[CAPTION]FINAL DECREE OF DIVORCE

On the day of , l9XX, this case came on for hearing.Appearances

Petitioner, , Social Security Number , appeared in person and by attorney and announced ready for trial.

Respondent, , Social Security Number , appeared in person and announced ready or waived issuance and service of citation by waiver duly filed and did not otherwise appear.Record

The making of a record of testimony was waived by the parties with the consent of the parties.Jurisdiction and Domicile

The Court finds that the pleadings of Petitioner are in due form and contain all the allegations, information, and prerequisites required by law. The Court, after receiving evidence, finds that it has jurisdiction over this cause of action and the parties and that at least sixty (60) days have elapsed since the date the suit was filed. The Court finds that Petitioner has been living in this state for at least a six- month period preceding the filing of this action and a resident of the county in which this suit is filed for at least a ninety- day period preceding the filing of this action. All persons entitled to citation were properly cited.Jury

A jury was waived, and all questions of fact and of law were submitted to the Court.

The parties have consented to the terms of this decree and stipulated it is not a contract.Divorce

IT IS ORDERED AND DECREED that , Petitioner, and , Respondent, are divorced and that the marriage between them is dissolved.Child of Marriage

The Court finds that Petitioner and Respondent are the parents of the following child:NAME: SEX: BIRTHPLACE: BIRTHDATE: PRESENT RESIDENCE: Currently resides with (Petitioner or Respondent).SOCIAL SECURITY NUMBER:

The Court finds that no other children are expected.

Conservatorship and SupportThe Court, having considered the circumstances of the

parents and of the child, finds that the following orders are in the best interest of the child.

Sole Managing Conservator. IT IS ORDERED AND DECREED that is appointed Sole Managing Conservator of the child.

IT IS ORDERED AND DECREED that Managing Conservator shall have all the rights, privileges, duties, and powers of a parent, subject only to the rights, privileges, duties, and powers granted to the Possessory Conservator named in this decree.

Possessory Conservator. IT IS ORDERED AND DECREED that is appointed Possessory Conservator of the child.

IT IS ORDERED AND DECREED that Possessory Conservator shall have the following rights, privileges, duties, and powers:

the duty of care, control, protection, and reasonable discipline of the child during periods of possession;

the duty to provide the child with clothing, food, and shelter during periods of possession;

the power to consent to medical and surgical treatment during an emergency involving an immediate danger to the health and safety of the child during periods of possession;

the right of access to medical, dental, and educational records of the child to the same extent as Sole Managing Conservator;

the right to consult with any treating physician or dentist of the child; and

the right to consult with school officials concerning the child's welfare and educational status, including school activities.

Standard Possession Order:The Court finds that the following provisions of this

Standard Possession Order are intended to and do comply with the requirements of Texas Family Code {14.033}. IT IS ORDERED AND DECREED that Sole Managing Conservator and Possessory Conservator shall comply with all terms and conditions of this standard Possession Order. IT IS ORDERED AND DECREED that this standard Possession order is effective immediately and applies to all periods of possession occurring on and after the signing of this Standard Possession Order. IT IS, THEREFORE, ORDERED AND

DECREED:(a) Definitions

1. "School" means the primary or secondary school in which the child is enrolled or, if the child is not enrolled in a primary or secondary school, the public school district in which the child primarily resides.

2. "Standard Order" or "Standard Possession Order" means an order that provides a parent named as a Possessory Conservator with rights of possession of a child in accordance with the terms and conditions provided by this section.

3. "Child" includes each child who is the subject of this suit whether one or more.

(b) The Possessory Conservator may have possession of the child at any and all times mutually agreed to in advance by the parties and, in the absence of mutual agreement, shall have the right to possession of the child under the specific terms herein.

(c) Times of possession:

I. Conservators who reside one hundred (100) miles or less apart: Except as otherwise explicitly provided, if the Possessory Conservator resides one hundred (100) miles or less from the primary residence of the child, the Possessory Conservator shall have the right to possession of the child, as follows:

1. Weekends: On weekends beginning the first, third, and fifth Friday of each month beginning at the time the child's school is regularly dismissed and ending at 6:00 o'clock p.m. on the following Sunday.2. Weekend Possession Extended by a School Holiday or Summer Holiday: Except as otherwise explicitly provided, if a weekend period of possession of the Possessory Conservator coincides with a school holiday during the regular school term or with a federal, state, or local holiday during the summer months in which school is not in session, the weekend possession shall end at 6:00 o'clock p.m. on a Monday holiday or school holiday or shall begin at the time the child's school is regularly dismissed Thursday for a Friday holiday or school holiday, as applicable.

3. Wednesdays: On Wednesdays of each week during the regular school term beginning at the time the child's school is regularly dismissed and ending at 8:00 o'clock p.m.

