attention1).pdf · father to marry and for the father to then recognize the child as his. ......
TRANSCRIPT
ATTENTION PLEASE READ ALL FORMS AND INSTRUCTIONS VERY CAREFULLY WE ARE NOT ATIORNEYS AND WE CAN NOT AND WILL NOT PROVIDE YOU WITH ANY LEGAL ASSISTANCE OR ANSWER ANY QUESTIONS WE WILL ONLY PROVIDE THE FORMS TO YOU AS A COURTESY AND IF YOU PROCEED IN PRO-SE FORM YOU ARE ACTING AS YOUR OWN ATIORNEY IF YOU DO NOT UNDERSTAND OR NEED HELP YOU MUST CONSULT AN ATIORNEY PLEASE UNDERSTAND THAT THIS MAY NOT BE ALL YOU NEED AND A JUDGE MAY REQUIRE OTHER DOCUMENTATION OR REQUIREMENTS BEFORE AN ORDER CAN BE GRANTED YOU CAN GO TO WWWGEORGIALEGALAIDCOM FOR FURTHER ASSISTANCE IF NEEDED FILING A CIVIL CASE IS $21000 CASH WOUT SERVICE AND IF YOU HAVE TO SERVE THE OTHER PARTY IT IS $26000 IF YOU HAVE TO RUN A PUBLICIATION IN THE NEWS PAPER THAT IS AN ADDITIONAL COST THAT MUST BE PAID TO THE ROME NEWS TRIBUNE AND YOU MUST DISCUSS THE PUBLICATION FEE WITH THEM
BARBARA PENSON CLERK OF COURTmiddot
LEGITIMATION PACKET
FAQ
hy should children be legitimated
The law encourages the fathers ofchildren to legally recognize them The legitimization process is a way for them to do this It gives the father and the child certain rights Legitimization means that a child may inherit from the father and the father may inherit from the child
How maya child born out of wedlock be legitimated
There are three ways to legitimate a child The first way is for the mother and the reputed father to marry and for the father to then recognize the child as his
The second way is for the mother and father to sign a voluntary acknowledgement of paternity According to OCGA sect 19-7-22(g)(2) In any voluntary acknowledgment of paternity which has been made and has not been rescinded pursuant to Code Section 19shy7-461 when both the mother and father freely agree and consent the child may be legitimated by the inclusion ofa statement indicating a voluntary acknowledgment of legitimation For more information on how to sign a voluntary acknowledgement of
paternity or call the Georgia Paternity Acknowledgement program at 1-866-296-8262
The third way to legitimate a child is for the father to file a legitimization petition in Superior Court
How do I get a certified copy of my childs signed voluntary acknowledgementof paternity
Write to the Georgia Department of Vital Records at 2600 Skyland Dr NE Atlanta GA 30319 The following items must be included with your request
1 Full name of person shown on the birth certificate (last name at birth iffemale) 2 Date ofBirth (month day year) 3 Place ofBirth (city county) 4 Current age 5 Sex 6 Race (optional) 7 Full name of mother (include mothers maiden last name) 8 Full name of father
9 Relationship to the person named on the birth certificate requested 10 The number ofcertified copies requested II A copy of the birth certificate 12 A photocopy of the requestors drivers license 13 A money order in the amount of$1 0 per certified copy requested
How does a man go about filing for legitimization in the superior or state court
The first step is for the father to file a petition in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship of the child resides outside the state or cannot after due diligence be found within the state the petition may be filed in the county of the fathers residence or the county ofthe childs residence Ifa petition for the adoption of the child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed (OCGA 19shy7-22) The mother of the child must be named as a party served with a copy of the petition and given an opportunity to be heard
The father has no absolute right to legitimate a child The Court will consider the best interest of the minor in determining whether the legitimization should be awarded Sometimes a Court will deny a legitimization petition ifthe Court believes that it has been filed to harass or interfere with the life of the mother
Vhat effect does a legitimization have
The Court will pass an order declaring the child legitimate and capable of inheriting from the father just as if the child had been born during a marriage
At the time of the legitimization the Judge will determine the duty of the father to support the child Additionally the Court may order visitation andor custody based on the best interests of the child The Court may also change the childs name to that of the father but the Court has wide discretion as to whether or not it will do so
Vhen the father files for legitimization may he also ask for custody
Until July 12005 the father could only get custody in a legitimization action if the mother consented The Georgia Legislature changed OCGA sect 9-7-22 effective July 12005 to allow a father to ask for custody in a legitimIzation suit
Vhat if paternity has been established-isnt that enough for legitimization
No a finding in a paternity action that a person is the father ofa child is not a legitimization Paternity establishes the identity of the biological father and it establishes the fathers duty to support the child After July 12005 it can also establish custody
2
OeGA sect 19-7-2 provides that the petition for legitimization may be brought in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship ofthe child resides outside the state or cannot after due diligence be found -vithin the state the petition may be filed in the county of the fathers residence or the county of the childs residence If a petition for the adoption ofthe child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed
OeGA sect 19-7-40(a) gives the superior and state COLlrts concurrent jurisdiction in all proceed ings for the determination of paternity ofchildren who are Georgia residents
3
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1 THE SUPERIOR COliRT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
PETITION FOR LEGITIMATIO~ CUSTODY ANDOR VISITATION
Plaintiff files this Petition and shows the following
l
Plaintifrs Residence
o Plaintiff is a resident of___________ County Georgia
2
Information about child(ren)
o Plaintiff is the father of the following child(ren)
Name Date of Birth Place of Birth
3
Jurisdiction and Venue (Choose only one a b c or d)
o a) The mother of said child(ren) is ________________ vho now resides in __________ County Georgia and is subject to the jurisdiction of this Court o b) The child(ren)s ______________ Crelationship) whose name is has 0 custody
4
D guardianship of the child(ren) 0 HelD She lives in _____________ County Georgia o c) The mother or other party having cllstody or guardianship
__------------_------------_-----_---------__----=---_----_---_ (state name and relationship to the child) resides outside the state ofGeorgia and cannot after due diligence be found within the state D d) A petition for adoption for the child(ren) is pending in _____________ County Georgia Therefore venue is proper in that county
4
Service of Process (Choose a b or c)
o a) The mother or other legal custodian or guardian has signed an Acknowledgment of Service form D b) The mother or other legal custodian or guardian has signed the Defendants Acknovledgment ofService Affidavit of Waiver of Venue and Personal Jurisdiction o c) The mother or other legal custodian or guardian may be personally served at hisher workresidence address of
o d) While the mother or other legal custodian or guardian resides in Georgia his or whereabouts of the mother are unknown and she must be served by publication as provided by OeGA sect 9-11-4(f)(l)(A) o e) The mother or other legal custodian or guardian reside outside the state of Georgia However his or her whereabouts are unknown and slhe must be served by publication as provided by O e GA sect 9-11-4(f)( 1 )(A)
5
Mothers Consent (Choose a b c d or e)
D a) The mother of said child(ren) has consented in writing to the legitimation of said child (ren) and to the D legal andlor D physical cllstody being awarded to the Plaintiff Her consent is attached hereto as Exhibit D b) The mother of said child(ren) has consented in writing to the legitimation ofsaid child(ren) and to visitation by the Plaintiff D c) The mother of said child(ren) is deceased having died on ________ A copy ofher death certificate is attached hereto as Exhibit o d) There is no other legal parent ofthe child(ren) and the child(ren) have no legal guardian De) The mother of said child(ren) is opposing the legitimation of said child(ren)
5
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
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--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
LEGITIMATION PACKET
FAQ
hy should children be legitimated
The law encourages the fathers ofchildren to legally recognize them The legitimization process is a way for them to do this It gives the father and the child certain rights Legitimization means that a child may inherit from the father and the father may inherit from the child
How maya child born out of wedlock be legitimated
There are three ways to legitimate a child The first way is for the mother and the reputed father to marry and for the father to then recognize the child as his
The second way is for the mother and father to sign a voluntary acknowledgement of paternity According to OCGA sect 19-7-22(g)(2) In any voluntary acknowledgment of paternity which has been made and has not been rescinded pursuant to Code Section 19shy7-461 when both the mother and father freely agree and consent the child may be legitimated by the inclusion ofa statement indicating a voluntary acknowledgment of legitimation For more information on how to sign a voluntary acknowledgement of
paternity or call the Georgia Paternity Acknowledgement program at 1-866-296-8262
The third way to legitimate a child is for the father to file a legitimization petition in Superior Court
How do I get a certified copy of my childs signed voluntary acknowledgementof paternity
Write to the Georgia Department of Vital Records at 2600 Skyland Dr NE Atlanta GA 30319 The following items must be included with your request
1 Full name of person shown on the birth certificate (last name at birth iffemale) 2 Date ofBirth (month day year) 3 Place ofBirth (city county) 4 Current age 5 Sex 6 Race (optional) 7 Full name of mother (include mothers maiden last name) 8 Full name of father
9 Relationship to the person named on the birth certificate requested 10 The number ofcertified copies requested II A copy of the birth certificate 12 A photocopy of the requestors drivers license 13 A money order in the amount of$1 0 per certified copy requested
How does a man go about filing for legitimization in the superior or state court
The first step is for the father to file a petition in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship of the child resides outside the state or cannot after due diligence be found within the state the petition may be filed in the county of the fathers residence or the county ofthe childs residence Ifa petition for the adoption of the child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed (OCGA 19shy7-22) The mother of the child must be named as a party served with a copy of the petition and given an opportunity to be heard
The father has no absolute right to legitimate a child The Court will consider the best interest of the minor in determining whether the legitimization should be awarded Sometimes a Court will deny a legitimization petition ifthe Court believes that it has been filed to harass or interfere with the life of the mother
Vhat effect does a legitimization have
The Court will pass an order declaring the child legitimate and capable of inheriting from the father just as if the child had been born during a marriage
At the time of the legitimization the Judge will determine the duty of the father to support the child Additionally the Court may order visitation andor custody based on the best interests of the child The Court may also change the childs name to that of the father but the Court has wide discretion as to whether or not it will do so
Vhen the father files for legitimization may he also ask for custody
Until July 12005 the father could only get custody in a legitimization action if the mother consented The Georgia Legislature changed OCGA sect 9-7-22 effective July 12005 to allow a father to ask for custody in a legitimIzation suit
Vhat if paternity has been established-isnt that enough for legitimization
No a finding in a paternity action that a person is the father ofa child is not a legitimization Paternity establishes the identity of the biological father and it establishes the fathers duty to support the child After July 12005 it can also establish custody
2
OeGA sect 19-7-2 provides that the petition for legitimization may be brought in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship ofthe child resides outside the state or cannot after due diligence be found -vithin the state the petition may be filed in the county of the fathers residence or the county of the childs residence If a petition for the adoption ofthe child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed
OeGA sect 19-7-40(a) gives the superior and state COLlrts concurrent jurisdiction in all proceed ings for the determination of paternity ofchildren who are Georgia residents
3
----------------
1 THE SUPERIOR COliRT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
PETITION FOR LEGITIMATIO~ CUSTODY ANDOR VISITATION
Plaintiff files this Petition and shows the following
l
Plaintifrs Residence
o Plaintiff is a resident of___________ County Georgia
2
Information about child(ren)
o Plaintiff is the father of the following child(ren)
Name Date of Birth Place of Birth
3
Jurisdiction and Venue (Choose only one a b c or d)
o a) The mother of said child(ren) is ________________ vho now resides in __________ County Georgia and is subject to the jurisdiction of this Court o b) The child(ren)s ______________ Crelationship) whose name is has 0 custody
4
D guardianship of the child(ren) 0 HelD She lives in _____________ County Georgia o c) The mother or other party having cllstody or guardianship
__------------_------------_-----_---------__----=---_----_---_ (state name and relationship to the child) resides outside the state ofGeorgia and cannot after due diligence be found within the state D d) A petition for adoption for the child(ren) is pending in _____________ County Georgia Therefore venue is proper in that county
4
Service of Process (Choose a b or c)
o a) The mother or other legal custodian or guardian has signed an Acknowledgment of Service form D b) The mother or other legal custodian or guardian has signed the Defendants Acknovledgment ofService Affidavit of Waiver of Venue and Personal Jurisdiction o c) The mother or other legal custodian or guardian may be personally served at hisher workresidence address of
o d) While the mother or other legal custodian or guardian resides in Georgia his or whereabouts of the mother are unknown and she must be served by publication as provided by OeGA sect 9-11-4(f)(l)(A) o e) The mother or other legal custodian or guardian reside outside the state of Georgia However his or her whereabouts are unknown and slhe must be served by publication as provided by O e GA sect 9-11-4(f)( 1 )(A)
