Form-9/99 - Consent To Change Of Custody And Child Support
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1
2IN THE SUPERIOR COURT OF ________ COUNTY
STATE OF GEORGIA
FAMILY DIVISION
Civil Action
Petitioner:
File No:
And
Respondent:
CONSENT TO CHANGE OF CUSTODY AND CHILD SUPPORT
1.
I, _____________________________, am the mother/father of the child(ren) named
______________________________________________________________________.
2.
I consent in writing to the following custody arrangement:
‘
a) That the father/mother of said child(ren) have sole legal and sole physical custody of
the child(ren).
‘
b) That the father/mother of said child share joint legal custody with me and I will be the
primary physical custodian from ____________________ to ___________________and
the mother/father shall be the secondary physical custodian from
_____________________ (date) to ______________________ (date).
‘
c) That the father/mother of said child share joint legal custody with me and mother/father
shall be the primary physical custodian from ______________________ to
___________________ and I will be secondary physical custodian from
___________________ to ______________________.
3.
I consent in writing to the following visitation arrangement attached hereto as Exhibit “A”.
4.
I consent to child support being modified as follows:
a) My gross monthly income is __________________.
b) The mother’s/father’s gross income is ___________________ .
c) Child support is being determined for _____ number of children.
d) (Check the guideline that applies to you.)
No. of children
Percentage Range of Gross Income
1
17 percent to 23 percent
2
23 percent to 28 percent
3
25 percent to 32 percent
4
29 percent to 35 percent
5 or more
31 percent to 37 percent
e) No special circumstances exist, or the following special circumstances exist and check those
applicable:
If you require materials in alternate format, please notify the Family Law Information Center as soon as possible.
Consent to Change of Custody-9/99
Page 1 of 2
1999 Superior Court Family Division
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