4. Vacations and Holidays: IT IS ORDERED, ADJUDGED, AND DECREED by the Court that the following provisions shall govern possession of the child for vacations and for certain specific holidays and supersede any conflicting weekend or Wednesday periods of possession provided by paragraphs 1, 2, and 3 above. IT IS ORDERED, ADJUDGED, AND DECREED by the Court that the Possessory Conservator and the Managing Conservator shall have the right of possession of the child as follows:

a. Christmas Holidays:

1. In even-numbered years: The Possessory Conservator shall have possession of the child in even numbered years beginning at 6:00 o'clock p.m. on the day the child is dismissed from school for the Christmas school vacation and ending at noon on December 26, and the Managing Conservator shall have possession for the same period in odd-numbered years.

2. In odd-numbered years: The Possessory Conservator shall have possession of the child in odd numbered years beginning at noon on December 26 and ending at 6:00 o'clock p.m. on the day before school resumes after that vacation, and the Managing Conservator shall have possession for the same period in even-numbered years.

b. Thanksgiving: The Possessory Conservator shall have possession of the child in odd-numbered years, beginning at 6:00 o'clock p.m. on the day the child is dismissed from school before Thanksgiving and ending at 6:00 o'clock p.m. on the following Sunday, and the Managing Conservator shall have possession for the same period in even-numbered years.

c. Spring Break: The Possessory Conservator shall have possession in even-numbered years, beginning at 6:00 o'clock p.m. on the day the child is dismissed from school for the school spring vacation and ending

at 6:00 o'clock p.m. on the day before school resumes after that vacation, and the Managing Conservator shall have possession for the same period in odd-numbered years.

d. Summer:

1. If the Possessory Conservator gives the Managing Conservator written notice by May 1 of each year specifying an extended period or periods of summer possession, the Possessory Conservator shall have possession of the child for thirty (30) days beginning no earlier than the day after the child's school is dismissed for the summer vacation and ending no later than seven (7) days prior to school resuming at the end of the summer vacation, to be exercised in no more than two (2) separate periods of at least seven (7) consecutive days each.

2. If the Possessory Conservator does not give the Managing Conservator written notice by May 1 of each year specifying an extended period or periods of summer possession, the Possessory Conservator shall have possession of the child for thirty (30) consecutive days, beginning at 6:00 o'clock p.m. on July 1 and extending through 6:00 o'clock p.m. on July 31.

e. Child's Birthday: The parent not otherwise entitled under this standard order to present possession of a child on the child's birthday shall have possession of the child beginning at 6:00 o'clock p.m. and ending at 8:00 o'clock p.m. on that day, provided that said parent picks up the child from the residence of the conservator entitled to possession and returns the child to that same place.

f. Father's Day/Mother's Day:

1. Father's Day: If a conservator, the father shall have possession of the child beginning at 6:00 o'clock p.m. on the Friday preceding Father's Day and ending on Father's Day at 6:00 o'clock p.m., provided that if he is not otherwise entitled under this standard order to present possession of the child, he picks up the child from the child's residence of the conservator entitled to possession and returns the

child to that same place; and

2. Mother's Day: If a conservator, the mother shall have possession of the child beginning at 6:00 o'clock p.m. on the Friday preceding Mother's Day and ending on Mother's Day at 6:00 o'clock p.m., provided that, if she is not otherwise entitled under this standard order to present possession of the child, she picks up the child from the residence of the conservator entitled to possession and returns the child to that same place.

Notwithstanding the weekend and Wednesday periods of possession ORDERED AND DECREED for Possessory Conservator, it is explicitly ORDERED AND DECREED that Sole Managing Conservator shall have a superior right of possession to the child as follows:

1. Christmas Holidays in Odd-Numbered Years.In Odd-numbered years, beginning at 6:00 p.m. on

the last school day before the Christmas school vacation begins and ending at noon on December 26.

2. Christmas Holidays in Even-Numbered Years. In even-numbered years, beginning at noon on December 26 and ending at 6:00 p.m. on the day before school resumes.

3. Thanksgiving in Even-Numbered Years. In even-numbered years, beginning at 6:00 p.m. on the Wednesday before Thanksgiving and ending at 6:00 p.m. on the following Sunday.

4. Spring Break in Odd-Numbered Years. In odd-numbered years, beginning at 6:00 p.m. on the last school day before the school's spring vacation begins and ending at 6:00 p.m. on the day before school resumes.

5. Summer Weekend Possession by Managing Conservator: If the Managing Conservator gives the Possessory Conservator written notice by June 1 of each year, the Managing Conservator shall have possession of the child on any one (1) weekend beginning Friday at 6:00 o'clock p.m. and ending at 6:00 o'clock p.m. on the following Sunday during any one (1) period of summer session

by the Possessory Conservator under paragraphs (c) (I) (4) (d) (1) and (2) above, provided that the Managing Conservator picks up the child from the Possessory Conservator and returns the child to that same place.6. Extended Summer Possession by Managing Conservator: If the Managing Conservator gives the Possessory Conservator written notice by May 15 of each year or gives Possessory Conservator fourteen (14) days' written notice on or after May 16 of each year, the Managing Conservator may designate one (1) weekend beginning no earlier than the day after the child's school is dismissed for the summer vacation and ending no later than seven (7) days prior to school resuming at the end of the summer vacation, during which an otherwise scheduled weekend period of possession by the Possessory Conservator will not take place, provided that the weekend so designated does not interfere with the Possessory Conservator's period or periods of extended summer possession or with Father's Day if the Possessory Conservator is the father of the child.