5
Mothers Consent (Choose a b c d or e)
D a) The mother of said child(ren) has consented in writing to the legitimation of said child (ren) and to the D legal andlor D physical cllstody being awarded to the Plaintiff Her consent is attached hereto as Exhibit D b) The mother of said child(ren) has consented in writing to the legitimation ofsaid child(ren) and to visitation by the Plaintiff D c) The mother of said child(ren) is deceased having died on ________ A copy ofher death certificate is attached hereto as Exhibit o d) There is no other legal parent ofthe child(ren) and the child(ren) have no legal guardian De) The mother of said child(ren) is opposing the legitimation of said child(ren)
5
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
9 Relationship to the person named on the birth certificate requested 10 The number ofcertified copies requested II A copy of the birth certificate 12 A photocopy of the requestors drivers license 13 A money order in the amount of$1 0 per certified copy requested
How does a man go about filing for legitimization in the superior or state court
The first step is for the father to file a petition in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship of the child resides outside the state or cannot after due diligence be found within the state the petition may be filed in the county of the fathers residence or the county ofthe childs residence Ifa petition for the adoption of the child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed (OCGA 19shy7-22) The mother of the child must be named as a party served with a copy of the petition and given an opportunity to be heard
The father has no absolute right to legitimate a child The Court will consider the best interest of the minor in determining whether the legitimization should be awarded Sometimes a Court will deny a legitimization petition ifthe Court believes that it has been filed to harass or interfere with the life of the mother
Vhat effect does a legitimization have
The Court will pass an order declaring the child legitimate and capable of inheriting from the father just as if the child had been born during a marriage
At the time of the legitimization the Judge will determine the duty of the father to support the child Additionally the Court may order visitation andor custody based on the best interests of the child The Court may also change the childs name to that of the father but the Court has wide discretion as to whether or not it will do so
Vhen the father files for legitimization may he also ask for custody
Until July 12005 the father could only get custody in a legitimization action if the mother consented The Georgia Legislature changed OCGA sect 9-7-22 effective July 12005 to allow a father to ask for custody in a legitimIzation suit
Vhat if paternity has been established-isnt that enough for legitimization
No a finding in a paternity action that a person is the father ofa child is not a legitimization Paternity establishes the identity of the biological father and it establishes the fathers duty to support the child After July 12005 it can also establish custody
2
OeGA sect 19-7-2 provides that the petition for legitimization may be brought in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship ofthe child resides outside the state or cannot after due diligence be found -vithin the state the petition may be filed in the county of the fathers residence or the county of the childs residence If a petition for the adoption ofthe child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed
OeGA sect 19-7-40(a) gives the superior and state COLlrts concurrent jurisdiction in all proceed ings for the determination of paternity ofchildren who are Georgia residents
3
----------------
1 THE SUPERIOR COliRT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
PETITION FOR LEGITIMATIO~ CUSTODY ANDOR VISITATION
Plaintiff files this Petition and shows the following
l
Plaintifrs Residence
o Plaintiff is a resident of___________ County Georgia
2
Information about child(ren)
o Plaintiff is the father of the following child(ren)
Name Date of Birth Place of Birth
3
Jurisdiction and Venue (Choose only one a b c or d)
o a) The mother of said child(ren) is ________________ vho now resides in __________ County Georgia and is subject to the jurisdiction of this Court o b) The child(ren)s ______________ Crelationship) whose name is has 0 custody
4
D guardianship of the child(ren) 0 HelD She lives in _____________ County Georgia o c) The mother or other party having cllstody or guardianship
__------------_------------_-----_---------__----=---_----_---_ (state name and relationship to the child) resides outside the state ofGeorgia and cannot after due diligence be found within the state D d) A petition for adoption for the child(ren) is pending in _____________ County Georgia Therefore venue is proper in that county
4
Service of Process (Choose a b or c)
o a) The mother or other legal custodian or guardian has signed an Acknowledgment of Service form D b) The mother or other legal custodian or guardian has signed the Defendants Acknovledgment ofService Affidavit of Waiver of Venue and Personal Jurisdiction o c) The mother or other legal custodian or guardian may be personally served at hisher workresidence address of
o d) While the mother or other legal custodian or guardian resides in Georgia his or whereabouts of the mother are unknown and she must be served by publication as provided by OeGA sect 9-11-4(f)(l)(A) o e) The mother or other legal custodian or guardian reside outside the state of Georgia However his or her whereabouts are unknown and slhe must be served by publication as provided by O e GA sect 9-11-4(f)( 1 )(A)
5
Mothers Consent (Choose a b c d or e)
D a) The mother of said child(ren) has consented in writing to the legitimation of said child (ren) and to the D legal andlor D physical cllstody being awarded to the Plaintiff Her consent is attached hereto as Exhibit D b) The mother of said child(ren) has consented in writing to the legitimation ofsaid child(ren) and to visitation by the Plaintiff D c) The mother of said child(ren) is deceased having died on ________ A copy ofher death certificate is attached hereto as Exhibit o d) There is no other legal parent ofthe child(ren) and the child(ren) have no legal guardian De) The mother of said child(ren) is opposing the legitimation of said child(ren)
5
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
OeGA sect 19-7-2 provides that the petition for legitimization may be brought in the county of the residence of the childs mother or other party having legal custody or guardianship of the child provided however that if the mother or other party having legal custody or guardianship ofthe child resides outside the state or cannot after due diligence be found -vithin the state the petition may be filed in the county of the fathers residence or the county of the childs residence If a petition for the adoption ofthe child is pending the father shall file the petition for legitimation in the county in which the adoption petition is filed
OeGA sect 19-7-40(a) gives the superior and state COLlrts concurrent jurisdiction in all proceed ings for the determination of paternity ofchildren who are Georgia residents
3
----------------
1 THE SUPERIOR COliRT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
PETITION FOR LEGITIMATIO~ CUSTODY ANDOR VISITATION
Plaintiff files this Petition and shows the following
l
Plaintifrs Residence
o Plaintiff is a resident of___________ County Georgia
2
Information about child(ren)
o Plaintiff is the father of the following child(ren)
Name Date of Birth Place of Birth
3
Jurisdiction and Venue (Choose only one a b c or d)
o a) The mother of said child(ren) is ________________ vho now resides in __________ County Georgia and is subject to the jurisdiction of this Court o b) The child(ren)s ______________ Crelationship) whose name is has 0 custody
4
D guardianship of the child(ren) 0 HelD She lives in _____________ County Georgia o c) The mother or other party having cllstody or guardianship
__------------_------------_-----_---------__----=---_----_---_ (state name and relationship to the child) resides outside the state ofGeorgia and cannot after due diligence be found within the state D d) A petition for adoption for the child(ren) is pending in _____________ County Georgia Therefore venue is proper in that county
4
Service of Process (Choose a b or c)
o a) The mother or other legal custodian or guardian has signed an Acknowledgment of Service form D b) The mother or other legal custodian or guardian has signed the Defendants Acknovledgment ofService Affidavit of Waiver of Venue and Personal Jurisdiction o c) The mother or other legal custodian or guardian may be personally served at hisher workresidence address of
o d) While the mother or other legal custodian or guardian resides in Georgia his or whereabouts of the mother are unknown and she must be served by publication as provided by OeGA sect 9-11-4(f)(l)(A) o e) The mother or other legal custodian or guardian reside outside the state of Georgia However his or her whereabouts are unknown and slhe must be served by publication as provided by O e GA sect 9-11-4(f)( 1 )(A)
5
Mothers Consent (Choose a b c d or e)
D a) The mother of said child(ren) has consented in writing to the legitimation of said child (ren) and to the D legal andlor D physical cllstody being awarded to the Plaintiff Her consent is attached hereto as Exhibit D b) The mother of said child(ren) has consented in writing to the legitimation ofsaid child(ren) and to visitation by the Plaintiff D c) The mother of said child(ren) is deceased having died on ________ A copy ofher death certificate is attached hereto as Exhibit o d) There is no other legal parent ofthe child(ren) and the child(ren) have no legal guardian De) The mother of said child(ren) is opposing the legitimation of said child(ren)
5
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
----------------
1 THE SUPERIOR COliRT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
PETITION FOR LEGITIMATIO~ CUSTODY ANDOR VISITATION
Plaintiff files this Petition and shows the following
l
Plaintifrs Residence
o Plaintiff is a resident of___________ County Georgia
2
Information about child(ren)
o Plaintiff is the father of the following child(ren)
Name Date of Birth Place of Birth
3
Jurisdiction and Venue (Choose only one a b c or d)
o a) The mother of said child(ren) is ________________ vho now resides in __________ County Georgia and is subject to the jurisdiction of this Court o b) The child(ren)s ______________ Crelationship) whose name is has 0 custody
4
D guardianship of the child(ren) 0 HelD She lives in _____________ County Georgia o c) The mother or other party having cllstody or guardianship
__------------_------------_-----_---------__----=---_----_---_ (state name and relationship to the child) resides outside the state ofGeorgia and cannot after due diligence be found within the state D d) A petition for adoption for the child(ren) is pending in _____________ County Georgia Therefore venue is proper in that county
4
Service of Process (Choose a b or c)
o a) The mother or other legal custodian or guardian has signed an Acknowledgment of Service form D b) The mother or other legal custodian or guardian has signed the Defendants Acknovledgment ofService Affidavit of Waiver of Venue and Personal Jurisdiction o c) The mother or other legal custodian or guardian may be personally served at hisher workresidence address of
o d) While the mother or other legal custodian or guardian resides in Georgia his or whereabouts of the mother are unknown and she must be served by publication as provided by OeGA sect 9-11-4(f)(l)(A) o e) The mother or other legal custodian or guardian reside outside the state of Georgia However his or her whereabouts are unknown and slhe must be served by publication as provided by O e GA sect 9-11-4(f)( 1 )(A)
5
Mothers Consent (Choose a b c d or e)
D a) The mother of said child(ren) has consented in writing to the legitimation of said child (ren) and to the D legal andlor D physical cllstody being awarded to the Plaintiff Her consent is attached hereto as Exhibit D b) The mother of said child(ren) has consented in writing to the legitimation ofsaid child(ren) and to visitation by the Plaintiff D c) The mother of said child(ren) is deceased having died on ________ A copy ofher death certificate is attached hereto as Exhibit o d) There is no other legal parent ofthe child(ren) and the child(ren) have no legal guardian De) The mother of said child(ren) is opposing the legitimation of said child(ren)
5
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
D guardianship of the child(ren) 0 HelD She lives in _____________ County Georgia o c) The mother or other party having cllstody or guardianship
__------------_------------_-----_---------__----=---_----_---_ (state name and relationship to the child) resides outside the state ofGeorgia and cannot after due diligence be found within the state D d) A petition for adoption for the child(ren) is pending in _____________ County Georgia Therefore venue is proper in that county
4
Service of Process (Choose a b or c)
o a) The mother or other legal custodian or guardian has signed an Acknowledgment of Service form D b) The mother or other legal custodian or guardian has signed the Defendants Acknovledgment ofService Affidavit of Waiver of Venue and Personal Jurisdiction o c) The mother or other legal custodian or guardian may be personally served at hisher workresidence address of
o d) While the mother or other legal custodian or guardian resides in Georgia his or whereabouts of the mother are unknown and she must be served by publication as provided by OeGA sect 9-11-4(f)(l)(A) o e) The mother or other legal custodian or guardian reside outside the state of Georgia However his or her whereabouts are unknown and slhe must be served by publication as provided by O e GA sect 9-11-4(f)( 1 )(A)
5
Mothers Consent (Choose a b c d or e)
D a) The mother of said child(ren) has consented in writing to the legitimation of said child (ren) and to the D legal andlor D physical cllstody being awarded to the Plaintiff Her consent is attached hereto as Exhibit D b) The mother of said child(ren) has consented in writing to the legitimation ofsaid child(ren) and to visitation by the Plaintiff D c) The mother of said child(ren) is deceased having died on ________ A copy ofher death certificate is attached hereto as Exhibit o d) There is no other legal parent ofthe child(ren) and the child(ren) have no legal guardian De) The mother of said child(ren) is opposing the legitimation of said child(ren)
5
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
6
Plaintiffs desire to legitimate child(ren and change surname(s)
