Petition For Dissolution Of Marriage With Dependent Or Minor Child(Ren) Page 9
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11__________________________________________________________________________________
__________________________________________________________________________________
4. Explain why this request is in the best interests of the child(ren): __________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION IV. CHILD SUPPORT
[Choose all that apply]
1. ___ Petitioner requests that the Court award child support as determined by Florida’s child support
guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet,
Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such support should be
ordered retroactive to:
a. ___ the date of separation {date} ______________.
b. ___ the date of the filing of this petition.
c. ___ other {date} ______________ {explain} __________________________________________
2. ___ Petitioner requests that the Court award child support to be paid beyond the age of 18 years
because:
a. ___ the following child(ren) {name(s)} _______________________________________________
is (are) dependent because of a mental or physical incapacity which began before the age of 18.
{explain} _______________________________________________________________________
______________________________________________________________________________
b. ___ the following child(ren) {name(s)} ________________________is (are) dependent in fact
and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren)
is (are) performing in good faith with reasonable expectation of graduation before the age of 19.
3. ___Petitioner requests that the Court award a child support amount that is more than or less than
Florida’s child support guidelines/ Petitioner understands that Motion to Deviate from Child Support
Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be filed before the
court will consider this request.
4. ___Petitioner requests that medical/dental insurance for the minor child(ren) be provided
by:
[Choose only one]
a. ___ Father.
b. ___ Mother.
5. ___Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid:
[Choose only one]
a. ___by Father.
b. ___by Mother.
c. ___by Father and Mother [each pay one-half].
d. ___according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law
Rules of Procedure Form 12.902(e).
e. ___Other {explain}: _____________________________________________________________
__________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (10/11)
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