7. Child's Birthday. If Sole Managing Conservator is not in possession of the child on the child's birthday, Sole Managing Conservator shall have possession of the child beginning at 6:00 p.m. and ending at 8:00 p.m. on that day, provided that Sole Managing Conservator picks up the child from Possessory Conservator's residence and returns the child to that same place.

This concludes the Standard Possession Order.IT IS FURTHER ORDERED AND DECREED that, until the child

reaches the age of five (5) years, the following arrangements for the travel of that child shall control:

Adult to Accompany Child. IT IS FURTHER ORDERED AND DECREED that Possessory Conservator shall travel with the child between the residence of Sole Managing Conservator and that of Possessory Conservator at the beginning of each period of possession. IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall travel with the child between the residence of Possessory Conservator and that of Sole Managing Conservator at the end of each period of possession. In place of this requirement, each conservator is authorized to designate an immediate relative over the age of eighteen (18) years, or another responsible adult, to

travel with the child between the residence of the parties. IT IS FURTHER ORDERED AND DECREED that the child shall not travel alone between the residence of Possessory Conservator and that of Sole Managing Conservator until the child reaches the age of five (5) years.

Expenses Shared by Possessory Conservator and Sole Managing Conservator. IT IS FURTHER ORDERED AND DECREED that Possessory Conservator shall pay all travel expenses, charges, escort fees, and air fares incurred for the child for transportation from the residence of Sole Managing Conservator to the residence of Possessory Conservator. IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall pay all travel expenses, charges, escort fees, and air fares incurred for the child for transportation from the residence of Possessory Conservator to the residence of Sole Managing Conservator.

IT IS FURTHER ORDERED AND DECREED that the following provision shall govern the arrangements for the travel of the child to and from Possessory Conservator after the child reaches the age of five (5) years.

Notice of Place and Time of Possession. IT IS FURTHER ORDERED AND DECREED that, if Possessory Conservator desires to take possession of the child at an airport near Possessory Conservator's residence, Possessory Conservator shall state in a notice letter to Sole Managing Conservator the following facts:

a. the airport where Sole Managing Conservator is to surrender the child;

b. the date and time of the flight on which the child is scheduled to leave;

c. the airline and flight number of the airplane on which the child is scheduled to leave;

d. the airport where the child will return to Sole Managing Conservator at the end of the period of possession;

e. the date and time of the flight on which the child is scheduled to return to that airport; and

f. the airline and flight number of the airplane on which the child is scheduled to return to Sole Managing Conservator at the end of the period of possession.

Flight arrangements. IT IS FURTHER ORDERED AND DECREED that each conservator shall make airline reservations for the child only on major commercial passenger airlines on flights having no change of airplanes between the airport of departure and the airport of final arrival (referred to in this order as a "nonequipment change flight"). IT IS FURTHER ORDERED AND DECREED that each conservator shall make airline reservations for the child on flights that depart from a commercial airport near the residence of the other conservator that offers regularly scheduled passenger flights to various cities through the United

States on major commercial passenger airlines.Delivery/Delivery and Pickup by Sole Managing Conservator.

IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall deliver the child to the airport from which the child is scheduled to leave at the beginning of each period of possession at least one hour before the scheduled departure time. IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall surrender the child to a flight attendant who is employed by the airline and who will be flying on the same flight on which the child is scheduled.

IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall take possession of the child at the end of Possessory Conservator's period of possession at the airport where the child is scheduled to return and at the specific airport gate where the passengers from the child's scheduled flight disembark.

Pickup/Pickup and Return by Possessory Conservator. IT IS FURTHER ORDERED AND DECREED that Possessory Conservator shall take possession of the child at the beginning of each period of possession at the airport where the child is scheduled to arrive and at the specific airport gate where the passengers from the child's scheduled flight disembark.

IT IS FURTHER ORDERED AND DECREED that Possessory Conservator, at the end of each period of possession, shall deliver the child to the airport where the child is scheduled to depart at least one hour before the scheduled departure time and surrender the child to a flight attendant who is employed by the airline and who will be flying on the same flight on which the child is scheduled to return.

Missed Flights. IT IS FURTHER ORDERED AND DECREED that any conservator who has possession of the child at the time shall notify the other conservator immediately if the child is not placed on a scheduled flight at the beginning or end of a period of possession. IT IS FURTHER ORDERED AND DECREED that, if the child should miss a scheduled flight, the conservator having possession of the child when the flight is missed shall schedule another nonequipment change flight for the child as soon as is possible after the originally scheduled flight and give the other conservator notice of the date and time of that flight.

