ENTER YOUR OWN HEADER IN THIS SPACE
IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT,
IN AND FOR ESCAMBIA COUNTY, FLORIDA
Case No: _________________________
FA-2012-489
Paul A. Sample
_______________________________ ,
Division: _________________________
Family
Petitioner,
And
Martha C. Sample
_______________________________ ,
Respondent,
MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES
(
) Petitioner (
x
) Respondent requests that the Court enter an order granting the following:
SECTION I
[Choose only
]
one
A. _____
child support than the amount required by the child support guidelines. The Court
x
MORE
should order MORE child support than the amount required by the child support guidelines
because of:
[Choose
all
that apply to your situation]
1. ___ Extraordinary medical, psychological, educational, or dental expenses;
x
2. ___ Seasonal variations in one or both parent's income or expenses;
3. ___ Age(s) of the child(ren), taking into consideration the greater needs of older child(ren)
4. ___ Special needs, such as costs that may be associated with the disability of a child or
x
child(ren), that have traditionally been met within the family budget even though the
fulfilling of those needs will cause support to exceed the presumptive amount established
by the guidelines;
5. ___ Total available assets of obligee, obligor, and the child(ren);
6. ___ Impact of the Internal Revenue Service Child & Dependent Care Tax Credit, Earned
Income Tax Credit, and dependency exemption and waiver of that exemption;
7. ___ The Parenting Plan, such as where the child or children spend a significant amount
of time, but less than 20 percent of the overnights, with one parent, thereby reducing
the financial expenditures incurred by the other parent, or the refusal of a parent to
become involved in the activities of the child(ren) has increased the financial expenditure
incurred by the obligee;
8. ___ The obligee parent’s low income and ability to maintain the basic necessities of the
home for the child(ren);
9. ___ The likelihood that either parent will actually exercise the time-sharing schedule set
forth in the parenting plan and/or whether all the children are exercising the same time-
sharing schedule;
10. ___ Any other adjustment that is needed to achieve an equitable result, which may in-
clude reasonable and necessary expenses or debts jointly incurred during the marriage.
Explain any items marked above: __________________________________________
parents agree to continue with private school.
______________________________________________________________________
Unreimbursed psychological expenses are $500 per month and will be a continuing ex
______________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support
Guidelines (5/12)
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