IN THE SUPERIOR COURT OF ________ COUNTY
STATE OF GEORGIA
CONSENT TO CHANGE OF CUSTODY AND CHILD SUPPORT
I, _____________________________, am the mother/father of the child(ren) named
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
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 ______________________.
I consent in writing to the following visitation arrangement attached hereto as Exhibit “A”.
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
17 percent to 23 percent
23 percent to 28 percent
25 percent to 32 percent
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
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
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1999 Superior Court Family Division