Expenses Shared by Possessory Conservator and Managing Conservator. IT IS FURTHER ORDERED AND DECREED that Possessory Conservator shall purchase in advance the airline tickets (including escort fees) to be used by the child for the child's flight from the airport near the residence of the Sole Managing Conservator to the airport near the residence of the Possessory Conservator. IT IS FURTHER ORDERED AND DECREED that Possessory conservator shall make the necessary arrangements with the

airlines and with Sole Managing Conservator in order that the airline tickets are available to the child before a scheduled flight. IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall purchase in advance the airline tickets (including escort fees) to be used by the child for the child's flight from the airport near the residence of the Possessory Conservator to the airport near the residence of the Sole Managing Conservator. IT IS FURTHER ORDERED AND DECREED that Sole Managing Conservator shall make the necessary arrangements with the airlines and with Possessory Conservator in order that the airlines tickets are available to the child before the scheduled flight.

IT IS FURTHER ORDERED that the parties will work together to make travel arrangements whereby they can meet at a convenient location for purposes of child visitation in the event the previous Orders are not practical on that occasion.

Miscellaneous Expenses. IT IS FURTHER ORDERED AND DECREED that the expenses of a conservator incurred in travelling to and from an airport, as well as related parking and baggage-handling expenses, are the sole responsibility of the conservator delivering or receiving the child at the airport.

IT IS FURTHER ORDERED that shall purchase a child restraint seat in order to properly secure the child in a motor vehicle during his periods of possession with the child.

IT IS ORDERED AND DECREED that any employer of , Possessory Conservator, shall be ordered to withhold from earnings for child support from the disposable earnings of , Possessory Conservator. "Earnings" means compensation paid or payable to , Possessory Conservator, for personal services, whether called wages, salary, commission, bonus, or otherwise, and includes periodic payments pursuant to a pension, disability, and retirement program and unemployment benefits. "Disposable Earnings" is that part of , Possessory Conservator's earnings remaining after deduction of any amounts required by law to be withheld, union dues, nondiscretionary retirement contributions, and medical, hospitalization, and disability insurance coverage for Possessory Conservator and his/her children. Depending on the regularly scheduled wage and salary payments established by the employer, the employer shall be ordered to withhold from earnings for child support on the schedule appropriate to employer's payroll period as follows: $ monthly; $ semi-monthly; $ biweekly; or $ weekly, provided that the amount of income withheld shall not exceed 50 percent of , Possessory Conservator's disposable earnings. The first payment is due and payable no later than the first pay period that occurs fourteen (14) days following the date on which the "Order Withholding from Earnings

for Child Support" is served on the employer. The employer shall continue to withhold income as long as , Possessory Conservator, remains in employment.

IT IS FURTHER ORDERED AND DECREED that all amounts withheld from the disposable earnings of , Possessory Conservator, by the employer and paid in accordance with the order to that employer shall constitute a credit against the child support obligation. Payment of the full amount of child support ordered paid by this decree through the means of withholding from earnings shall discharge the child support obligation. If the amount withheld from earnings and credited against the child support obligation is less than 100 percent of the amount ordered to be paid by this decree, the balance due remains an obligation of , Possessory Conservator; and IT IS HEREBY ORDERED AND DECREED that , Possessory Conservator, pay the balance due directly to the Child Support Division of County, County Courthouse, P.O. Box , .

On this date the Court signed an "Order Withholding from Earnings for Child Support."

IT IS ORDERED AND DECREED that all payments shall be made through the Child Support Division of County, County Courthouse, P.O. Box , and then remitted by that agency to , Sole Managing Conservator, for the support of the child(ren).

For the purposes of federal income tax withholding, , Possessory Conservator, is ORDERED AND DECREED to claim no fewer that the actual number of his dependents on Form W-4.

IT IS FURTHER ORDERED AND DECREED that , Possessory Conservator, shall notify this Court and , Managing Conservator, by U.S. Certified Mail, return receipt requested, of any change of address and of any termination of employment. This notice shall be given no later than seven (7) days after the change of address or the termination of employment. This notice or a subsequent notice shall also provide the current address of , Possessory Conservator, and the name and address of his current employer, whenever that becomes available.

IT IS ORDERED AND DECREED that, on the request of a prosecuting attorney, the Attorney General, (Sole Managing Conservator's Name), or (Possessory Conservator's Name), the Clerk of this Court shall cause a certified copy of the "Order Withholding from Earnings for Child Support" to be delivered to any employer. IT IS FURTHER ORDERED AND DECREED that the Clerk of this Court shall attach a copy of Section 14.43 of the Texas Family Code for the information of any employer.

IT IS ORDERED AND DECREED that health insurance shall be

provided for the child(ren) as follows:[1.] (Name of Possessory Conservator)'s Responsibility. It

is the intent and purpose of this decree that (Name of Possessory Conservator) shall, at all times, provide and pay for health insurance for the child. IT IS FURTHER ORDERED AND DECREED that, as additional child support, (Name of Possessory Conservator), shall provide health insurance for the parties' child(ren) through a coverage available through (Name of Possessory Conservator)'s employment.