o This Petition is brought pursuant to OeGA sect 19-7-22 to legitimate said child(ren) and to change hishertheir surname(s) from _____________ to ___________________
7
Current Custody Arrangement (Choose a or b)
o a) The Defendant presently has legal custody of the minor child(ren) They have lived with himher since ________________________ (date)
o b) The 0 legal custodian 0 legal guardian ofthe minor child(ren) is ______________ (name) ho is related to the children as follows
The legal custodian -----~--_---------- has the folloving type of legal custody or guardianship
(temporary guardianship permanent guardianship permanent custody etc) She has had this legal custody or guardianship since (date)
8
Future Custody Arrangement
o It is in the best interest(s) of the child(ren) for the custody to be as follows
9
Visitation (Choose a or b)
o a) It is in the best interest(s) of the child(ren) that the following visitation schedule be established
6
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
o b) It is in the best interest(s) of the child(ren) that the visitation schedule in the forms packet on page thirty (30) be adopted
WHEREFORE Plaintiff demands the following (a) That the name of said child be changed from to _______ (b) That said child be legitimized by (his) (her) new name as the legitimate (son)
(daughter) of petitioner (c) That the petitioner be granted visitation rights (d) That the petitioner be awarded custody as follows __________
(c) Ifnecessary rule nisi issue directing the said to appear before the Court to show cause why the relief demanded by this petition should not be granted
Plaintiffpro se Address Telephone
7
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
------------------I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ____________ )
Defendant ) ) )
VERIFICATION
Personally appeared before the undersigned officer duly authorized to administer
oaths in the state ofGeorgia ______________ who after being duly sworn deposes
and states that she is the Plaintiff in the above-styled action and verifies that the facts
contained in the within and foregoing Petition for Legitimization are true and correct to
the best ofher information knowledge and belief
This ___ day of__________________________ 20 ____
Plaintiffpro se
Sworn and subscribed before me This day of______________ 20 ___
Notary Public State of Georgia
My Commission Expires ____________
8
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
I THE SUPERIOR COURT OF _________ COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) ) )
Defendant )
PLAINTIFFS AFFIDAVIT REQUIRED BY OCGA sect 19-7-43(d)
State ofGeorgia County of ___________
Personally before the undersigned officer authorized to administer oaths appeared _________________ who being duly sworn does state on oath the tollowing
1
That affiant is the plaintiiTnamed in the above- styled action to legitimate the following child(ren) who were born to the affiant and to ___________
Name Date ofBirth Place of Birth
2
The present address ofthe Plaintiff is ________________
3
The present address ofthe Defendant is _______________
9
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
4
I attest that the defendant and I had sexual intercourse at or about the time 0 f the child(ren)s conception which would have been approximately the following dates
5
I attest that I was the sole sexual partner of the Defendant at the time her child(ren) _________-------------- waswere conceived
6
I attest that based upon my knowledge and belief as well as the defendants statements to me that I was the defendants sole sexual partner
7
I attest that the Defendant has admitted to me that her child(ren)
is fare my biological child(ren) and the product ofour sexual intercourse during OLlr relationship
8
I attest that our child(ren)
currently reside(s) at
9
I attest that the minor child(ren)
isare my bio logical child(ren)
AffiantlP laintiffiF ather Sworn to and subscribed before me this __ day of___________ 20 __
Notary Public
10
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
---------------------
-----------------------------------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
ACK~OVLEDGMENT OF SERVICE AND CONSEKT TO LEGITIMATION
1
Acknowledgement of Service
the natural mother of _________ hereby acknowledges that she has received a copy of the foregoing Petition to Legitimate the said and to change hisher name from to ______---_______________________ and she hereby waives any and all further ArTlt or notice of any nature in this proceeding
2
Consent to legitimation and change of name
The mother hereby consents to the judicial legitimization of
and the change of hishertheir surname(s) from
to
Non-interference with affection toward either parent
3
o The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster and encourage a feeling ofaffection betvveen themselves and the child(ren) Neither party shall do anything to hamper the natural development of the childrens love and respect for the other party
11
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
4
Custody (Check a b or c)
o a) The 0 Father 0 Mother shall have the temporary and permanent legal and physical custody of the minor child (ren)
o b) The Father and Mother shall share joint legal custody of the minor child(ren) The parties shall share decision-making concerning the children however the o Father 0 Mother shall have the right to make the final decision in the event the parties cannot agree
Primary physical custody of the minor child (ren) shall be vith the 0 Father DMother as follows
Secondary physical custody shall be with the 0 Father 0 Mother as follows
DC) The Father and Mother shall share jo int legal custody and jo int physical custody of the minor child (ren)
Physical custody shall be shared by the parties as follows
The parties shall share decision making concerning the child (ren) however in the event the parties cannot decide the 0 FatherD Mother shall have the final decision concerning
5
Visitation (Choose a or b)
o a) The 0 Father 0 Mother shall have the right ofvisitation with the minor children as fo llows
12
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
[OR]
o b) The visitation schedule is attached hereto and incorporated herein
Child Support
Please go to httpwwwgeorgiacourtsorgcsc and complete the Child Support Vorksheet Your papers will NOT be accepted for filing unless you complete and
attach the Child Support Vorksheet
6
o The 0 Fathero Mother shall pay to the 0 Fathero Mother as support of the minor child(ren) the sum of$ per oweek obi-weekly 0 month starting on and continuing per oweek obi-weekly 0 month thereafter until each respective child reaches the age ofeighteen (18) or so long as the child is enrolled in and attending secondary school (not to exceed age twenty (20raquo marries dies or becomes otherwise emancipated The child support obligation shall be reduced as follovvs as each child becomes emancipated
This amount vas derived from line 13 of the Child Support Worksheet which is attached hereto as Exhibit 1
middot6
Manner of Payment of Child Support (Check a or b)
o a) All payments of child support shall be paid directly to the 0 Fathero Mother at the following address
No Income Deduction Order will be entered into at this time However when ever in violation of the terms ofthis Agreement there shall have been a failure to make the support payments due hereunder so that the amount unpaid is equal to or greater than the amount payable for one (1) month the payments required to be made may be collected by
13
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
the process of continuing garnishment for support In the event 0 Father 0 Mother fails to pay any child support obligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12) month period the parties agree that an income deduction order shall then be entered o b) All payments of child support shall be paid to Georgia Child Support Enforcement pursuant to an Income Deduction Order
7
Health Insurance
o The 0 Father 0 Mother shall maintain a policy of medical dental and hospitalization insurance for the benefit of the minor child(ren) for so long as the child support obligation set forth herein exists Costs not covered under the insurance policy shall be divided betveen Father and Mother as follOvs
The 0 Father 0 Mother shall provide the 0 Husband 0 Wife with an insurance identification card or sLlch other acceptable proof of insurance coverage and shall cooperate with the 0 Husband 0 Wife in submitting claims under the policy
This __ day _______________20
MOTHER
Notary Public
My commission expires ___________
FATHER
Notary Public
My commission expires
14
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
------
--------------
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
AFFIDA VIT SUPPORTI~G ACKNOVLEDGEMENT OF SERVICE AND CO~SENT TO LEGITlMATION
STATE OF GEORGIA COUNTYOF~______ Personally appeared before the undersigned officer authorized to administer oaths
_~___________---- who states under oath that she is the natural mother a child born out of wedlock on 20- in County State of The natural father of said child is who is the petitioner named in the Petition to Legitimate the said ________
The above Acknowledgment of Service and Consent to Legitimation was voluntarily and freely made by me on _______________-
Affiant Mother
Notary Public
Sworn to and subscribed before me ________________20__ __ this day
15
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
----------
-------------------------------------------------
1 THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No -------- shy) ) )
Defendant )
CERTIFICATE OF SERVICE
I hereby certify that I have this day served the foregoing Petition for Legitimation upon the following counsel for [party] [or party ifno counsel of record] by delivering [or causing to be delivered] by hand a copy of same as follows
[Name and address of counsel of record or of parties ifno counsel of record]
_________________~20This __ day
Plaintiffpro se
Address
Telephone Number __________________________
16
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
-----
I~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
RULE NISI
The above Petition to Legitimate having been read and considered let the same be filed and let
--~--~-~---
the natural mother of said child appear before this Court on the day of ______---_______ 20 __ at oclock m to show cause if any she have vvhy the relief demanded in said Petition should not be granted
Let the said be served with a copy of said Petition and this Order as provided by law
This __ day 20
JUDGE Superior Courts Judicial Circuit
Presented by
Petitioner pro se
l7
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
I~ THE SUPERIOR COURT OF _________ COUlTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
DEFENDANTS ACKNOVLEDGEMENT OF SERVICE AFFIDAVIT OF VAIVER OF VENUE AND PERSONAL JURISDICTION
I ________--- the named Defendant in the above-styled case after
being duly sworn do hereby depose and say that I am a resident of_______
County (state) and that the Plaintiff in the above-styled case is a
resident County Georgia 1 affirm that 1 have received a
copy of said PetitionComplaint and I hereby waive any and all filrther notice service
and issuance of process
After being duly informed that I have a constitutional right to a trial by Judge or
jury on the above matter in the county of my residence and with that knowledge I
hereby expressly waive my right to venue in the county ofmy residence and consent to
venue and personal jurisdiction in the county of this Superior Court
This __ day ____________~20
Affiant
Notary Public
Sworn to and subscribed before me this __ day of__________ 20 __
18
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
[~ THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintift ) )
v ) ) Civil Action File No ______ )
Defendant ) ) )
MOTIO~ FOR SERVICE BY PUBLICATION
Comes plaintiff pursuant to OCGA sect 9-10-71 and moves the Court for an order directing that service on the defendant be made by publication upon the grounds that heshe cannot after due diligence be found within the state as more fully appears from the affidavit filed herewith and attached hereto
Plaintiffpro se
Address
Telephone Number
19
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
------------------------------------------------------
[N THE SUPERIOR COURT OF COCNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No
Defendant ) ) )
AFFIDAVIT--SERVICE BY PUBLICATION-OCGA sect9-11-4(e)
Personally appeared who after being duly svorn states That the Defendant resides outside the State of Georgia and hisher last known
address is
--or-shy
That the Defendant has departed from the State ofGeorgia or cannot after due diligence be found within the state The Defendants last known address is
--or-shy
The last knovn residence of the Defendant was outside the State ofGeorgia at
____~------~----~~--~~~~on 20___ The Defendant no longer resides at the foregoing address nor within the State of Georgia to the best of Affiants knowledge and the present address or whereabouts of the Defendant is unknown to the Affiant
--or-
The affiant has made a diligent effort to locate defendant by
And cannot find defendant within this state for the reason that defendant has concealed himself by
20
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Affiant has no knowledge as to the present residence or whereabouts of the defendant
The affiant has made the following efforts to find the Defendant (check all that apply)
o Checking with the Defendants friends and relatives Names addresses and telephone numbers ofeveryone plaintiff contacted
o Contacting the Defendants former landlord Name address amp telephone number of former landlord
o Checking telephone information and directories List which directories you checked
o Attempting to have Defendant served at hisher last known address which is listed above
o Other
Plaintiffpro se
Sworn to and subscribed before me this __ day
Notary Public
21
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
------
-----
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No )
Defendant ) ) )
ORDER FOR SERVICE BY PUBLICATION
Plaintiff having moved the Court for an order directing service to be made upon defendant in the above-styled action by publication of summons and it appearing to the Court from the verified Complaint and Affidavit in support of such motion that defendant is a nonresident and that the action is an action in which a defendant may be served by publication pursuant to OCGA sect 9- 10-71 it is
ORDERED that service upon be made by publication as provided by law
This day of 20 __
JUDGE Superior Courts Judicial Circuit
Presented by
Plaintiffpro se
22
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
---------------------------
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ )
Defendant ) ) )
NOTICE OF SUMMONS
TO ___________________ Defendant Named Above You are hereby notified above-styled action seeking
