Parenting Plan Page 7
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The amount of child support agreed to by the parties is not based upon the attached Child Support
Worksheet which reflects an amount of child support of $__________ per month. Please identify the
agreed upon amount and the reasons why you agree to deviate from the amount identified in the Child
Support Worksheet. (The Court must approve any deviation from the guideline amount and will do
so only for compelling reasons if this amount is lower than the guideline amount.)
b. Child Support Agreement
The
Father
Mother shall pay child support to the
Father
Mother
Other Party in the sum of
$____________ per month beginning on _________________________ (date).
Child support payments shall be paid: (check one)
To the Family Support Registry (FSR), P. O. Box 2171, Denver, CO 80201-2171.
Directly to the
Father
Mother
Other Party
Child support payments shall be paid: (check one)
weekly
bi-weekly
twice a month
monthly
Other: ________________________ and will be paid
on the _____________ day of the
week
month.
It is the responsibility of the Obligee (the person receiving the payment) to complete the
appropriate forms to activate an income assignment, pursuant to §14-14-111.5(3)(a)(II), C.R.S.
Please see JDF 1801 - Instructions, if applicable.
2. Medical, D ental, Vision, and M ental H ealth I nsurance and Extraordinary/Out-of
Pocket Medical Expenses
Father shall provide
medical
dental
vision
mental health insurance for the child(ren). If not all
children, please identify the names of the children the Father will be providing insurance for:
_________________________________________
and/or
Mother shall provide
medical
dental
vision
mental health insurance for the child(ren). If not all
children, please identify the names of the children the Mother will be providing insurance for:
_______________________________________________________________________________________
and/or
________________________________ (name of party) shall provide
medical
dental
vision
mental
health insurance for the child(ren). If not all children, please identify the names of the children that this party will
be providing insurance for:
_______________________________________________________________________________________
JDF 1113 R5/10
PARENTING PLAN
Page 7 of 10
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