[2.] Definitions. "Health insurance" means insurance coverage that provides basic health care services, including usual physician services, office visits, hospitalization, and laboratory, x-ray and emergency services and may be provided through a health maintenance organization or other private or public organization.

"Through employment" means through the party's employment or membership in a union, trade association, or other organization.

[3.] (Name of Possessory Conservator) to Purchase Insurance. IT IS ORDERED AND DECREED that (Name of Possessory Conservator) shall purchase and maintain, at his/her sole cost and expense, health insurance coverage for the child no later than 30 days following the Court's signing of this decree. (Name of Possessory Conservator) is ORDERED AND DECREED to provide verification of the purchase of insurance to (Name of Sole Managing Conservator) at (Name of Sole Managing Conservator)'s last known address, including the insurance certificate number and the plan summary, no later than thirty (30) days following the Court's signing of this decree and to provide verification of the maintenance of the coverage within fifteen (15) days of a written request from (Name of Sole Managing Conservator) on January 1, of each year.

[4.] Insurance Through (Name of Possessory Conservator). IT IS ORDERED AND DECREED that, if health insurance is available for the child through (Name of Possessory Conservator)'s employment, (Name of Possessory Conservator) shall, at his/her sole cost and expense, keep and maintain at all times in full force and effect the health insurance coverage that now insures the parties' child(ren) through (Name of Possessory Conservator)'s employer, or through such health insurance plan as is available through other employment or other insurance provider.

[5.] Insurance Through (Name of Sole Managing Conservator)'s Employment. If health insurance is not available for the child to (Name of Possessory Conservator) through his/her employment but is available to (Name of Sole Managing Conservator) through her/his employment, Name of Sole Managing Conservator) through her/his employment, (Name of Sole Managing Conservator) is ORDERED AND DECREED to have the child(ren) covered as a dependent

on her/his health insurance plan and (Name of Possessory Conservator) is ORDERED AND DECREED to pay to (Name of Sole Managing Conservator) at her/his last known address the cost of insuring the child(ren) on (Name of Sole Managing Conservator) health insurance plan on the first day of each month after (Name of Possessory Conservator) receives written demand from (Name of Sole Managing Conservator) for payment.

[6.] Conversion of Policy. IT IS ORDERED AND DECREED that if the party through whose employment health insurance has been provided for the child(ren) is leaving that employment or for any other reason health insurance will not be available for the child(ren) through the employment of either party, the party leaving employment or losing coverage shall, within ten (10) days of termination of his or her employment or coverage, convert the policy to individual coverage for the child in an amount equal to or exceeding the coverage at the time his or her employment or coverage terminated. Further, if that health insurance was available through (Name of Sole Managing Conservator)'s employment, (Name of Possessory Conservator) shall reimburse (Name of Sole Managing Conservator) for the cost of the converted policy in accordance with paragraph [5.] above.

[7.] If Policy Not Convertible. If the health insurance policy covering the child is not convertible and if no health insurance is available for the child through the employment of either party, IT IS ORDERED AND DECREED that (Name of Possessory Conservator) shall purchase and maintain, at his/her sole cost and expense, health insurance coverage for the child(ren). (Name of Possessory Conservator) is ORDERED AND DECREED to provide verification of the purchase of the insurance to (Name of Sole Managing Conservator) at (Name of Sole Managing Conservator)'s last known address, including the insurance certificate number and the plan summary, no later than 30 days following the issuance of the policy.

[8.] Copy of Policy. IT IS FURTHER ORDERED AND DECREED that within fourteen (14) days after this Decree of Divorce is signed, the party carrying the health insurance policy covering the child shall furnish to the other party a true and correct copy of the health insurance policy or certificate and a schedule of benefits covering the child. IT IS FURTHER ORDERED AND DECREED that the party carrying the policy shall furnish to the other party a true and correct copy of any renewals or changes (including conversions) of the insurance policy within fourteen (14) days after the issuance of the renewal or change.

[9.] Claim Forms. The party who is not carrying the health insurance policy covering the child(ren) is ORDERED AND DECREED to submit to the party carrying the policy any and all forms, receipts, bills, and statements reflecting the medical and health

care expenses the party not carrying the policy incurs on behalf of the child(ren) within ten (10) days of receiving them.

The party who is carrying the health insurance policy covering the child(ren) is ORDERED AND DECREED to submit all forms required by the insurance company for payment or reimbursement of medical or health care expenses incurred by either party on behalf of the child(ren) to the insurance carrier within ten (10) days of that party's receiving any form, receipt, bill, or statement reflecting the expenses.