the relief sought] was filed against you in said Court on 20 __ and that by reason of an order for service of summons by publication entered by the Court on 20__ you are hereby commanded and required to file with the clerk of said Court and serve upon plaintiff whose address is an answer to the complaint within SLxty (60) days of the date of the order for service by publication Ifyou fail to do so judgment by default will be taken against you for the relief demanded in the complaint
Witness the Honorable _______________ Judge of said Court
________________20This the ___ day
Clerk ofCourt
23
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
-----
----
In the Superior Court of ______ County Georgia
) _________ Plaintiff )
) vs ) Civil Action No
) _________ Defendant )
)
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF
1 AFFIANTS NAME ____________Age ____
Spouses Name ____________---Age ____
Date of Marriage _________ Date of Separation _______
Names and birth dates of children for whom support is to be determined in this action
Name Date of Birth Resides with
Names and birth dates of affiants other children
Name Date of Birth Resides with
2 SUMMARY OF AFFIANTS INCOME AND NEEDS
(a) Gross monthly income (from item 3A)
(b) Net monthly income (from item 3C)
(c) Average monthly expenses (item 5A)
1V10ntrily payments to creditors
$_--shy
$_--shy
$_--shy
+
24
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Total monthly expenses and payments to creditors (item 5C)
(subsections (d) amp (e) deleted)
3 A AFFIANTS GROSS MONTHLY INCOME (complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receiptJ
Salary or Wages $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS ---shy
Commissions Fees Tips $ _____
Income from self-employment partnership close corporations and independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $ ____
Bonuses $----shyOvertime Payments $ _____
Severance Pay $ _____
Recurring Income from Pensions or Retirement Plans $ _____
Interest and Dividends $ _____
Trust Income $ _____
Income from Annuities $ _____
Capital Gains $ _____
Social Security Disability or Retirement Benefits $ _____
Workers Compensation Benefits $ _____
Unemployment Benefits $ _____
Judgments from Personal Injury or Other Civil Cases $ _____
Gifts (cash or other gifts that can be converted to cash) $ _____
PrizesLottery Winnings $ _____
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Alimony and maintenance from persons not in this case $_---shy
Assets which are used for support of family $_---shy
Fringe Benefits (if significantly reduce living expenses) $_---shy
Any other income (do NOT include means-tested Public assistance such as TANF or food stamps) $_---shy
GROSS MONTHLY INCOME $_--shy(prior section B deleted) B Affiants Net Monthly Income from employment
(deducting only state and federal taxes and FICA) $_---shy
Affiants pay period (Le weekly monthly etc) ________
Number of exemptions claimed _____
4 ASSETS
(If you claim or agree that all or part of an asset is nOll-marital indicate the non-marital portion under the appropriate spouses column and state the amount and the basis preshymarital gift inheritance source of funds etc)
Description Value Separate Asset of the Husband
Separate Asset of the Wife
Basis of the Claim
Cash $
Stocks bonds $
CDsMoney Market Accounts
$
Bank Accounts (list each account)
$
$
$
Retirement Pensions 401 K IRA or Profit Sharing
$
Money owed you $
Tax Refund
26
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
owed you $
Real Estate
home $
debt owed $
other $
debt owed AutomobilesNehicles
Vehicle 1
$
$
debt owed Vehicle 2
$ $
debt owed $
Life Insurance (net cash value) $
Furniturefurnishings $
Jewelry $
Collectibles $
Other Assets $
$
$
$
Total Assets $
5 A AVERAGE MONTHLY EXPENSES
HOUSEHOLD Mortgage or rent payments $ Cable TV $
Property taxes $ Misc household and grocery Items
$
HomeownerRenter Insurance $ ____ Meals outside the home $
Electricity $_--- Other $
27
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Water
Garbage and Sewer
Telephone residential line
$
$
$
AUTOMOBILE Gasoline and oil
Repairs
Auto tags and license
$
$
$
cellular telephone $ Insurance $
Gas
Repairs and maintenance
Lawn Care
Pest Control
$
$
$
$
OTHER VEHICLES boats l trailers l RVs 1 etc Gasoline and oil
Repairs
Tags and license
Insurance
$
$
$
$
CHILDRENS EXPENSES AFFIANTS OTHER EXPENSES
Child care (total monthly cost) $ Dry cleaningllaundry $
School tuition $ Clothing $
Tutoring
Private lessons (eg music dance)
$
$
Medical dental prescription (out of [1ocketuncovered exenses)
Affiants gifts (special holidays)
$
$
School suppliesexpenses $ Entertainment $
Lunch Money $ Recreational Expenses (eg fitness)
$
Other Educational Expenses (list) Vacations $
$ Travel Expenses for Visitation
$ Publications $
Allowance $ Duesclubs $
Clothing $ Religious and charities $
Diapers $ Pet expenses $
Medical dental prescription (out of pockeUuncovered expenses $
Alimony paid to former spouse
Child support paid for other
$
28
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Grooming hygiene $ children $
Gifts from children to others $ Date of initial order
Entertainment $ Other (attach sheet) $
Activities (including extra-curricular school religious cultural etc)
$
Summer Camps $
OTHER INSURANCE Health
Child(rens portion Dental
Child(renls Qortion Vision
Child(ren)s portion Life
Relationship of Beneficiay Disability
$
$
$
$
$
$
$
$
Other(specify) $ TOTAL ABOVE EXPENSES $
B PAYMENTS TO CREDITORS (please check one)
Balance DueTo Whom Monthly Joint Plaintiff Defendant Payment
29
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
TOTAL MONTHLY PAYMENTS TO CREDITORS $ _______
C TOTAL MONTHLY EXPENSES $_---shy
This __ day of _____________ 20 __
Affiant
Notary Public
30
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Exhibit----
VISITATION SCHEDULE
The non-custodial parent is ___________________________
The custodial parent is _____________________________
The non-custodial parent shall be entitled to exercise reasonable visitation with the minor child 1th the follo1ng minimum provisions
A On every 1 3fd and 5th Friday at 600 pm until the lbllowing Sunday at 600 pm
B During even numbered years (2008 2010 etc) the non-custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week of Christmas Vacation from 200 pm on December 25 until New Years
Eve C During odd numbered years (2009 20 etc) the non-custodia parent shall have the right of
visitation on the hoi idays delineated below 1 New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First Week of Christmas vacation including Christmas Day until 200 pm on December
25 D During even numbered years (2008 2010 etc) the cLlstodial parent shall have the minor
child on the holidays delineated below I New Years Day 2 Easter or Spring Break 3 July 4th
4 Halloween 5 First week of Christmas vacation including Christmas Day until 200 pm on Decembershy
-)
E During odd numbered years (2009 20 II etc) the custodial parent shall have the right of visitation on the holidays delineated below I Martin Luther Kings Birthday 2 Memorial Day 3 Labor Day 4 Thanksgiving 5 Second week ofChristmas vacation from 200 pm on December 25 until New Years
Eve F The Mother shall have the minor child on Mothers Day G The Father shall have the minor child on Fathers Day H The non-custodial parent shall have the right to visit ith the minor child for tVO consecutive
weeks in the summer between June 15 and August 15 During this period the custodial parent shall have the minor child on the first (I 5t) weekend from 600 pm Friday lmtil 600 pm Sunday The non-custodial parent shall give the custodial parent a minimum of thirty (30) days written notice of the intent to exercise this visitation
1 Holiday visitation shall take precedence over veek-end visitation
31
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Instructions for Using the Pen and Paper EZ Worksheet
Velcome to the Georgia Child SUPPOlt Pen and Paper EZ Vorksheet Georgia Imv (OeGA sect 19-6-15) requires guidelines to be used in establishing new and modified child support obligations in every Georgia court This pen and paper mrksheet provides a manual form ith steps to estimate the amount of the child support obligation that a court may order depending on indhidual circumstances
This packet includes the follovin~ forms and information in this order a) Instructions for using the Pen and Paper EZ Worksheet b) Guide ofUsefuL Definitions and Information c) The Georgia Pen and Paper EZ Child Support Worksheet (2 pageform - may be printed 2-sided) d) How tofind the Basic Child Support Obligation (BCSO) using an exampLe of the TabLe and e) The Child Support Obligation TabLe
General Information COmplete the worksheetform in black or blue ink only Fill in the blanks at the top of the worksheet page to identify the Court County and Civil Action Case Number (if already knom) the name of the Mother Father and Nonparent Custodian if applicable and the name and birth year of each child included in this action Also identify which parent is the Noncustodial Parent in this action for the purpose of paying child support Note Both parents may be identitied as noncustodial parents if a Nonparent Custodian is included in the action
Documents or information you need to begin using this form It is recommended that you prepare a first draft of the worksheet in pencil rather than in ink The final version must be completed in bi ue or black ink for filing ith the Clerk of Court (Do not use red ink) Gather the folloving information or documents before you begin
Alonthly income for both parents if possible and if applicable the amount of any Social Security benefits (ie RSDISSD for a noncustodial parents disabilityretirement) paid to a child in this action as a dependent on that parents account
Important If this worksheet includes a nonparent custodian do not include income for that person
You may iew the actual child support guidelines statute on the Internet at http-wgeorgiacourtsgovcsc
Instructions for Calculating Begin Here
jLine ~ Parents 11onthly Gross Income - Elllllr each parents month(v income llnder appropriate columns (a) and (b) Add (+) incomes togetha and enter total under column (c) Helpful tip Countable income includes all income from any source before deductions for taxes For more information see OCGA sect 19-6-15(0(1)(A) for a list of income sources E(ample (a) Mothers income $101790 + (b) Fathers income $195000 = (c) Combined income $29679deg
jLine ~ Parents Percentage of Total Income - Divide (--) Line 1 column (a) bycohlmn Mfor mothers percentage ofincome and then divide (--) Line I cOlimn (b) bY column (c) for the fathers percentage ofincome Enter percentages () for each parenlllnder the appropriate column Combined percentages mllst total 100 Helpful tip If the calculated percentage is for example 06570 you may round to a whole percentage such as 066 rather than 06570 Example 1 Mother $1017middot90 -- $2967middot90 = 0middot3430 or 34 Example 2 Father $195000 -- $296790 = 06570 or 66
Georgia EZ Manual Worksheet V~rsion 32 July L 201-1
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
ILine 31 Basic Child Support Obligation (BCSO) from Child Support Obligation Tablemiddot Find the amount all tht tabll hased on the nWl1her ochildren and thtl parents comhintld gross income (illcom ji-olll Lintl I columll (c)) that is closest to the cOlllbintld acljllstc(1 gross income amollnt set alit ill tht jlrst coilimn ofthe rabll Helpful tip At the end of this set of forms you ill tind the Child Support Obligation Table
ILine 41 lHonthly BCSO Amount for Each Parentmiddot Mllltip(v each parents plrcelltage atotal income (Line 2) b tbl amollntrom the BCSO Table (elltaed on Line 3) Enter amoumsor each parellt under rhe appropriate cohmin Examples Amount from BCSO Table is 5868 To find mothers portion of the BCSO multiply the total BCSO of $868 X 34 =529512 and to find fathers portion of the BCSO multiply the total BCSO of 5868 X 66 = $57288 The hvo amounts total $868
Note Calculations for Lines 5 6 and 7 may include the nonparent custodian if that person is a party to the action
ILine 51 llIonthly York Related Child Care Costsmiddot Ellter toral anrage month amount paid or that will be paid for lrork related child care by a parent or nonparent cllsrodian under the appropriate column Total thl amounts in COlllnIllS (a) (b) and (c) and ellter the toral il1 coilimn (d)
ILine 61 lHonthly Health Insurance Premium Paid for Childrenmiddot InclIdt total average monthv ([mOllit 0health insurance paid or that will be paidor children included in this action Enter answers under appropriare columnsor each parent alld or nOllparent cllstodian Total the amounts in columns (a) (b) and (c) and enter the rotal in column (d)
Helpful Tip Include only the portion of the cost of the premium as it applies to the children in the case Note The amount one enters is the total amount for all the children in the case-Option (A) If the childrens portion of cost is k-nown total the amount for all children in the case and vrite the answer on the line for the appropriate parent paying the cost Option (B) If the childs portion of the cost is not known diide the total premium cost by the total number of persons in the policy and multiply that answer by the number of children in the case Example Total cost of $150 dhided (--) by 3 (mother and hm children) people in the p~licy $50 per person Two children in the case multiply 2 X $50 $100
iLine 7l Total11Ionthly York Related Child Care and Health Insurance Costsmiddot Add (+)
Lines 5 and 6 under each column and enrtr answers all Line 7 und the appropriate colllmn 01 each parenf andor nonparent custodian Total the amollnfs in columns (a) (b) and (C) and enter the total in collimn (d)
Example Mothers Line 5 monthly amount is $30000 and the Line 6 monthly amount is $10000 totaling $40000 monthly Enter $40000 on Line 7 column Ca) for mother Repeat these steps for father and non parent custodian if applicable
Line 81 Parents Percentage () of Income from Line 1 -Enter pltrcen tages from Line 2 under the appropriate columns Amounts mllst total 100 in columll (el)
iLine 91 Parents Share ofVork Related Child Care and Health Insurance Costs middotAIultiply the total amount on Line 7 Column (d) by the percentage for each parent on Line 8 Enter amounts under the appropriate columnfor each parent Eample 1 $400 (from line 7 column Cd)) X 34 (from Line 8 column Ca) = S13600 representing Mothers share of Health InsuranceWork Related Child Care costs Example 2 $400 (from line 7 column (d)) X 66 (from Line 8 column (b) == $26400 representing Fathers share of Health InsuranceWork Related Child Care costs The hvo amounts total $400 (column Cd))
G~orglU EZ Manual Worksheet Verion 3 2 11 Julv 1 20 1-1
