CIVIL ACTION FILE NO. _____________________
_____ 4.
The Respondent shall be responsible for _____% and Petitioner shall be responsible for
_____% of the uninsured health care expenses for the minor child/ren.
_____ 5.
The following deviation(s) to the child support calculations as outlined in O.C.G.A.
§19-6-15 applies in this case: ______________________________________________
______________________________________________________________________
The reason for such deviation(s) is/are: ______________________________________
______________________________________________________________________
The presumptive amount of child support required under O.C.G.A. §19-6-15 if the
deviation had not been applied is $___________ per month; however, the guidelines
would be unjust or inappropriate considering the relative ability of each parent to
provide support and it is in the best interest of these child/ren to deviate from the
Presumptive Amount of Child Support because ________________________________
______________________________________________________________________
Deviation from the presumptive amount of child support would not seriously
impair the ability of the custodial parent to maintain minimally adequate housing, food,
clothing, and other basic necessities for the child/ren being supported by this order.
_____ 6.
The Respondent’s parenting time as set forth in the visitation paragraph of the main
order is ____days per year.
_____ 7.
It is further Ordered:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
SO ORDERED this _______ day of ______________________, 20_____.
_____________________________
JUDGE, SUPERIOR COURT
_______________________ County
_____________________________
Print or stamp Judge’s name
Rev’d 10/2008
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