[10.] Secondary Coverage. IT IS FURTHER ORDERED AND DECREED that nothing in this decree shall prevent either party from providing secondary health insurance coverage for the child at that party's sole cost and expense. IT IS FURTHER ORDERED AND DECREED that if a party provides secondary health insurance coverage for the child(ren), both parties shall cooperate fully with regard to the handling and filing of claims with the insurance carrier providing the coverage in order to maximize the benefits available to the child(ren) and to ensure that the party who pays for health care expenses for the child(ren) is reimbursed for the payment.

IT IS FURTHER ORDERED AND DECREED that if a party provides secondary health insurance coverage for the child(ren), that party shall furnish to the other party a true and correct copy of the policy and a schedule of benefits within (fourteen) 14 days after the policy becomes effective.

[11.] Constructive Trustee for Payments Received. IT IS ORDERED AND DECREED that any insurance payments received by the party carrying the health insurance policy covering the child(ren) from the health insurance carrier as reimbursement for health care expenses incurred by or on behalf of the child(ren) shall belong to the party who incurred or paid those expenses. IT IS FURTHER ORDERED AND DECREED that the party carrying the policy is designated a constructive trustee to receive any insurance checks or payments for expenses incurred and paid by the other party, and the party carrying the policy shall endorse and forward the checks or payments, along with any explanation of benefits, to the other party within three (3) days of receiving them.

[12.] Uninsured Expenses. Each party is ORDERED AND DECREED to pay 50 percent of all health care expenses not paid by insurance and incurred by or on behalf of the parties' child(ren), including, without limitation, the yearly deductible and medical, prescription drug, psychiatric, psychological, dental, eye care, ophthalmological, and orthodontic charges, for as long as child(ren) support is payable under the terms of this decree.

[13.] Exclusions. This provision shall not be interpreted

to include expenses for psychological testing, travel to and from the health care provider, or nonprescription medication.

[14.] Payment of Uninsured Expenses. IT IS FURTHER ORDERED AND DECREED that the party who paid for a health care expense on behalf of the child(ren) shall submit to the other party any and all forms, receipts, bills and statements reflecting the uninsured portion of the medical or health care expenses the paying party incurs on behalf of the child(ren) within ten (10) days after he or she receives them. IT IS ORDERED AND DECREED that, within ten days after the nonpaying party receives the forms, receipts, bills, or statements, that party shall pay his or her 50 percent share of the uninsured portion of the medical or health care expenses either by paying the health care provider directly or by reimbursing the paying party for any advance payment over and above the paying party's share of the expenses.

[15.] Reasonableness of Charges. IT IS ORDERED AND DECREED that reasonableness of the charges for medical expenses shall be presumed on presentation of the bill to a party and that disallowance of the bill by a health insurer shall not excuse that party's obligation to make payment or reimbursement as otherwise provided herein.

[16.] Information Required. (Name of Possessory Conservator) is ORDERED AND DECREED to furnish to (Name of Sole Managing Conservator) the following information not later than the 30th day after the date the notice of the rendition of this decree is received:

(a.) (Possessory Conservator's) Social Security Number;(b.) the name and address of (Possessory Conservator)'s

employer;(c.) whether the employer is self-insured or has health

insurance available; and(d.) the name of the health insurance carrier, the number of

the policy, a copy of the policy and schedule of benefits, a health insurance membership card, claim forms, and any other information necessary to submit a claim or, if the employer is self-insured, a copy of the schedule of benefits, a membership card, claim forms, and any other information necessary to submit a claim.

Additionally, IT IS ORDERED AND DECREED that (Name of Possessory Conservator) shall provide to (Name of Sole Managing Conservator) any additional information regarding health insurance coverage that becomes available to (Name of Possessory Conservator). IT IS ORDERED AND DECREED that the information shall be provided no later than the 15th day after the date the information is received.

[17.] Order to Employer Entered. On this date an "Order to Employer to Withhold from Earnings for Child Support, Order to

Provide Health Insurance, and Order to Employer to Withhold from Earnings for Health Insurance" was entered by this Court.

[18.] Notice of Termination or Lapse of Insurance. If the health insurance coverage for the children lapses or terminates, (Name of Possessory Conservator) is ORDERED AND DECREED to notify (Name of Sole Managing Conservator) not later than the 15th day after the date of termination or lapse. If additional health insurance is available or becomes available to (Name of Possessory Conservator) for the child(ren), (Name of Possessory Conservator) must notify (Name of Sole Managing Conservator) not later than the 15th day after the date the insurance becomes available. (Name of Possessory Conservator) must enroll the child(ren) in a health insurance plan at the next available enrollment period.

[19.] WARNING. ANY OBLIGOR WHO FAILS TO PROVIDE HEALTH INSURANCE AS ORDERED IS LIABLE FOR ANY NECESSARY MEDICAL EXPENSES OF THE CHILD, WITHOUT REGARD TO WHETHER THE EXPENSES WOULD HAVE BEEN PAID BY HEALTH INSURANCE HAD IT BEEN APPROVED.