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Line 101 Parents Adj usted Child Support Obligation - To idlllfij) each parllIrs adjtlstld cMId wpporr obligatioll f1t(llIillg each partllfs sharI ofllt momMy BCSO pIlls htalth insllranco alld IlOrk ndatd child cart costs find each partlIt s BCSO 011 Lillo 4 (of this 1I()rkshoeo alld add (+) to tlIOSt amounts each parollfs aJlslIerJi-ol1l Lillt 9 Toral the Sllms01 each partl1t and entt1 amollllts ulldt1 the appropriare coluInns Example 1 S29512 (from Line 4 column (a)) + 813600 (from Line 9 column (a) = $43112 representing Iothers BCSO and share of Health InsuranceWork Related Child Care costs Example 2 S57288 (from line 7 column (b)) + 826+00 (from Line 9 column (b) = S83688 representing Fathers BCSO and share of Health InsuranceWork Related Child Care costs
ILine d Credit for lHonthly Amounts Parents Actually Payor Vill Pay for ork Related Child Care andor Health Insurance Costs - Enter mothers amolinfFom Lillt 7 collllnn fa) 011 tlli lil1t Enter fathers amollnt Jiom Lillt 7 COIln11l (b) on rhis line
IUne 121 Total Parents Presumptive Child Support Obligation - Subtract (-) amOlll1rS 011 Line 11 from amounts 011 Line 10 for each parellf and enter those amollnts on this line undtr the appropriare cownnfor each partllt After subtracting credit from each parents adjusted child SUppOI1 obligation for amounts actually paid or that will be paid for work related child care and heal th insurmcl costs thl rlsuiting amount is known as the Presumptive Amount of Child Support
ILine 131 Subtract Social Security - Writ in on tilt toral mOl1fh(r amoullt paid bv the Social Securiry rldministration (SSA) and receiwd by a child tlnclur tho appropriate noncustodial parent (NPC) column The child must be receiving a chlck on the parents disability or retirement account that is a Title II Social Slcurity benetit (RSDIlSSD) otherwisl leave this line blank Do not include payments for SupplllTIent Security Income (SSI) as SSI does not count
ILine 1-l Final ~Ionthly Child Support Obligation Amount - Subtract (-) amounts on LiI1Il 13 Fom amollnts 011 Line 11 for IlCl(il parent (lnd elller the amounts 011 this lint IIndr th appropriate column for each parent This line vvill show the fmal monthly child support obligation for the parlnt or parents designated as thl noncustodial parent for the purpose of paying child support
ILine 15 Uninsured Health E~Penses - Carry dOHI1 and enter 011 this linefor each parent the percentagt ji-om Line 3 or enttr a pllrcelltage agreed upon by the parties or ordered b-v the coart The child(ren)s future uninsured health care expenses are the tinancial responsibility of both parents The tinal child support order will includl requirements for payment of the future uninsured health care expenses
YOll will tind electronic versions of the Child Support Calculators in an Excel format at this vebsite httplwgeorgiacourtsgOYcsc
Guide of Usend Definitions
Below are seven useful definitions that may help you better understand teJJTIS used in thisf 0 TJTI
1 Basic Child Support Obligation means the monthly amount of support displayed on the child support obligation table which corresponds to the combined adjusted income and the number of children for vhom child support is being determined
2 Health Insurance means the cost of premiums for any general health or medical policy paid by the Mother Father andor Nonparent Custodian for children included in this action Costs for vision dental or life insurance are not considered a part of Health Insurance If the childs portion of the health insurance premium is not knmm divide the total premium cost by the total number of persons included in the policy Multiply that answer by the total number of children included in the policy to determine a per child premium cost (Example Total Monthly Health Insurance Premium of $200 divided by 4 persons = $50 per person multiplied by 2
children covered and included in this action = $100 Ansver - Each childs portion of the health insurance premium is $50 per month)
Georgia EZ vlanual Workshlt VCfiion L III Juh L 201~
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
3 Imputed Income means when establishing the amount of child support if a parent fails to produce reliable evidence of income sllch as tax returns for prior years check stubs or other information for determining current ability to pay child support and the court or the jury has no other evidence of the parents income or income potential gross income for the current year i1l be imputed based on a 40 hOllr workweek at minimum wage
4 Parents lHonthly Gross Income is found at OCGA sect 19-6-15 (f) of the Child Support Guidelines The gross income of each parent includes all income from any source before deductions for taxes and other deductions Gross income does not include
A Child support payments received by either parent for the benefit of a child of another relationship B Benefits received from public assistance programs such as PeachCare TA~F food stamps
Supplemental Security Income (SSI) benetits benefits under Section 402(d) of the Social Security Act for disabled adult children low-income heating and energy assistance payments
C Foster Care payments and D Nonparent custodians income
5 Presumptive Child Support Obligation means the basic child support obligation including health insurance and work related child care costs
6 Social Security Important Social Security Benefits as described here only apply to Title II (RSDISSD) benefits and not Supplemental Security Income (SSI) benefits received under Title X1 of the federal Social Security Act
Benefits received by a child on the noncustodial parents account shall be counted as child support payments and shall be applied against the noncustodials tinal child support amount
If the noncustodial parents child support obligation is greater than the Social Security benefits paid on behalf of the child then the noncustodial parent is required to pay the amount exceeding the Social Security benefit as part of the final child support amount in the case If the countable Social Security benefits are more than or equal to the amount of the noncustodial parents child support amount the noncustodial parents child support responsibility is met and no further child support shall be paid
Any Social Security benetit amounts sent to the custodial parent or nonparent custodian by the Social Security Administration for the childs benefit that is greater than the final child support amount shall be retained by the nonparent custodian or custodial parent for the childs benefit and may not be used to decrease the final child support order or reduce arrearages The court vill make a vTitten finding of fact in the tinal child support order regarding the use of Social Security benefits in the calculation of the child support
7 middotVork Related Child Care means expenses for the care of the child for whom support is being determined that are due to employment of either parent The court may consider the child care costs associated vith a parents job search job training or education of a parent that is necessary to obtain a job or enhance earning potential not to exceed a reasonable time as determined by the court if the parent proves by evidence that the job search job training or education vill benefit the child being supported
Georgia EZ Manual Workhel V crjon 3 2 IV Julv I 211 1-+
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If you ILt1l1t to claim IllY o tile circumstaJlces SUcfl as preexisting ordas qualified c1lildreJI selfshyel1lploY11Iellt taxes deviatiolls you lJIust STOP HOH as you cmlJlot use til is fonH Please iustead lise the Standard Cllild Support ~Vorfslteet lJId Schedules (paper or electroJlic - see page iii of the Illstructiolls)
Advisory To complete this form use the attached illstruCtiOlls to reacII the correct caiculatioll tWIOUlltS Also see the Referellce Guide attached for defillitiolls of terms illforlllatioll awl helpflll tips filter Ill amounts as fIlolltlzlu tWIOlllltS
TypeofCourt __________________________ Coun~middot _______________________________
~---------------------------------shyCourtCivil ActionOSAH Case Number DHSIV-D Case Number (ifapplicable)
o Check box if DHS is Petitioner
Mothers name (please print) Fathers name (please print) CJ Custodial Parent 0 Noncustodial Parent (check aile) o Custodial Parent c Noncustodial Parent (chlck one)
o Initial Action 0 Modification Action (check one) Nonparent Custodians name ifany (please prin) Date of Initial Child Support Order _______
L tonvI Chld ren f om Suppor IS emg e ermme ISIS I or Vh t B D t d10 Th Case
Childs Name Year of Birth
C1
I C2
I C3 i
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income
(Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation TableI
lHonthly BCSO amount for each parent
Childs Name Year of Birth
C4
i C5
C6
s s s
o 100
G~orglj El gtlanual Worksheet VersIOn 3 2 F I Juh I 2f)I~
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
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---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
i
(a) (b) Mother Father
Additional Ex
5 lHonthly Nork Related Child Care Costs (1fI1one enter zero) 8
6 lt[onthly Health Insurance premium 8 middot8paid for the Children (ffnone enter zero)
7 TotallUonthly Vork Related Child S SCare and Health Insurance Costs
(finone enter zero)
100 8 Parents percentage () of Income
from Line 2
9 Parents share ofVork Related Child Care and Health Insurance Costs 8 s lvlultiply on Line 8 for each parent by total monthly amount on Line 7
10 Parents Adjusted Child Support Obligation - Each parents monthly BCSO s from Line 4 pillS parents share ofwork reipoundlttd child care expenses amp health insurance COSlS
middot 11 Credit for 1Honthly Amounts parents actually payor ill pay for VorkshyRelated Child Care andor Health Insurance Costs
$ s
12 Total Parents Presumptive Child Support Obligation s 8
0middot (e) 0
Nonparent middotCustodian
8 S
S S
S 8
13 Subtract Social Security offset - ffa s S child receives Title II Social Security bellejirs (ie RSDFSSD for parent s disabiliry Iretirement) (15 a dependll1t 011 lIoncllstodial parfnts account entlr monthiy amotlnt child recliles tlilder lhat parcIIls column fInol1l enter zero
1t Final monthly child support obligation amount for each parent shy011(- the noncustodial parel1t(s) will have the duty EO pav
15 Uninsured Health Expenses- Carry
dOW1 thl percentage from Line 2 or ellter a percelltage agreed upon by thl parties or orcIrld by the court
G~orgia EZ Manual Work5h~~L V~rion 3 2 12 Jul L 20 1-1
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Hov to find the Basic Child Support Obligation (BCSO) using an example of the Table
See below an example using an excerpt from the Table intended to help one understand hmv to select the correct BCSO
The table displays the dollar amount of the BCSO corresponding to various levels of combined adjusted income of the childrens parents and the number of children for vhom a child support order is being established or modified in the present action To use the table correctly one must find the amount of the Combined Adjusted Income on the table that is most closely related to the parents gross income
Once you have determined the amount of Total Combined Adjusted Income to use go to the column that represents the number of children included in your worksheet Follmv across the line of income and dmvn the column for the number of children in the action until they intersect That sum vill be used as the Basic Child Support Obligation amount and entered on Line 3 of the worksheet
Georgia Schedule of Basic Child Support Obligations Combined Adjusted Income
One I Two Child Children
Three I Four Children Children
Five Children
Six Children
2800 i 583 I 829 962 1073 1180 1284 2850 I 592 I 842 977 1089 1198 1303 2900 601 i 855 992 1106 1216 1323
In this example the parents Total Combined Adjtlsted Income is $286790 (found on Line 2) The amount of income on the table that is closest to the parents income is $285000 Thus in this example the correct amount of the Total Combined Adjusted Income to use is 8285000
Why did we choose $285000 and neither of the other two amounts This can be explained by looking at the difference in the actual gross income of the parents when compared to the amounts found under the column in the table labeled Combined Adjusted Income
The difference between $286790 and $2800 is $6790 The difference between $286790 and $2850 is $1790 (Most closely related amount) The difference betveen $286790 and $2900 is $3210
II llll- 12)i-l
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Georgia
Schedule ot Basic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
800 197 283 330 367 404 440 850 208 middot298 347 387 425 463
900 218 313 364 406 447 486 950 229 328 381 425 468 middot509 1000 239 343 398 444 489 532 1050 250 357 415 463 510 middot554 1100 260 372 432 482 530 577 1150 270 387 449 501 middot551 600 1200 280 401 466 520 572 622
1250 291 416 483 539 593 645 1300 301 431 500 558 614 668
1350 311 middotmiddot445 1middot517 577 634 690 1400 321 459 533 594 654 711 1450 331 473 middot549 612 middot673 733 1500 340 487 565 630 693 754 1550 350 500 581 647 712 775 1600 360 514 597 665 732 796 1850 369 528 612 683 751 817
1700 379 542 628 701 771 838 1750 389 555 644 718 790 880 1800 398 569 660 736 809 881 1850 408 583 676 754 829 ) 902
1900 418 596 692 771 848 923 middot1950 427 610 middot708 789 868 944
2000 437 624shy 723 807 887 965 middot2050 446 637 739 824 906 986 2100 455 650 754 840 924 1006 2150 465 663 769 857 943 1026 2200 474 676 783 873 961 1045 2250 483 688 798 890 979 1065 2300 492 701 813 907 997 1085
I 2350 501 714 828 923 1016 1105 2400 510 727 843 940 1034 1125
lt2450 519 740 858 956 1052 1145 2500 528 752 873 973 1070 1165 2550 537 765 888 990 1089 1184 2600 547 778 902 1006 1107 1204
2650 556 middot791 917 ~1023 1125 1224 2700 565 804 932 1039 1143 1244 2750 middot574 816 947 1056 1162 1264
2800 583 829 962 1073 1180 1284 2850 592 842 977 1089 1198 1303 2900 601 855 992 1106 1216 1323 2950 611 868 1006 1122 1234 1343 3000 620 881 1021 1139 1253 1363 3050 629 893 1036 1155 1271 1383 3100 638 906 1051 1172 1289 1402 3150 647 919 1066 1188 middot1307 1422
3200 655 930 1079 1203 1323 1440 3250 663 941 1092 1217 1339 1457
3300 671 952 1104 1231 1355 1474 3350 679 963 1117 1246 1370 1491 3400 687 974 1130 1260 1386 1508
3450 --694 985 -1143 1274 middot1402 1525
3500 702 996 1155 1288 1417 1542 3550 710 middotmiddot1008 1168 middot1303 1433 1559
3600 718 1019 1181 1317 1448 1576 3650 middot726 middot1030 1194 ~1331 1464 middotJ593
3700 734 1041 1207 1345 1480 1610 middot3750 741 1051 1219 1 359 1495 4627
3800 749 1062 1231 1373 1510 1643 3850 gt756 --1072 1243 1386 )1525 ~middotmiddot1659
3900 764 1083 1255 1400 1540 1675 3950 gtinl 1093 i~1267 413 middotmiddotmiddot1555 )-1691
4000 779 1104 1280 1427 1569 1707 ~middoti4050 middot~ltq86 -1114 11292 middott4 0144Q ~middot1584 lt1 724 j
4100 794 1125 1304 1454 1599 1740 4150 ) 801 middot1135 middot middot1316 middotmiddot~1467 1614 middot1756
4200 809 1146 1328 1481 1629 1772 4250 gt816 1156 1340 middot1494 1643 -1788
4300 824 1167 1352 1508 1658 1804 4350 831 1177 1364 1521 1673 1820 4400 839 1188 1376 1534 1688 1836 4450 846 1198 1388 1548 1703 1853 4500 853 1209 1400 1561 1718 1869
