

If the custodian could not reasonably have known enough information to complete the form in time to give 60 days’ notice, the custodian must give notice within 5 days after learning the information.

If the custodian is relocating to a domestic violence shelter or moving to avoid a clear, immediate and unreasonable risk to health or safety, notice may be delayed 21 days.

If information is protected under a court order or the address confidentiality program, it may be withheld from the notice.

A custodian who believes that giving notice would put her/himself or a child at unreasonable risk of harm, may ask the court for permission to leave things out of the notice or to be allowed to move without giving notice. Use form Motion to Limit Notice of Intent to Move with Children (Ex Parte) (FL Relocate 702).

The Notice of Intent to Move with Children can be delivered by having someone personally serve the other party or by any form of mail that requires a return receipt.

If the custodian wants to change the Parenting Plan because of the move, s/he must deliver a proposed Parenting Plan together with the Notice.

Move within the same school district

If the move is within the same school district, the custodian still has to let the other parent know. However, the notice does not have to be served personally or by mail with a return receipt. Notice to the other party can be made in any reasonable way. No specific form is required.

Warning! If you do not notify…

A custodian who does not give the required notice may be found in contempt of court. If that happens the court can impose sanctions. Sanctions can include requiring the custodian to bring the children back if the move has already happened, and ordering the custodian to pay the other side’s costs and lawyer’s fees.

Right to object

A person who has court-ordered time with the children can object to a move to a different school district and/or to the custodian’s proposed Parenting Plan. If the move is within the same school district, the other party doesn’t have the right to object to the move, but s/he may ask to change the Parenting Plan if there are adequate reasons under the modification law (RCW 26.09.260).

An objection is made by filing the Objection about Moving with Children and Petition about Changing a Parenting/Custody Order (Relocation) (form FL Relocate 721). File your Objection with the court and serve a copy on the custodian and anyone else who has court-ordered time with the children. Service of the Objection must be by personal service or by mailing a copy to each person by any form of mail that requires a return receipt. The Objection must be filed and served no later than 30 days after the Notice of Intent to Move with Children was received.

Right to move

During the 30 days after the Notice was served, the custodian may not move to a different school district with the children unless s/he has a court order allowing the move.

After the 30 days, if no Objection is filed, the custodian may move with the children without getting a court order allowing the move.



p. 13 of 14

After the 30 days, if an Objection has been filed, the custodian may move with the children pending the final hearing on the Objection unless:

The other party gets a court order saying the children cannot move, or

The other party has scheduled a hearing to take place no more than 15 days after the date the Objection was served on the custodian. (However, the custodian may ask the court for an order allowing the move even though a hearing is pending if the custodian believes that s/he or a child is at unreasonable risk of harm.)

The court may make a different decision about the move at a final hearing on the Objection.

Parenting Plan after move

If the custodian served a proposed Parenting Plan with the Notice, and if no Objection is filed within 30 days after the Notice was served (or if the parties agree):

Both parties may follow that proposed plan without being held in contempt of the Parenting Plan that was in place before the move. However, the proposed plan cannot be enforced by contempt unless it has been approved by a court.

Either party may ask the court to approve the proposed plan. Use form Ex Parte Motion for Final Order Changing Parenting Plan – No Objection to Moving with Children (FL Relocate 706).

Forms

You can find forms about moving with children at:

The Washington State Courts’ website: www.courts.wa.gov/forms,

The Administrative Office of the Courts – call: (360) 705-5328,

Washington LawHelp: www.washingtonlawhelp.org, or

The Superior Court Clerk’s office or county law library (for a fee).

(This is a summary of the law. The complete law is in RCW 26.09.430 through 26.09.480.)

11. Other

12. Proposal

Does not apply. This is a court order.

This is a proposed (requested) residential schedule. (The person/s requesting this schedule must read and sign below.)

I declare under penalty of perjury under the laws of the state of Washington that this

schedule was proposed in good faith and the information in section 3 above is true.

Person requesting schedule signs here Signed at (city and state)

Other person requesting schedule. (if agreed) signs here Signed at (city and state)

13. Court Order

Does not apply. This is a proposal.



p. 14 of 14

This is a court order (if signed by a judge or commissioner below).

Findings of Fact – Based on the pleadings and any other evidence considered:

The Court adopts the statements in section 3 (Reasons for limiting a parent’s

visitation) as its findings.

The Court makes additional findings which are:

contained in an order or findings of fact entered at the same time as this Residential Schedule.

attached as Exhibit A as part of this Residential Schedule.

other:

Conclusions of Law – This Residential Schedule is in the best interest of the children.

Other:

Order – The parties must follow this Residential Schedule.

Date Judge or Commissioner signs here

Warning! If you don’t follow this Residential Schedule, the court may find you in contempt (RCW 26.09.160). You still have to follow this Residential Schedule even if the other party doesn’t.

Violation of residential provisions of this order with actual knowledge of its terms is punishable by contempt of court and may be a criminal offense under RCW 9A.40.060(2) or 9A.40.070(2). Violation of this order may subject a violator to arrest.

If this is a court order, the parties and/or their lawyers (and any GAL) sign below.

This order (check any that apply): This order (check any that apply): is an agreement of the parties. is an agreement of the parties. is presented by me. is presented by me. may be signed by the court without notice to me. may be signed by the court without notice to me.

Petitioner signs here or lawyer signs here + WSBA # Respondent signs here or lawyer signs here + WSBA #


This order (check any that apply): This order (check any that apply): is an agreement of the parties. is an agreement of the parties. is presented by me. is presented by me. may be signed by the court without notice to me. may be signed by the court without notice to me.

Other party or lawyer signs here + WSBA # Other party or Guardian ad Litem signs here


3116EN RESIDENTIAL SCHEDULES AND CHILD SUPPORT: NON-PARENT CUSTODY EVALUATION FORM

Your comments are appreciated and will help to make this packet more useful to others.

Please take a moment to complete this form and return it to: LeeAnn Friedman

Northwest Justice Project 500 W. 8th, Suite 275

Vancouver, WA 98660 Or email to [email protected]

1. Where did you get this packet?

CLEAR washingtonlawhelp.org Court Clerk or Facilitator

Other:

2. What is your primary language?

3. Are you low-income? yes no

4. What is the last grade you finished in school?

5. Did you read the instructions? yes no

6. Did you need the help of an agency, court facilitator, or advocate to complete your

case? yes no

If yes, what agency or individual helped you?

7. Did you find anything hard to understand? yes no

If yes, please tell us what.

8. Did you find any mistakes? yes no

Describe mistakes. Include the page #.

9. Additional Comments [use back if you need to]:

10. Today’s Date:

mailto:[email protected]