IT IS FURTHER ORDERED AND DECREED that the provisions for child support in this decree shall be an obligation of the estate of (Name of Possessory Conservator), and shall not terminate on the death of (Name of Possessory Conservator).

(Name of Sole Managing Conservator) is ORDERED AND DECREED to inform (Name of Possessory Conservator) within 24 hours of any medical condition of the parties' child(ren) requiring surgical intervention and/or hospitalization.

Each party is ORDERED AND DECREED to keep the other party fully and promptly informed of his or her current address, home telephone number, name of employer, place of employment, and work telephone number and of the address of the child(ren)'s school or day-care center. Each party who intends a change of place of residence is ORDERED AND DECREED to give written notice of the intended date of change and new address of residence to the other party on or before thirty (30) days before the change of residence or, if the party did not know and could not have known of the change before the thirty-(30) day period, within five (5) days after the first day the party knew or should have known of the change or of the related information.

WARNINGS TO PARTIESFAILURE TO OBEY A COURT ORDER FOR CHILD SUPPORT OR FOR

POSSESSION OF OR ACCESS TO A CHILD MAY RESULT IN FURTHER LITIGATION TO ENFORCE THE ORDER, INCLUDING CONTEMPT OF COURT. A FINDING OF CONTEMPT MAY BE PUNISHED BY CONFINEMENT IN JAIL FOR UP TO SIX MONTHS, A FINE OF UP TO $500 FOR EACH VIOLATION, AND A MONEY JUDGMENT FOR PAYMENT OF ATTORNEY'S FEES AND COURT COSTS.

FAILURE OF A PARTY TO MAKE CHILD SUPPORT PAYMENTS TO THE PLACE AND IN THE MANNER REQUIRED BY A COURT ORDER MAY RESULT IN

THE PARTY'S NOT RECEIVING CREDIT FOR MAKING THE PAYMENT.FAILURE OF A PARTY TO PAY CHILD SUPPORT DOES NOT JUSTIFY

DENYING THAT PARTY COURT-ORDERED POSSESSION OF OR ACCESS TO A CHILD. REFUSAL BY A PARTY TO ALLOW POSSESSION OF OR ACCESS TO A CHILD DOES NOT JUSTIFY FAILURE TO PAY COURT-ORDERED CHILD SUPPORT TO THAT PARTY.

EACH PERSON WHO IS A PARTY TO THIS ORDER OR DECREE IS ORDERED TO NOTIFY THE CLERK OF THIS COURT WITHIN 10 DAYS AFTER THE DATE OF ANY CHANGE IN THE PARTY'S CURRENT RESIDENCE ADDRESS, MAILING ADDRESS, HOME TELEPHONE NUMBER, NAME OF EMPLOYER, ADDRESS OF PLACE OF EMPLOYMENT, OR WORK TELEPHONE NUMBER. ALL NOTICES SHALL BE IN WRITING AND SHALL STATE THE NEW INFORMATION AND THE EFFECTIVE DATE OF THE CHANGE. THE DUTY TO FURNISH THIS INFORMATION TO THE CLERK OF THE COURT CONTINUES AS LONG AS ANY PERSON, BY VIRTUE OF THIS DECREE, IS ENTITLED TO PAY CHILD SUPPORT OR IS ENTITLED TO POSSESSION OF OR ACCESS TO A CHILD. FAILURE TO OBEY THE ORDER OF THIS COURT TO PROVIDE THE CLERK WITH THE CURRENT MAILING ADDRESS OF A PARTY MAY RESULT IN THE ISSUANCE OF A CAPIAS FOR THE ARREST OF THE PARTY IF THAT PARTY CANNOT BE PERSONALLY SERVED WITH NOTICE OF A HEARING AT AN ADDRESS OF RECORD.Division of Marital Estate

The Court finds that the following is a just and right division of the parties' marital estate, having due regard for the rights of each party and of the child of the marriage.

IT IS ORDERED AND DECREED that the estate of the parties is divided as follows:

Petitioner is awarded the following as Petitioner's sole and separate property, and Respondent is divested of all right, title, interest, and claim in and to such property:

(1) An undivided one-half (1/2) interest in and to the following real property, including, but not limited to, a proportionate part of any escrow funds, prepaid insurance, utility deposits, keys, house plans, warranties and service contracts, and title and closing documents:

[Insert property description.]

(2) All household furniture, furnishings, fixtures, goods, appliances, and equipment in the possession of or subject to the sole control of Petitioner.

(3) All clothing, jewelry, and other personal effects in the possession of or subject to the sole control of Petitioner.

(4) Any and all sums of cash in the possession of or subject to the sole control of Petitioner, including money on account in banks, savings institutions, or other financial institutions, which accounts stand in Petitioner's sole name or from which Petitioner has the sole right to withdraw funds or which are subject to Petitioner's sole control.

(5) Any and all sums, whether matured or unmatured, accrued or unaccrued, vested or otherwise, together with all increases thereof, the proceeds therefrom, and any other rights related to any profit-sharing plan, retirement plan, employee savings plan, accrued unpaid bonuses or other benefits program existing by reason of Petitioner's past, present or future employment.

