CHILD SUPPORT CALCULATION WORKSHEET
State of Mississippi — Percentage of Income Model
Court: [________________________________]
County: [________________________________]
Case Number: [________________________________]
Chancellor/Judge: [________________________________]
TABLE OF CONTENTS
- Party and Children Information
- Non-Custodial Parent Gross Income
- Adjusted Gross Income
- Statutory Percentage Calculation
- Healthcare and Additional Expenses
- Total Child Support Obligation
- Deviations from Guidelines
- Duration and Termination
- Mississippi-Specific Notes
1. PARTY AND CHILDREN INFORMATION
Custodial Parent:
Name: [________________________________]
Address: [________________________________]
Employer: [________________________________]
Non-Custodial Parent:
Name: [________________________________]
Address: [________________________________]
Employer: [________________________________]
Children Subject to This Order:
| # | Full Legal Name | Date of Birth | Age | Resides Primarily With |
|---|---|---|---|---|
| 1 | [________________] | [__/__/____] | [____] | ☐ Custodial ☐ Non-Custodial |
| 2 | [________________] | [__/__/____] | [____] | ☐ Custodial ☐ Non-Custodial |
| 3 | [________________] | [__/__/____] | [____] | ☐ Custodial ☐ Non-Custodial |
| 4 | [________________] | [__/__/____] | [____] | ☐ Custodial ☐ Non-Custodial |
Custody Arrangement:
☐ Sole physical custody — Custodial Parent
☐ Joint physical custody
☐ Split custody (each parent has physical custody of at least one child)
2. NON-CUSTODIAL PARENT GROSS INCOME
| Income Source | Non-Custodial Parent (Monthly) |
|---|---|
| Salary/Wages | $[________] |
| Commissions/Bonuses | $[________] |
| Self-Employment (net) | $[________] |
| Rental Income | $[________] |
| Dividends/Interest | $[________] |
| Pension/Retirement | $[________] |
| Social Security Benefits | $[________] |
| Workers' Compensation | $[________] |
| Unemployment Benefits | $[________] |
| Alimony Received (from other relationship) | $[________] |
| Disability Benefits | $[________] |
| Trust/Estate Income | $[________] |
| Other: [____________] | $[________] |
| TOTAL MONTHLY GROSS INCOME | $[________] |
☐ Income imputed — Basis: [________________________________]
3. ADJUSTED GROSS INCOME
| Deduction | Monthly Amount |
|---|---|
| Federal income tax | $[________] |
| State income tax | $[________] |
| FICA (Social Security and Medicare) | $[________] |
| Mandatory retirement contributions | $[________] |
| Pre-existing child support obligations | $[________] |
| TOTAL DEDUCTIONS | $[________] |
| ADJUSTED GROSS INCOME | $[________] |
4. STATUTORY PERCENTAGE CALCULATION
Number of children subject to this order: [____]
| Number of Children | Statutory Percentage |
|---|---|
| ☐ 1 child | 14% |
| ☐ 2 children | 20% |
| ☐ 3 children | 22% |
| ☐ 4 children | 24% |
| ☐ 5 or more children | 26% |
Applicable Percentage: [____]%
Calculation:
Adjusted Gross Income: $[________] x [____]% = $[________] per month
5. HEALTHCARE AND ADDITIONAL EXPENSES
| Additional Expense | Monthly Amount | Responsibility |
|---|---|---|
| Health insurance premiums for child(ren) | $[________] | ☐ Custodial ☐ Non-Custodial ☐ Shared |
| Unreimbursed medical/dental expenses | $[________] | ☐ Custodial ☐ Non-Custodial ☐ Shared |
| Child care costs | $[________] | ☐ Custodial ☐ Non-Custodial ☐ Shared |
| Extraordinary educational expenses | $[________] | ☐ Custodial ☐ Non-Custodial ☐ Shared |
| Other: [____________] | $[________] | ☐ Custodial ☐ Non-Custodial ☐ Shared |
| TOTAL ADDITIONAL EXPENSES | $[________] |
6. TOTAL CHILD SUPPORT OBLIGATION
| Component | Monthly Amount |
|---|---|
| Basic child support (statutory percentage) | $[________] |
| Additional expenses allocated to non-custodial parent | $[________] |
| TOTAL MONTHLY CHILD SUPPORT | $[________] |
7. DEVIATIONS FROM GUIDELINES
☐ No deviation requested
☐ Deviation requested — Basis:
☐ Extraordinary medical, psychological, or educational needs of the child
☐ The age of the child and its impact on costs
☐ Season or cyclical variations in income
☐ Shared custody or joint custody arrangement reducing expenses
☐ The income of the custodial parent
☐ The support obligations to other children or dependents
☐ The particular needs of the child
☐ Other: [________________________________]
Requested adjustment: $[________] per month (☐ increase / ☐ decrease)
Justification: [________________________________]
8. DURATION AND TERMINATION
Child support shall continue for each child until:
☐ The child reaches age 21
☐ The child is emancipated
☐ The child marries
☐ Other: [________________________________]
9. MISSISSIPPI-SPECIFIC NOTES
- Percentage of Income Model: Mississippi is one of a few states using the Percentage of Income Model, basing support solely on the non-custodial parent's adjusted gross income (§ 43-19-101).
- Custodial Parent Income Not Considered: Unlike Income Shares states, the custodial parent's income is not part of the statutory percentage calculation.
- Statutory Percentages: 14% (1 child), 20% (2), 22% (3), 24% (4), 26% (5+).
- Age 21 Obligation: Mississippi extends child support obligations to age 21, which is higher than most states.
- Pending Legislation: There have been legislative proposals to switch Mississippi to an Income Shares Model (e.g., HB 1552, 2025 session), but these have not been enacted as of this date.
- Modification: Either party may seek modification upon a material change in circumstances.
VERIFICATION
I declare under penalty of perjury that the information provided in this worksheet is true, correct, and complete to the best of my knowledge.
Custodial Parent:
Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]
Non-Custodial Parent:
Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]
SOURCES AND REFERENCES
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