Georgia
SChedule of Basic Child Support Obligation
COMBINED ADJUSTID ONE TWO THREE FOUR FIVE SIX
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN INCOME
4550 861 1219 1412 1575 1732 1885 4600 C 868 12301425 middot1588 17471901
4550 876 1240 1437 1602 1762 1917 middot-4700 middotmiddotmiddotmiddot883 1251 1middot1449 1615 1m Ii 1933
4750 891 1261 1461 1629 1792 1949 4600 middot896 1middot271 1473 1642 middot1807 1966
4850 906 1282 1485 1656 1821 1982 I 4900-middotmiddot 911 1289 1493middot1664 1 831- 1992
4950 914 1293 1496 1668 1835 1997 5000 middotmiddot917 middotmiddot12971500 1672 1839 )2001
5050 921 1300 1503 1676 1844 2006 5100 middot924 1304 1507 [1680 yen1848 1~middot2011
5150 927 1308 1510 1684 1852 2015 5200 930 F1312 middot1514 middot1688 --1857 2-020 5250 934 1316 1517 1692 11861 2025
5300 937 1320 middotlt1521 gt1696 1865 2029 5350 940 1323 1524 1700 1870 2034 5400 943 13271528 1704 1874 2039 5450 947 1331 1531 1708 1878 2044 5500 950 1335 15351711 1 883 2048 5550 953 1339 1538 1715 1887 2053
5600 956 ~1342 1542 [1719 891 middot~-2058
5650 960 1347 1546 1724 1896 2063 5700 9641352 -1middot552 731 middot1904 2071
5750 968 1357 1558 1737 1911 2079 5800 ~ 9711363 middotmiddot1564-~1744 -M18 middot2087
5850 975 1368 1570 1750 1925 2094 5900 979 1373 1575 1757 ~19327-2102
5950 983 1379 1581 1763 1939 2110 6000 987 1384middot1587 1770 1947lt2118 6050 991 1389 1593 1776 1954 2126
6100middot 995 1394 21599 1783)middot1961~r2133A
6150 999 1400 1605 1789 1968 2141 6200 1003 1405 16101796 1975 2149
6250 1007 1410 1616 1802 1982 2157 630010111416 1622 middot1809 1989 2164 6350 1015 1421 162B 1815 1996 2172
middot6400 10181426 1633-1821- 2003 2180 6450 1023 1432 1639 1828 2011 2188
6500 1027 1437 1646 middot1835 2018 2 196 6550 1031 1442 1652 1841 2026 2204
6600 1035 -1448-16581848 20332212 6650 1039 1453 1664 1855 2040 2220
6700 1043 1459 middot16701862 20482228 6750 1047 1484 1676 1869 2055 2236 6800 middot1051 1470 682 middot1~875middot 2063 2244 6850 1055 1475 1688 1882 2070 2252
6900 middot1059 1480 iq694 ~~1middot889 2 078 middot-~2260
6950 1063 1486 1700 1896 2085 2269 middot7000 r067 1491 +706 H902 middot~2092i~2277
7050 1071 1497 1712 1909 2100 2285 7100 0middotmiddot1075 1502 middot~718 1916 2107 2293 I
7150 1079 1508 1724 1923 2115 2301 [lt7200 1083 513 W1730 i~ 929 ~2122~~2309middoti
7250 1087 1518 1736 1936 2130 2317 7300 1092 4 524 ~t1742 1943middot F2137- ~2325
7350 1096 1529 1748 1950 2144 2333 7400 1~1100 1535 ~ll4755- middot~11956 412152 middot~$f2341
7450 1104 1540 1761 1963 2159 2349 -7500 1108 546 1167 ~~970 middotI~2167 52middot357middot
7550 1112 1552 1773 1977 2175 2366 middotmiddot~7 600 middot1middot116 middot1556 v1778 01983 middotmiddot-2181middot middotiiJ2373
7650 1117 1557 1779 1984 2182 2375 ~q7oo middot1118 Q1559 ii1781 1~1986 ~li2~84 ~2 376~
7750 1119 1560 1782 1987 2186 2378 hQ8oo ~112O Kcent1562 middotl~~184i1989 4142188 20380
7850 1122 1563 1785 1990 2189 2382 ~t7Illoo middot1123 ~S1565~1786-middotgtjr992 ~middotP2191middot )rt2384
7950 1124 1566 1788 1993 2193 2386 8000 11251567 W789 019952194 2367
8050 1127 1569 1790 1996 2196 2389 )8100 1128 1570 r792 J~1998 K~2198 middot2391 8150 1129 1572 1793 1999 2199 2393
82001130 1573 1795 2001 02201 middotgt2395 8250 1111 1575 1796 2003 2203 ~l7
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Georgia Schodulo of Sallie Child Support Obligations
NCOME
1576 1797 2004 2204 2398 1578 1799 2006 2206 2400 1579 middot1800 2007 2208 2402 1580 1802 2009 210 2-104 1582 1 803 2010 2 211 2406 1583 1804 2012 2213 2408 1585 1806 2 013 2215 2410 1586 1807 2015 2216 2411 1588 1 B08 2016 2218 2413 1589 1810 2013 2220 2415 1591 1811 2019 2221 2417
1164 1617 18olO 2052 2257 24551 1170 1624 1849 2062 226B 24671 1175 1632 1858 2071 2279 24791 1181 1640 1867 2081 2290 2491 11d7 1648 1876 2091 2301 2503 1 192 1656 1885 2101 2311 2515 1198 1663 1894 2111 2322 2527 1203 1671 1902 2121 2333 middot2539 1209 1679 1911 2131 2344 2551
middot1214 1687 1920 2141 2355 middot2563 1220 1694 1929 2151 2366 257ltl 1226 1702 193B middot 2161 2377 2586
1710 1947 2171 2388 2598 1718 1956 2181 2399 2610 1725 1965 I 2191 2410 2622 1733 19741 2201 2421 2634 171 19831 2211 2432 25-16 1749 1992 2221 2443 2658
2001 2231 I54 2670 2010 2 241 2465 2662 2019 225~ 2476 2694 202B 2261 2487 2706
COMBINEDCOMBJNE~p IADJUSTED ONE TWO THREE FOUR FIVE SIX ADJUSTED GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN GROSS
middot13500 13550 13600 13650 13700 13750 13800 13050
middot13900 13950 14000 14050 14100
10250 1287 17861 2036 2271 21913 2718 14150 10300 1292 1 795 2045 22Bl 2509 2729 14200 10350 1298 1803 2054 2291 2520 2741 14250 10400 1303 1811 2063 2301 2531 2753 14300 10450 1309 1819 2072 2311 2542 2765 14350 10500 1 313 1825 middot2079 2318 2550 2774 I 14400 10550 1317 1630 2085 2325 2557 2782 14450
10600 1321 1835 2091 2331 2564 2790 14500 10650 1325 18oll 2096 2338 2571 2798 14550 10700 middot1329 1646 2102 2344 2578 2B05 14600 10750 1332 1851 2108 2351 2586 2S13 14650 10BOO 1336 1856 2114 2357 2593 2821 14700 10850 1340 1862 2120 2364 2600 2829 lol750
14800
15350 Ie 15400 1
15450 e 15500
15550 15600 ~
10900 1344 1867 2126 middot 2370 2607 2836
2441 2686 2922 2446 2693 2930
2454 2700 2938 middot 2461 2707 2945
2467 2714 2953 i
2474 2721 2961 2480 2728 29691
2487 2736 2976 2493 2743 2984
~ 2500 2506
~ 2513 2519
~ 2526 2532
Georgia Schedule of Sasie Child Support Obligations
ONE TWO THREE ICHILD CHILDREN CHILDREN
middot-2418 2423
middot2428 2432 2437 24-12 2447 2452
2457 2462
2467 2472 2477 2482
middot2487 2492
2497 2502
2506 2511 2516 2521
middot2526 2531
2536 2541
~ 2546
2600 2605 2610
~2615 2620
2625 2630
INCOME
12200 1443 12250 1447
12300 1451 2014 12350 1455 2019 12400 1459 2024 12450 1462 2030 I 12500 1466 2035 12550 1 470 2040
12600 1474 middot2045 12650 1477 2050 12700 1 481 2055
148 2060 1487 - 2064
1491 2069 2351 1494 2074 2356 1497 2078 2361 1501 20B3 middot2367
r 130501 1504 2087 13100 1507 2092
1 13150 1510 2097 I 13200 1514 middot2101
13350 1523 2114 2403 13400 1526 2118 2408T middot 2 685 --2953 3213 13450 1529 2123 2413 2690 2959 3220
1532 2127 1535 2131 1538 2136 1541 2110 1544 2144 1547 218 1550 middot2153 1553 2157 1556 2161 1559 2166
1562 2170 1565 2174 1568 2178 1571 2183 1574 21B7 1577 2191 1581 2195 158ol 2200 1587 2204 1590 2208
1593 2213 1596 2217 1599 2221 1602 2225 1605 2230 1606 234 1611 2238
1644 2285 1647 2290
2294 1653
1650 2298
1656 2302 1659 2307 -~r- 2311
FOUR I I FIVE I CHILDREN CHILDREN
bull middot2696 2965 2701 middot2971 2707 middot2977 2712 2983 2718 2989 2723 2996 2729 3002 273ol 3008
middot2740 3014 2745 3020
2751 3026 2756 3032 2762 3038 2767 3044 2773 3050 2778 3056 2784 3062 2789 3068
2795 middotmiddot3074 2800 3080 2806 3086 2811 3092 2817 3098 2822 3104
middot 2828 3 111 2833 3117
middot2639 middot3123
2899 3189 middot 2905 middot3195
2910 3201 ~ middot2916 gtmiddot3207
2921 3213 2927 3219 2932 3226
SIX CHILDREN
~ 3226 3233 3239 3246
middot3253 3259 3266 3272 3279 3285
3292 3299
3305 3312
3318 3325 3332 3338 3345 3351 3358 3365 3371 3376 3384 3391 3397 3404
3411 3417
~ 3424 3430 3437 344ol
3450 3457 3463 3470 3476 3483
3490 3496 3503
~509
3549 ~3 558
3562
Georgia EZ Manual Worksheet VerSion 3 2 TJ lui 120 I)
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Goorgia SchodufD of Basic Child Support ObliqaCions
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX
GROSS CHILO CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
INCOME
16100 1690 3569
16150 1692 357-1
16200 1695 3579 16250 1698 35B4 16300 1700 3589 16350 1703 3594 i 16400 1706 3599 16150 1708 i 3604 16500 1 711 3609
GeorgiQ Schedulo of Basic Child Support ObliqilljonJ
COMBINED
ADJUSTED ONE TWO THREE FOUR SIX GROSS CHtLD CHILDREN CHILDREN INCOME
20000 -1896 2622 20050 1899 2625 20100 1901 2628 20150 1904 2632 20200 1907 2635 20250 1909 20300 middot1912
4006 4011
4D16 4021
4102 4107
3780 4112 3784 4117 3789 4123 3794 4128 3798 4133 3803 4138
4143 middot3812 3808
41 3817 4153
4158 - 3822 3827 4163
4168 4173 4178 4184 4189 4194
4199 4204 4207 4210
3292 3621 -3 96 3626
2611 3300 3630 2615 3305 3635
2618 3309 3640
Georgm EZ MUillial Workshe~L VersIon 3 ~ T-l July l ~Ol-l
4279
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
COMBINED
ADJUSTED ONE TWO THREE FOUR
GROSS CHILO CHILDREN CHILDREN CHILDREN
INCOME
23900 2065 3517 23950 3579 24000 3561 24050 3563 24100 3585 24150 3587 24200 3589 21250 3592 24300 3594 24350 3596 24400 3596 24450 3600 24500 3602 24550
3265 3267 3269
2906 3271 2908 3273 2910 3275
2117 2911 3276 2119 2913 3278 2120 2915 3280 4024 2121 2917 3282 4027 2123 2919 3284 4029 2124 2921 3286 4031 2126 2923 3287 3666 4034 2127 2924 3289 3668 4036 2128 2926 3291 3670 4038 2130 middot2928 3293 3672 4040 4396 2131 2930 3295 4043 43991 2133 2932 3297 4045 4401 2134 2934 3299 4047 4403
2136 middotmiddot2935 3300 4Q50 4406 2137 2937 3302 4052 4l08 2138 2939 4054 4411 2110 2941 4056 4413 2141 2943 4059 middot4416 2143 2945 4061 4418 i
2947 4063 lt 4421 4066 4423
4068 4426 4070 4428
4072 4431 4075 4433
27000 4077 4436 27050 2154 4079 4438
27 00 2155 4082 4441 27150 2157 3711 4084 4443 27200 2158 3713 4086 4448 27250 2160 3715 4088 4448
27300 2161 3717 4091 14451
27350 2162 3719 4093 4453 27400 2164 721 middot4095 ~4456
27450 2165 3339 723 4098 4458 27500 2167 ~3 341 3725 4
27550 2168 3343 3727 4 27500 2170 middot3345 ~ 3729 4
27650 2171 3347 3731 4107 27700 2172 3348 3733 4109 27750 2174 3350 3735
Georgia Georgia Schedule of Basic Child Support Obligations Schedule o( 6dSic Child Support Obligations
COMBINED ADJUSTED ONE TWO THREE FOUR FIVE SIX I
GROSS CHILD CHILDREN CHILDREN CHILDREN CHILDREN CHILDREN
3352 middot4114 4475 4478 4460
21 4483 4485
2996 4488 2998 4490
3000 4492 3001 4495 3003 4A97 middot3005 4500 3007 4502 3009 4504 3010 4507
3012 4509 014 4512
3016 4514 3017 4151 4516
3019 4153 4519 3021 4521 3023 4524 3025 4526 3026 4528 3028 3030 3032
3039 3404 3041 3406 3042 3407 3044 3409 3046 3411 4555 3048 3413 4557 3050 3415 4560 3051 3416 4562 3053 3418 3811 4564 3055 3420 3813 4567 3057 3A22 3815 4569 3058 3423 3817 4572 3060 3425 3819 3062 3427 3821 3064 3429 3823 4208 3066 3431 3825 4211
Gorgra EZ lal1l1al Workshlt VaSlO1l 3 2 f5 July 1 21) P
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
The Georgia Pen and Paper EZ Child Support lVorksheet Simple Calculations with No Adjusted Income or Deviations
Read the following to find out if this is the right worksheet for you to use
If YOIl UtlIlt to claim lilY other cirClllllstallces sllch as preexistillg orders qualified childrell selfshyelllpiaYlIle1lt taxes de ia tiaIls YOll III liS t STO P lOW tlS yo LL Cl1H11O t llse this fa rill Please ills tead lse tIle StalldMd Child Support vVorksfteet alld Schedules (paper or electronic - see page iii of the Instmctiolls)
Advisory To cOlllplete tit is foml lise tIle attlcled illslrJ1ctiQlls to reach the correct calculatioll tlIIlOlIltS Also see tlte RefereJlce Guide tl ttaclted for defiIlitioIls of terms illforlllation and helpJill tips Enter all alJlounts as lJIolltllili alllOlIJlts
=~=L_l--__________Type of Court ~S4=E=erCcr________ County L-middot - A-y _
CV-12345 NA CourtCivil ActionOSAH Case Number DHSIIV-D Case Number (ifapplicable)
o 9~ck b~~HS is Petitioner
M~JyenfulltNCU41eI f~1~~ivCU41el Mothers name (please prillt) Fat~e-r~a~~fplease print) ~ Custod ial Parent IoNoncustodial Parent Icheel one) ttO ~~alaquont I ~ None ustodial Par en (ch eck one)
NA ~~taf~~tj9n 0 Modification Action (check one)
Nonparen Custodians name ifany (pi p~ t~~nitiarchild Support Order ________
List Olliv Children for YhoinSu o1s Beincr Determined in This Case
bull Childs Name Year of Birth Childs Name Year of Birth
I I
C1 chiJii (9 V1e t~7~ ~
lt~f~C2 Chail-woshy201iJlt~ i
V C3
Parents Presum tive Amount of Child Su
1 Parents monthly gross income
2 Parents percentage of total income (Must total 100)
3 Basic Child Support Obligation (BCSO) from attached Child Support Obligation Table
4 llIonthly BCSO amount for each parent
C4
C5
i C6
8101790 1$195000 18296790
34 66 i 100
$29512
I
Georgia EZ Manuul Worksheet V~r5ion 32 EI July I 201-l
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
5
(a) )tfother
6 JUonthly Health Insurance premium paid for the Children (fnone elller ero) $10000
7 TotallUonthly York Related Child Care and Health Insurance Costs $40000 ((Il 011e emer ero)
8 Parents percentage () of Income from Line 2 34
9 Parents share ofVork Related Child Care and Health Insurance Costs 813600 l1Iultiply on Line 8 for each parent by total monthly amount on Line 7 tshy
10 Parents Adjusted Child Support Obligation shy Each parents mOlllh(r BCSO from Line 4 pIlls parents share owork related child care expenses amp health insurallce costs
s $30000
8 s $10000
s 840000
100
11 Credit for lHonthly Amounts parents actuall)~ payor ill pay for Vork~ Related Child Care andor Health t Insurance Costs ifshy ~ ~) (~
12 Total Parents PresumptinfChitd~ Support Obligation ~) gt
lt--v 13 Subtract Social Security offset -if(
child receives Title 11 Social Security benejits (ie RSD1SSD for parents disabililY relirement) as a dependent Oil noncustodial parents account enter momhly amount child receives undr that parents column Ifnone enter ero
bull l~ Final monthly child support obligation amount for each parent - 8 3112 Only the noncustodial parent(j will have the dury to pav
50
S 000
8 000
Georgm EZ 1~nul1 W)rkhect Vas ion 3 2 Julvlll)l
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Rule 2410 Parenting Plans
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence) each parent shall prepare and submit a parenting plan or the parties may jointly submit a parenting plan as directed by the judge
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA sect 19-9-1 (b) and be presented in substantially the following fonn
_______ COUNTY SUPERIOR COURT ST ATE OF GEORGIA
Plaintiff Civil Action
v Case Number ---- shy
Defendant
PARENTING PLAN
( ) TI1e parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA sect 19-9-1 The parties agree on the terms of the plan and affirm the accuracy of the information provided as shown by their signatures at the end of this order
( ) This plan has been prepared by the judge
This plan ( ) is a new plan ( ) modifies an existing Parenting Plan dated _____ ( ) modifies an existing Order dated ________
Childs Name Year of Birth
9
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
I Custody and Decision llaking
A Legal Custody shall be (choose one) ( ) with the Mother ( ) with the Father ( ) Joint
B Primary Physical Custodian
For each of the children named below the primary physical custodian shall be
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother ( ) Father ( ) Joint
yolb () Mother () Father ( ) Joint
yolb () Mother () Father ( ) Joint
WHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN
C Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent including any emergency decisions affecting the health or safety of a child
D Major Decisions
Major decisions regarding each child shall be made as follows
