Cl-0722-0503 Child Support Guidelines Worksheet - Volusia County, Florida Page 2
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28. TOTAL MONTHLY CHILD(REN)’S HEALTH
INSURANCE COSTS
8. $ _________
This is only amounts paid for insurance on the child(ren). Enter
answer on line 8.
Multiply the number on 4a. by the amount on line 8 to get Father’s
share of the child(ren)’s health insurance obligation. Enter answer
8a. $ ________
on line 8a.
Multiply the number on 4b. by the amount on line 8 to get Mother’s
share of the child(ren)’s health insurance obligation. Enter answer
8b. $ ________
on line 8b.
9. TOTAL MONTHLY OBLIGATION
9a. $ ________
Add lines 5a, 7a, and 8a to determine Father’s total obligation. Enter
answer on line 9a.
Add lines 5b, 7b, and 8b to determine Mother’s total obligation.
9b. $ ________
Enter answer on line 9b.
10. ADJUSTMENTS TO GUIDELINES AMOUNT.
If you or the other parent are requesting the Court to award a
child support amount that is more or less than the child support guidelines, you must complete and file Motion to Deviate from
Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943.
[√ one only]
a. Deviation from the guidelines amount is requested. The Motion to Deviate from Child Support Guidelines,
Florida Supreme Court Approved Family Law Form 12.943, is attached.
b. Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child Support Guidelines,
Florida Supreme Court Approved Family Law Form 12.943, is not attached.
I certify that a copy of this document was [√ one only]
mailed /
faxed and mailed /
hand delivered to the person(s) listed
below on {date}
.
Other party or his/her attorney:
Name:
Address:
City, State, Zip:
Fax Number:
Date:
Signature of Party
Printed Name:
Address:
City, State, Zip:
Telephone Number:
STATE OF FLORIDA
Fax Number:
COUNTY OF VOLUSIA
Sworn to or affirmed and signed before me on
by
.
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or deputy clerk.]
Personally known
Produced identification
Type of identification produced __________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks]
I, {full legal name and trade name of nonlawyer}
a nonlawyer, located at {street}
, {city}
,
{state}
, {phone}
, helped {name}
,
who is the [√ one only]
petitioner or
respondent, fill out this form.
CL-0722-0503
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