Child Support Addendum To Family Violence Protective Order Form

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ORI Number ____________________
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THE SUPERIOR COURT FOR THE COUNTY OF________________
STATE OF GEORGIA
_____________________,
:
Petitioner,
:
Civil Action File
vs.
:
_____________________,
:
No._____________________
Respondent.
:
CHILD SUPPORT ADDENDUM TO
FAMILY VIOLENCE PROTECTIVE ORDER
This Addendum is entered in conjunction with the Family Violence Protective Order dated
______________________, 20_____ and supersedes any contradictory language in that order. This
Addendum is intended to fulfill the requirements of O.C.G.A. §19-6-15.
_____ 1.
The Respondent is ordered to pay to the Petitioner support for the minor child/ren in the
amount of $___________ every ___________________ beginning the _______ of
______________________, 20_____.
All payments are to be made by or to: ____ income deduction order
____ child support receiver
____ by mail directly to the Petitioner
or ____ _____________________________
In determining child support the Court finds as follows:
The gross income of the father is $___________ yearly or $___________ monthly.
The gross income of the mother is $___________ yearly or $___________ monthly.
Child support is being determined for ______ child/ren.
_____ 2.
Social Security benefits of $___________ per month received by the child/ren on behalf
of the Respondent have reduced the Respondent’s presumptive child support obligation
from $___________ to $___________ per month.
_____ 3.
Health insurance is available at a reasonable cost to Petitioner/Respondent (circle one).
Petitioner/Respondent (circle one) shall provide health insurance for the parties’ minor
child/ren. The parent who maintains the insurance shall provide the other parent with an
insurance identification card or other acceptable proof of insurance coverage and shall
cooperate with the other parent in submitting claims under the policy.
1

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