Uniform Domestic Relations Form 17 - Shared Parenting Plan Page 8
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14FOURTH: CHILD SUPPORT
As required by law, the parties have completed a Child Support Worksheet, which is attached to
and incorporated in this Agreement.
A.
Child Support with Private Health Insurance Coverage
When private health insurance coverage is being provided for the child(ren),
Plaintiff/Petitioner 1
Defendant/Petitioner 2, Obligor, shall pay child support in the amount of
$
per child per month, for
(number) child(ren) for a total of
$
per month.
B.
Child Support without Private Health Insurance Coverage
When private health insurance coverage is not available for the benefit of the child(ren),
Plaintiff/Petitioner 1
Defendant/Petitioner 2, the Obligor, shall pay child support in the amount
of
$
per child per month and
$
per child per month as cash medical support.
The total of child support and cash medical support for
(number) child(ren)
is
$
per month.
C.
Child Support Payment
The child support payment (including cash medical support, if any) plus a 2% processing charge
shall commence on
and shall be paid to the Ohio Child Support Payment
Center, P. O. Box 182372, Columbus, Ohio 43218-2372, as administered through the
County Child Support Enforcement Agency (CSEA) by income withholding at
Obligor’s place of employment or from nonexempt funds on deposit at a financial institution.
D.
Deviation of Child Support Amount
The child support amount agreed upon is different than the amount calculated on the attached
Child Support Worksheet because the amount calculated on the Worksheet would be unjust or
inappropriate and would not be in the best interests of the child(ren) for the following reason(s)
as provided in R.C. 3119.22, 3119.23, 3119.24 and shall be adjusted as follows:
Special and unusual needs of the child(ren) as follows:
Extraordinary obligations for child(ren) or obligations for handicapped child(ren) who is/are not
stepchild(ren) and who are not children from the marriage or relationship that is the basis of the
immediate child support determination as follows:
Other court-ordered payments as follows:
Supreme Court of Ohio
Uniform Domestic Relations Form – 17
SHARED PARENTING PLAN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Amended: March 15, 2016
Page 8 of 14
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