Commonwealth of Virginia Va. Code � 20-108.2                          
                      MOTHER       FATHER
1. Monthly Gross Income (see instructions)         $     $
2. Adjustments for spousal support payments (see instructions)                      
  a. Deduction from payor's income         -$     -$
  b. Addition to recipient's income         $     $
3. Adjustments for support of child(ren)(see instructions)   -$     -$
4. Deductions from Monthly Gross Income allowable by law     -$     -$
  (see instructions)                                  
5. a. Available monthly income           $     $
  b. Combined monthly available income                              
    (combine both available monthly income fugures from line 5.a.)     $      
6. Number of children in the present case for whom support is sought            
7. a. Monthly basic child support obligation                    
    (from schedule-see instructions)           a. $      
  b. Monthly amount allowable for health care coverage            
    (see instructions)               b. $      
  c. Monthly amount allowable for employment-related child care expenses            
    (see instructions)               c. $      
  d. Less actual monthly tax savings from child-care cost deductions or credits            
    (see instructions) d. $      
8. Total monthly child support obligation (add lines 7.a., 7.b. and 7.c. and subtract 7.d.) $      
                      MOTHER       FATHER
9. Percent obligation of each party (divide "available monthly income" on   %     %
  line 5.a. by line 5.b.)                              
10. Monthly child support obligation of each party (multiply line 8 by line 9) $     $  
11. Deduction by non-custodial parent for health care coverage when paid                    
  directly by non-custodial parent (from line 7.b) $     $  
12. Adjustments (if any) to Child Support Guidelines Calculation   MOTHER       FATHER
  a. Credit for benefits received by or for the child derived from the parent's -$     -$  
    entitlement to disability insurance benefits to the extent that such                  
    derivative benefits are included in a parent's gross income  
  b. use +/- $     $  
  c. use +/- $     $  
13. Each party's adjusted share (add or subtract lines 11 and 12 from line 10) $     $  
  Child support payable to custodial parent (check one): Mother Father $    
VA FORM DC-637 v. 2004-2005