Uncontested Divorce Online | BROWN & GILL, LLC

CHILD SUPPORT & VISITATION INTAKE FORM

With every divorce where there are children, a Child Support Worksheet and Child Support Addendum MUST be filed with the Court prior to the divorce being granted. The following section will assist us in drafting this worksheet. If your information is incomplete it may be necessary for us to contact you to complete the worksheet. You will need the following information:

1.	Income must be gross monthly. (before taxes)
2.	Total monthly amount spent for child care. (summer and school year)
3.	Cost of monthly medical coverage and expense for children.
4.	Self employed persons must give complete information including total monthly income and amount paid in taxes.
5.	Information concerning court-ordered child support for other children.

For more information, visit

http://www.georgiacourts.org/csc/materials/litigant_process.pdf

SECTION I - CLIENT INFORMATION

1. Legal Name:
2. Date of Birth:
3. Address:
4. County:
5. I am the:
6. Email Address:
7. Telephone No(s):

SECTION II - NON-CUSTODIAL PARENT (NCP) INFORMATION

1. Legal Name:
2. Date of Birth
3. Address:
4. County:
5. Employer:

SECTION III - CHILD SUPPORT INFORMATION

A. GENERAL CHILD INFORMATION

List all children living in household born as a result of this marriage: Full Name of Child, Date of Birth, Gender [Male/Female]

Who will maintain LEGAL custody?
Who will maintain PHYSICAL custody
List all children living in household born outside of this marriage: [Full Name of Child, Date of Birth, Gender, Indicate Parent of Child]

Gross monthly income for father:
Gross monthly income for mother:
If a parent is already paying court ordered child support we need the following: Child's Name, Birth Date, Case Number, County of Court, Date of Initial Order, Amount Paid

B. HEALTH CARE

Total amount spent for health insurance for the child(ren) only:
Who carries the insurance?
Who pays the premium?
If both parties pay, how much does father pay?
If both parties pay, how much does mother pay?
Does your child have extraordinary expenses NOT covered by insurance? If so, please list: Child name, Amount of Expense, What For, Amount Paid By Each Parent

C. CHILD CARE

Total amount of money spent for daycare during the school year:
Who pays for child care?
If both parties pay, how much does father pay?
If both parties pay, how much does mother pay?
Total amount of money spent for daycare during the summer:
Who pays for child care?
If both parties pay, how much does father pay?
If both parties pay, how much does mother pay?

D. SPECIAL CIRCUMSTANCES

Certain circumstances may be encountered that will warrant a deviation from the child support guidelines. Do any of the following circumstances apply to your situation?

High Income (Either party earns more than $30,000 /month)
Low Income (Either party earns less than $1850.00/month)
Other Health-Related Insurance (e.g. dental, vision)(type, cost per month)
Life Insurance (cost)
Child and Dependent Care Tax Credit
Extraordinary Travel Expenses (parent lives out of state)
Alimony (amount per month)
Mortgage (amount paid on behalf of the custodial spouse)
Permanent Plan or Foster Care Plan ( the child is in the legal custody of Dept of Human Resources, foster care or some agency)
Extraordinary Expenses ( e.g. private school, uncovered health expenses)
Parenting Time (deviation for non-standard visitation or custody arrangements)
Other special circumstances not covered above (Explain)

If any of these circumstances apply to you or your spouse, please identify seperately and explain below:

SECTION IV - PARENTING VISITATION PLAN

A. PARENTING SCHEDULE

1st & 3rd weekends (from 6:00pm on Friday until 6:00pm on Sunday)
2nd & 4th weekends (from 6:00pm on Friday until 6:00pm on Sunday)
5th weekend (from 6:00pm on Friday until 6:00pm on Sunday)
Thanksgiving (from 6:00pm on the Wednesday preceding Thanksgiving until 6:00pm on the following Sunday).
Christmas Vacation - First Half (from the day school ends until Noon on Christmas Day).
Christmas Vacation - Second Half (from noon on Christmas Day until 6:00pm on the day before school starts in January).
Spring Break (from 6:00pm on the day school ends until 6:00pm on the day before school starts again).
Memorial Day (from 6:00pm on Friday until 6:00pm on Monday)
Independence Day (from 6:00pm on July 3rd until 9:00pm on July 4th).
Labor Day(from 6:00pm Friday until 6:00pm on Monday).
Mother's Day (from 9:00am until 6:00pm).
Father's Day (from 9:00am until 6:00pm).

B. SPECIAL VISITATION PLAN
If you and your spouse have special visititation plans or agreements otherwise not detailed above, please explain in detail below:

Please read our Legal Services Agreement at this time. You cannot continue until you have typed in your name below.

Legal Services Agreement

I have read and consent to the Legal Services Agreement (type your name below):