Educational decisions () Mother () Father ( ) Joint Non-emergency health care () Mother () Father ( ) Joint Religious upbringing () Mother () Father () Joint Extracurricular activities () Mother () Father () Joint
() Mother () Father ( ) Joint () Mother () Father ( ) Joint
10
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
E Disagreements Where parents have elected joint decision making in Section 1 D above please explain how any disagreements in decision-making will be resolved
II Parenting TimeJVisitation Schedules
A Parenting TimeNisitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting timevisitation (choose an item)
( ) The weekend of the first and third Friday of each month
( ) The weekend of the first third and fifth Friday of each month
( ) The weekend ofthe second and fourth Friday of each month
( ) Every other weekend starting on _____ ( ) Each starting at ampm and ending ____ ampm () Other _____________________--shy
( ) and weekday parenting timevisitation on (choose an item) () None ( ) Every Wednesday evening ( ) Every other Wednesday during the week prior to a non-visitation weekend ( ) Every evemng () Other ------------------- shy
For purposes of this parenting plan a weekend will start at ___ ampm on [Thursday FridaySaturdayOther ] and end at ampm on [SundayMonday Other ]
Weekday visitation will begin at __ ampm and will end L~m when the child(ren) retum(s) to school or day care the next morningOther ]
This parenting schedule begins
()------- (day and time) OR () date of the Courts Order
11
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
B Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other an-angements are set forth
beginning _____________________________________________________________
Vinter Vacation
The ( ) mother ( ) father shall have the child(ren) for the first period from the day and time school is dismissed until December at___amlpm in ( ) odd numbered years ( ) even numbered years ( ) every year The other parent will have the child(rcn) for the second period from the day and time indicated above until 600 pm on the evening before school resumes Unless otherwise indicated the parties shall alternate the first and second periods each year
Other agreement of the parents Summer Vacation Define summer vacation period --____________________________---_________ The day to day schedule shall apply unless other arrangements are set forth
beginning ________________
Spring Vacation (if applicable) Define
------------------------~----------------------------------The day to day schedule shall apply unless other arrangements are set forth
beginning ______________
Fall Vacation (if applicable) Define ----------------------------------------------------------shyThe day to day schedule shall apply unless other an-angements are set forth
beginning _____________
C Other Holiday Schedule (if applicable)
Martin Luther King Day PresidentsDay Mothers Day Memorial Day Fathers Day July Fourth Labor Day Halloween Child(ren)s Birthday(s)
12
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Mothers Bilthday Fathers Bi11hday Religious Holidays
Other
Other
Other
D Other extended periods of time during school etc (refer to the school schedule)
E Start and end dates for holiday visitation
For the purposes of this parenting plan the holiday will start and end as follows (choose one)
( ) Holidays that fall on Friday will include the following Saturday and Sunday ( ) Holidays that fall on Monday will include the preceding Saturday and Sunday () Other ______________________
F Coordination of Parenting Schedules
Check if applicable
( ) The holiday parenting timevisitation schedule takes precedence over the regular parenting timevisitation schedule ( ) When the child(ren) isare with a parent for an extended parenting timevisitation period (such as summer) the other parent shall be entitled to visit with the child(ren) during the extended period as follows
G Transportation Arrangements
For visitation the place of meeting for the exchange of the child(ren) shall be
13
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
---------------------------------
------------------------------------
The ___________ will be responsible for transportation of the child at the beginning
of visitation The __________will be responsible for transportation of the child at the conclusion of visitation
Transportation costs if any will be allocated as follows
Other provisions
H Contacting the Child
When the child or children are in the physical custody of one parent the other parent will have the right to contact the child or children as follows
( ) Telephone
( ) Other __________________________
( ) Limitations on contact
1 Supervision of Parenting Time (if applicable)
( ) Check here if applicable
Supei-vised parenting time shall apply during the day-to-day schedule as
follows Place
PersonOrganization supervising ___________________________
Responsibility for cost
() Mother ( ) Father ( ) Both equally
J Communication Provisions
Please check
( ) Each parent shall promptly notify the other parent of a change of address phone number or cell phone number A parent changing residence mLlst give at least 30 days notice of the change and provide the full address of the new residence
( ) Due to prior acts of family violence the address of the child(ren) and victim of family violence shall be kept confidentiaL The proteCted parent shall promptly notify the other parent through a third party of any change in contact information necessary to conduct visi tation
14
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
---------------- --------------
III Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations pursuant to OCGA sect 19-9-1 (b) (l) (D) both parents are entitled to access to all of the child(ren)s records and information including but not limited to education health extracurricular activities and religious communications Designation as a non-custodial parent does not affect a parents right to equal access to these records
Limitations on Access Rights __________________---______
----------~-- ------------------ ----------------~------------
Other Information Sharing Provisions
--~---
IV Modification of Plan or Disagreements
Parties may by mutual agreement vary the parenting timevisitation however such agreement shall not be a binding cou11 order Custody shall only be modified by court order
Should the parents disagree about this parenting plan or wish to modify it they must make a good faith effort to resolve the issue between them
V Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (eg health issues educational issues etc)
VI Parents Consent
Please review the following and initial
1 We recognize that a close and continuing parent-child relationship and continuity in the childs life is in the childs best interest
Mothers Initials ____ Fathers Initials _____
2 We recognize that our childs needs will change and grow as the child matures we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized
MotherS Initials ____ Fathers Initials _____
15
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
3 We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent
Mothers Initials Fathers Initials _____
( ) We knowingly and voluntarily agree on the terms of this Parenting Plan Each of us affirms that the information we have provided in this Plan is true and correct
Mothers Signature Fathers Signature
ORDER
The Court has reviewed the foregoing Parenting Plan and it is hereby made the order of this Court
This Order entered on 20--------------------------------- ----shy
JUDGE ____ COUNTY SUPERIOR COURT
16
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
----
IN THE SUPERlOR COURT FOR THE COUNTY OF FLOYD
STATE OF GEORGIA
Plaintiff CIVIL ACTION
v NO _________
Defendant
CHILD SUPPORT ADDENDUM
The parties have agreed to the terms of this Order and this information has been furnished by both parties to meet the requirements of OCGA sect 19-6-15 The parties agree on the terms of the Order and affirm the accuracy of the information provided as shown by their signatures at the end of this addendum
This addendum includes findings of fact and conclusions oflaw and fact made by the Court in compliance with OCGA Q19-6-15
Application of Child Support Guidelines The statutory requirements of OCGA sect 19-6shyQ have been applied in reaching the amount of child support provided under the Final Order in this action The specifics are as follows
1 Fathers gross monthly income (before taxes) is =$_________
the Mothers gross monthly income is t (before taxes)
2 Number of Children-The number of children for whom support is being provided under this order is
3 Attachments-The Child Support Worksheet and Schedule E are attached and made a part of this Addendum along with any other applicable schedules
4 Child Support Amount-The __~______ shall pay to the _______ for the support of the minor children the sum of $ per month beginning on 20
5 Duration of Child Support
[You must check amp complete oilly one ofthe following paragraphs]
(a) Beyond Age 18 for High School - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated provided that if a child becomes eighteen years old while enrolled in and attending secondary
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
school on a full-time basis then the child support shall continue for the child through the month when the child has graduated from secondary school or through the month whenthe child reaches twenty years of age whichever occurs first
(b) Stops at Age 18 - The child support shall continue monthly thereafter until each child reaches the age of eighteen dies marries or otherwise becomes emancipated
(c) Until Further Order - This is not a final order so the child support shall continue until further order of this Court
(d) Until Specific Date - The child support shall continue monthly thereafter until ~_____
6 Deviation from Presumptive Amount
[You must check amp complete only one ofthe following paragraphs
(a) No Deviation - It has been determined that none of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The amount of support in Paragraph 4 above is the Presumptive Amount of Child Support shown on the attached Child Support Worksheet
(b) Deviation - It has been determined that one or more of the Deviations allowed under OCGA sect 19-6-15 applies in this case as shown by the attachedSchedule E The Presumptive Amount of Child Support that would have been required under OCGA sect 19-6-15 if the deviations had not been applied is $ per month as shown on the attached Child Support Worksheet The attached Schedule E explains the reasons for the deviation how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and how the best interest of the children who are subject to this child support determination is served by deviation from the presumptive amount of child support
7 Split Parenting-A split parenting situation occurs when the parents have two or more children together where at least one of the children spends more than 50 of the time with one parent and at least one of the children spends more than 50 of the time with the other parent
[You must check amp complete only one ofthe following paragraphs
(a) Not Split Parenting Case - This case does not involve Split Parenting
(b) Split Parenting Case - This is a Split Parenting case Separate Child Support Worksheets have been filed for the children living with the Mother and for the children living with the Father and a Child Support Order Addendum has been entered
--------intll1s action for each parent At tliiS11me th-e-NIOllier isoEIigatedTo pay lile sum of $ per month to the Father and the Father is obligated to pay the sum of $ per month to the Mother
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
aryou checked (b) above you must check amp complete only one ofthe follovving subshyparagraphs
(1) Net Payment - For so long as these amounts remain in effect the __________ shall pay only the difference between the two amounts (which is $ ) to the ______ who shall not be required to pay the child support obligation to the other parent
(2) Zero Payment - The parents child support obligations are equal For so long as the amounts remain equal neither parent shall pay any child support payment to the other parent
(3) Full Payment From Each - Each parent shall pay the full amount of his or her child support obligation to the other
8 Health Dental amp Vision Insurance for Children
[You much check amp complete all parts ofonly one ofthe following paragraphs (a) or (b)
(a) Insurance Available - The following insurance for the children involved in this action is available at a reasonable cost to the through that parents employer or the PeachCare program
Health (medical mental health and hospitalization) Dental Vision
So long as it remains available to that parent the shall maintain the types of insurance checked above for the benefit of the minor children until each child reaches the age of eighteen dies marries or otherwise becomes emancipated except that if a child becomes eighteen years old while emolled in and attending secondary school on a full-time basis then the insurance shall be continued for the child until the month when the child has graduated from secondary school or through the month the child reaches twenty years of age whichever occurs first
(1) The parent who maintains the insurance shall provide the other parent with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy
2)All money received by one of the parties for claims processed under the insurance policy shall be paid within five (5) days after the party receives the money to the other party (if that other party paid the applicable health care service provider) or to the applicable health care provider (if the provider has not been paid by one of the parties)
(b) Insurance Not Available - Insurance (other than Medicaid) is not available at this time to eitl1er party at a reasonaoIecosCIrheaHl1iiisuranceTortne cfiilCirenlater 6ecomes avairaolelO------shythe parent who is required to pay child support for these children then that parent must obtain the following types of insurance unless it is then being provided by the other parent
Health (medical mental health and hospitalization) Dental Vision
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
---------- ---------------------------
When insurance has been obtained by either party Paragraphs 8 (a)(I) and (2) shall apply
9 Uninsured Health Care Expenses - The shall pay _ and the _______ shall pay 5 of all expenses incurred for the childrens health care (including medical dental mental health hospital and vision care) that are not covered by insurance The party who incurs a health care expense for one of the children shall provide verification of the amount to the other party That other party shall reimburse the incurring party (or pay the health care provider directly) for the appropriate percentage of the expense within fifteen (I 5) days after receiving the verification of a particular health care expense