(6) The 19XX motor vehicle, vehicle identification number , together with all prepaid insurance, keys, and title documents.

Respondent is awarded the following property as

Respondent's sole and separate property, and Petitioner is herebydivested of all right, title, interest, and claim in and to suchproperty:

(1) An undivided one-half (1/2) interest in and to the following real property, including, but not limited to, a proportionate part of any escrow funds, prepaid insurance, utility deposits, keys, house plans, warranties and service contracts, and title and closing documents:

[Insert property description.]

(2) All household furniture, furnishings, fixtures, goods, appliances, and equipment in the possession of or subject to the sole control of Respondent.

(3) All clothing, jewelry, and other personal effects in the possession of or subject to the sole control of Respondent.

(4) Any and all sums of cash in the possession of or subject to the sole control of Respondent, including money on account in banks, savings institutions, or other financial institutions, which accounts stand in Respondent's sole name or from which Respondent has the sole right to withdraw funds or which are subject to Respondent's sole control.

(5) Any and all sums, whether matured or unmatured, accrued or unaccrued, vested or otherwise, together with all increases thereof, the proceeds therefrom, and any other rights related to any profit-sharing plan, retirement plan, employee savings plan, accrued unpaid bonuses or other benefits program existing by reason of Respondent's past, present or future employment.

(6) The 19XX motor vehicle, vehicle identification number together with all prepaid insurance, keys, and title documents.

IT IS ORDERED AND DECREED that Petitioner shall pay, as a part of the division of the estate of the parties, the following debts and obligations and shall hold Respondent and Respondent's property harmless from any failure to so discharge these debts and obligations:

Any and all debts, charges, liabilities, and other obligations incurred by Petitioner from and after .

IT IS ORDERED AND DECREED that Respondent shall pay, as a part of the division of the estate of the parties, the following debts and obligations and shall hold Petitioner and Petitioner's property harmless from any failure to so discharge these debts and obligations:

(1) The balance due, including principal and interest, on that certain promissory note.

(2) The balance due, including principal and interest, on that certain promissory note payable to which is secured by a lien against the motor vehicle awarded herein to Respondent.

(3) Any and all debts, charges, liabilities, and obligations incurred by Respondent from and after .

IT IS FURTHER ORDERED AND DECREED that, for the calendar year 19XX, , Petitioner, shall timely pay and hold , Respondent, harmless from any federal income tax liability attributable to the personal earnings of , Petitioner, from January 1, l9XX through the date of divorce.

IT IS FURTHER ORDERED AND DECREED that , MPetitioner, shall be entitled to use, as a credit against his or her tax liability all prepayments and withholdings made by , Petitioner, before the date of divorce and all deductions, exemptions, and adjustments attributable to the personal earnings of , Petitioner, before the date of divorce.

IT IS FURTHER ORDERED AND DECREED that , Petitioner, shall timely pay and hold , Respondent, and his or her property harmless from any tax liability attributable to [Petitioner]'s income from the date of divorce to December 31 of that year.

IT IS FURTHER ORDERED AND DECREED that, for the calendar year l9XX , Respondent, shall timely pay and hold , Petitioner, harmless from any federal income tax liability attributable to the personal earnings of , Respondent, from January 1, l9XX through the date of divorce.

IT IS FURTHER ORDERED AND DECREED that , Respondent, shall be entitled to use as a credit against his tax liability all prepayments and withholdings made by , Respondent, before the date of divorce and all deductions, exemptions, and adjustments attributable to the personal earnings of , Respondent, before the date of divorce.

IT IS FURTHER ORDERED AND DECREED that , Respondent, shall timely pay and hold , Petitioner, and her property harmless from any tax liability attributable to [Respondent]'s income from the date of divorce to December 31 of that year.

IT IS FURTHER ORDERED AND DECREED that each party shall be solely entitled to use as a credit against his or her own tax liability all prepayments and withholdings made by him or her after the date of divorce and all deductions, exemptions, and adjustments attributable to his or her income and expenses after the date of divorce.

IT IS FURTHER ORDERED AND DECREED that , Petitioner, and , Respondent, shall furnish such information to the other party as is requested to prepare federal income tax returns for each party for the year in which this decree is entered, and in no event shall such information be exchanged later than March 1 of the year following the year in which this divorce decree is entered. Each party shall pay for the preparation of his or her own tax return for the year in

which this divorce decree is entered.

IT IS ORDERED AND DECREED that Petitioner's name is changed to .

All costs of Court expended in this cause are taxed against the party incurring the costs, for which let execution issue.

Without affecting the finality of this Decree of Divorce, this Court expressly reserves the right to make orders necessary to clarify and enforce this decree.

SIGNED AND ENTERED this day of , l9XX.

JUDGE PRESIDING

Approved as to Content and Form:

[Typed name of Petitioner], PETITIONER