10 Parenting Time Amounts - The approximate number of days of parenting time per year according to the visitation order is days for the Father and _ days for the Mother
11 Social Security Benefits
[You must check amp complete only one ofthe following paragraphs
(a) Not Received - The children do not receive Title II Social Security benefits under the account of the parent ordered to pay child support
(b) Received - The children receive Title II Social Security benefits under the account of the parent ordered to pay child support The benefits received by the children shall be counted as child support payments and shall be applied against the final child support order to be paid by that parent
(1) If the amount of benefits received is less than the amount of support ordered the obligor shall pay the amount exceeding the Social Security benefit
(2) If the amount of benefits received is equal to or more than the amount of support ordered the obligors responsibility is met and no further supportshall be paid
(3) Any Title II benefits received for the childrens benefit shall be retained by the custodial parent or nonparent custodian for the childrens benefit and it shall not be used as a reason for decreasing the final child support order or reducing arrearages
12 Modification
[You must check amp complete ollly one ofthe follmving paragraphs
(a) Not Modification Action - This is an initial determination of child support not a
(b) Support Not Modified - This action is a modification action but the order does not modify the amount of child support that was previously ordered for these children The date of the initial support order conceming this child support case was
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
-----
(c) Support Amount Modified - The Order modifies the amount of child support that was previously ordered for these children The basis for the modification is
(1) Substantial change in the income and financial status of the Father
(2) Substantial change in the income and financial status of the Mother
(3) Substantial change in the needs of the Children
(4) The noncustodial parent failed to exercise visitation provided under the prior order
(5) The noncustodial parent has exercised more visitation than was provided in the prior order
The date of the initial support Order concerning this child support case was_
13 Continuing Garnishment for Child Support - Whenever in violation of the terms of the order there shall have been a failure to make the support payments so that the amount unpaid is equal to or greater than the amount payable for one month the payments required to be made may also be collected by the process of continuing garnishment for support
14 Income Deduction Order
[You must check amp complete only one ofthe following paragraphs (a) (b) or (c)
(a) An Income Deduction Order shall be entered by the Court under OCGA sect 19-6-32 for payment of the child support and alimony (if any) provided TheIncome Deduction Order shall take effect
[To finish (a) you must check either (1) or (2) Do not check both
(l) immediately upon entry by the Court
(2) upon accrual of a delinquency equal to one months support The Income Deduction Order may be enforced by serving a Notice of Delinquency as provided in OCGA sect 19-6-32
illmiddot
(b) The parties agree that an Income Deduction Order is not immediately necessary
(c) The Court finds that there is good cause not to require income deduction having determined that income deduction will not serve the childrens best interests and that there has been sufficient proof of timely payment of any previously ordered support
Parties Consent (if applicable) - We knowingly and voluntarily agree on the terms of this Order Each of us affirms that the information we have provided in this Addendum is true and correct
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
-----
Fathers Signature Mothers Signature
ORDER
The Court has reviewed the foregoing Child Support Addendum and it is hereby made the Order of this Court
This Order entered on 20
JUDGE SUPERIOR COURT OF FLOYD COUNTY
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
------------------------------
IT THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA
) )
Plaintiff ) )
v ) ) Civil Action File No _______ j
Defendant ) ) )
ORDER
The above matter having been heard it is therefore the judgment of this Court that
________________ is hereby declared to be legitimate and to
be the legitimate child and capable of
inheriting from the father in the same manner as ifborn in lawful wedlock and from
henceforth the name by which said child shall be known shall be
Vital
Records is directed to change the child(ren)s surnames on their birth certificate(s) to the
last name of their father and to add the fathers name on the birth certificate(s)
FURTHER ORDERED
o The COllrt incorporates into this order the agreement of the parties regarding
cllstody visitation and child support
o The Court awards custody of the minor children as follows
o The Court orders visitation as follows
32
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
---------------------
o Based on the evidence presented including the Child Support Worksheet Schedules An
through E incorporated by reference and specifically the Child Support Worksheet and
Schedule E attached hereto and where applicable Special Interrogatories also attached hereto
the Court finds as follows
1 Children for whom support is being determined
Child Date of Birth
2 (a) For purposes of Calculating Child Support the Court Orders that the
Custodial Parent shall be ______________________
(b) For purposes of Calculating Child Support the Court Orders that the
Non-custodial Parent shall be
(c) The Court finds that the amount ofthe Non-custodial Parents parenting
time as set forth in the Order of Visitation is days
3 (a) The Court finds as set on Schedule A the gross income of the father is
(b) The Court finds as set on Schedule A the gross income of the Mother
is $_-----shy4 (a) The Court finds as set on the Child Support Worksheet and Schedule
B the Non-custodial Parents Adjusted Income is
(b) The Court finds as set on the Child Support Worksheet and Schedule B the
Custodial Parents Adjusted Income is $_________
(c) The Court finds as set on the Child Support Worksheet and Schedule B the
Parties Total Adjusted Income
5 The Court finds as set by the Child Support Obligation Schedule Table and as
listed on the Child Support Worksheet the Basic Child Support Obligation is
$_------------- shy6 (a) The Court tinds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Custodial Parent is
33
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
(b) The Court finds as set on the Child Support Worksheet the Basic
Child Support Obligation for the Non-custodial Parent is
7 The Court finds that health insurance that provides for the health care needs of
the child 0 isDis not reasonably available at a reasonable cost If provided it
will be provided by ________________
8 (a) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support for the Custodial Parent is
$_----shy
(b) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Non-custodial Parent is
$_-----shy
(c) The Court finds as set on the Child Support Worksheet and Schedule
D the Presumptive Amount of Child Support due to the Custodial Parent is
9 The Court finds that the child receives benefits under Title II of the Federal
Social Security Act on the obligors account and the amount the child receives on a
monthly basis is $_------shy
1O The Court has considered the existence of special circumstances and as set forth on
the Child Support Worksheet and Schedule E has found the following special
circumstances marked with an [X] to be present in this case
Note Refer to Schedule E and where applicable Special Interrogatories attached hereto for an explanation for the reasons for the deviation how the applicatiol1 ofthe Presumptive Amount ofChild Support would hare been unjust and how the best interest ofthe childforwhom support is being determ1ed will be served by a deviation from the Presumptive Amount ofChild Support A High Income G Alimony
B Low Income H Mortgage
C Other Health-Related 1 Permanent Plan or Foster
Insurance Care Plan
D Life Insurance J Extraordinary Expenses
E Child and Dependent K Parenting Time
Care Tax Credit L Non-Specific Deviations
F Travel Expenses (Other)
34
--------
--------
11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
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11 (a) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Custodial Parent is $_-----shy
(b) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support for the Non-custodial Parent is $________
(c) The Court finds as set on the Child Support Worksheet the Final
Amount of Child Support the Non-custodial Parent shall Pay the Custodial Parent is
12 (a) The Court finds as set on the Child Support Worksheet that the
Custodial Parents allocated Uninsured Health Care Expenses based on their pro rata
responsibility is
(b) The Court finds as set on the Child Support Worksheet that the Nonshy
custodial Parents allocated Uninsured Health Care Expenses based on
their pro rata responsibility is
The Non-custodial parent ___________________ shall
pay Child Support for each of the __ minor child(ren) at per month for a
total of _________ per month to the Custodial parent starting
___________-- and continuing until each minor child reaches the age of
majority dies marries becomes emancipated whichever first occurs provided however the
Court in the exercise of its sound discretion directs (or does not direct) the Non-custodial Parent
to continue to pay child support for a Child who has not previously married or become
emancipated vho is enrolled in and attending a secondary school and who has attained the age
of majority before completing his or her secondary school education until that child graduates
from high school or unt il the child attains __ years of age (not to exceed 20 years) whichever
first occurs
SO ORDERED this __ day of_____________--- 20 __
JUDGE Superior Courts Judicial Circuit ------
35
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
IN THE SUPERIOR COURT OF ________ COUlllIY STATE OF GEORGIA
) )
Plaintiff ) )
v ) Civil Action No ------ shy) ) )
Defendant )
INCOME DEDUCTION ORDER
The above-styled matter was heard by the Court on The _______ was properly served and present and represented by counsel This Court having entered an order requiring the to pay child support to the _____ this Income Deduction Order is entered pursuant to OCGA sect 19-6shy32(a1)( 1 )
( ] Defendant shall pay child support of$ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly with the next payment due on 20_
[ ] Defendant shall pay $ [ ] weekly [ ] bi-weekly [ ] semi-monthly [ ] monthly with the next payment due on 20_
[ ] The total amount to be withheld is $ [ ] weekly [ ] bi-weekly [ ] semishymonthly [ ] monthly This amount shall be made payable to and forwarded within two (2) business days ofeach payment date Payments shall be made by cash cashiers check or money order personally or by mailing it to ________
The maximum amount to be deducted shall not exceed the amounts allowed under sect 303(b) of the Consumer Credit Protection Act 15 U S C sect l673(b) as amended This order applies to current and subsequent employers and periods ofemployment and may only be contested on the grounds of mistake of fact regarding the amount of support owed pursuant to a support order the arrearage or the identity of the obligor The obligor shall notify the within seven (7) days of any change of address employer or employ~rs address A copy of this order shall be served on the obligor and the employer
[ ] Other _____ This order shall become effective immediately upon signing and shall remain in full force and effect until modified suspended or terminated by order of this Court
SO ORDERED this __ day ______________20
JUDGE Superior Courts Judicial Circuit -----
36
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37
Date Notice To Employer or any other person private entity Federal or State Government or any unit oflocal government providing or administering income due to Defendant
Re Income Deduction Order
DATE ____________________~-----Attached you will find an Income Order Please read this order carefully and
follow the instructions as written IfyOll have any questions you should contact your attorney Employers are required by law to deduct from income due and payable an employee the
amount designated by the Court to meet support obligations Income includes wages salary bonuses commissions compensation as an independent contractor workers compensation disability benefits annuities and retirement benefits pensions dividends royalties or any other payment to an employee FAILURE TO DEDUCT THE AMOUNT DESIGNATED BY THE COURT MAKES THE EivlPLOYER LIABLE FOR THE AlllOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS INTEREST AND REASONABLE ATTORNEYS FEES
Payments must begin no later than the first pay period after fourteen (14) days following the postmark of the notice You are required to forward to the person or entity specified in the Income Deduction Order within two (2) days after each payment date the amount deducted from the employees income and a statement as to whether the amount fonvurded totally or partially satisfies the periodic amount specified in the Income Deduction Order
This deduction has priority over all other legal processes under Georgia law pertaining to the same income and the payment required by the Income Deduction Order It is a complete defense against any claims of the employee or the employees creditors as to the sLIm paid
Employers must continue to deduct the child support amount and send it to the person or entity specified in the Income Deduction Order until fiIrther notice by the Court or until the income is no longer provided to the employee In the event the income is no longer provided the employer is required to notifY the person or entity specified in the Income Deduction Order immediately of such and to give the employees last known address and to provide a name and address of any new employer of this employee ifknovvTI FAILURE TO DO THIS WILL RESULT IN A CIVIL PENALTY BEING IMPOSED NOT TO EXCEED $25000 FOR THE FIRST VIOLATION OR $50000 FOR A SUBSEQUENT VIOLATION
Employers may not discharge an employee by reason of the entry of an Income Deduction Order Ifan employee is discharged because of this reason A FINE OF NOT MORE THAN $25000 FOR THE FIRST VIOLATION AND $50000 FOR A SUBSEQUENT VIOLATION WILL BE IMPOSED AGAINST THE EMPLOYER
Employers should contact their attorney if more than one Income Deduction Order is received against the same employee
Employers may send a single payment if multiple employees have Income Deduction Orders to pay to the same depository provided the amount attributed to each employee is identified
An employer may collect up to $2500 against the employees income to reimburse for the administrative costs of the first income deduction and up to $300 for each subsequent income deduction
37