UNCONTESTED CHANGE OF CUSTODY A change of custody is allowed when the parent(s) can prove that there are substantialchanges affecting the welfare and best interests of the child(ren). Parents can enter into anagreement regarding custody, subject to the court’s approval. The parental agreement will beeffective unless the judge decides that the proposed change is not in the best interests of thechildr(en). The parents’ agreement can be made a Final Order of modification by the trialcourt at any time after the agreement has been submitted to the Court.

When a parent sues the other parent to change custody, the court has the power to awardsole custody, joint custody, joint legal custody, and joint physical custody. Additionally, the courtmay award custody to a third person when both parents are proved to be unfit. The Judge has thepower to Order a psychological evaluation of the family, an independent medical evaluation, oran investigation by the local family and children services agency.

A complaint for change of custody brought by the non-custodial parent must be broughtin the county in which the legal custodian of the child or children. A complaint for change ofcustody brought by the legal custodian must be brought in the county in which the Defendantresides.

A Judge may consider the desire of a child who is at least eleven years of age, but not yetfourteen. However, the child’s desire by itself is not a material change of conditions orcircumstances. The wishes of a child aged fourteen or older is controlling unless the parentwhom the child chooses is unfit. During a custody hearing, the trial court may Order the parentsto leave the courtroom when a child testifies.

mation about change of custody proceedings, please consult the following

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

COMPLAINT FOR CHANGE OF CUSTODY

Now comes the Plaintiff, ____ , and stateshis/her claim against the Defendant, , for achange of custody as follows:

1.Jurisdiction and Venue (choose a or b)

a) The Defendant is subject to the jurisdiction of this Court and has signed anAcknowledgment of Service and Summons.

b) The Defendant is not subject to the jurisdiction of this Court, but hassigned an Affidavit of Waiver of Venue and Personal Jurisdiction.

2.Current Custody Arrangement (choose a or b)

a) The Defendant presently has legal custody of the minor child(ren), , age(s) , by virtue of a Final Orderand decree of divorce in Civil Action No. , enteredon the day of , 20 in the Superior Court of County, Georgia.

b) The Defendant presently has legal custody of the minor child(ren), ,age(s) , by virtue of an Order oflegitimation in Civil Action No. , entered on the day of , 20 .

3.Change in Circumstances

There has been a change in circumstances materially affecting the welfare of the minorchild(ren) as follows:

4.Proposed New Custody Arrangement

As a result of such change of circumstances, the Plaintiff and Defendant have agreed thatcustody should be as follows:

5.Plaintiff’s Ability to be Custodial Parent

The Plaintiff is a fit and capable parent and is otherwise qualified to assume full custodyof the minor child(ren).

THEREFORE, Plaintiff prays:

(a) That custody of the minor child(ren) be changed as follows:

(b) That the Plaintiff have such additional relief as the Court may consider equitableand appropriate.

Plaintiff pro seAddress: Telephone number(s):

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

VERIFICATION

Personally appeared before me the undersigned who on oath states that the facts set forthin this Complaint are true and correct to the best of his/her knowledge and belief.

Plaintiff pro se

Sworn to and subscribed before methis day of , 20 .

Notary Public, State of Georgia

My Commission Expires:

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

PLAINTIFF’S AFFIDAVIT REQUIRED BY O.C.G.A. § 19-9-69

State of GeorgiaCounty of

Personally before the undersigned officer authorized to administer oaths appeared, who, being duly sworn, does stateon oath the following:

1.

That Affiant, , is the plaintiffnamed in the above- styled action.

2.

The above-styled action concerns the custody of:

Name: DOB: Sex: Name: DOB: Sex: Name: DOB: Sex: Name: DOB: Sex:

3.The present address of the child(ren) is:

4.

For the past five years, the children lived at the following addresses with the followingpersons:

Address Dates Lived With

5.

The child(ren) presently live/lives with .

6.Other Cases Concerning the Child(ren) (Choose a or b)

a) Plaintiff asserts that he/she has not participated as a party or a witnessor in any other capacity in any other litigation concerning the children named above, and knowsof no other proceeding concerning the minor children in this or any other state. No person otherthan the parties to this action has physical custody of the minor children or any claim to custodyor visitation with the minor children.

b) The minor children have been involved in the following custody actions:(The court wants to know about the following types of actions: custody, visitation, family violence,

protective Orders, termination of parental rights, and adoption.)

County/State/Court Type of Custody Action Date Filed Status

7.

Others with a Custody/Visitation Claim (Choose a or b)

a) I know of no other person, not a party to this proceeding, who has physicalcustody of the children or claims to have custody or visitation rights with respect to the minorchildren.

b) The following persons who are not a party to this proceeding have custody orvisitation rights with the minor children:

Name Claim

Affiant/Plaintiff

Sworn to and subscribed before me this day of , 20 .

Notary Public

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

ELECTION OF .

This Affidavit is given by who,after being duly sworn before an officer authorized in the State of Georgia to administer oaths,states the following:

1.

My name is , and I am theson or daughter of and . I was born on and am currently years old.

2.

I sign this Affidavit to inform the court that I wish to live and elect to live withmy [mother/father/other] on a permanentand full-time basis. I understand that my [mother/father/other] may ask the Court to be made my custodial parent anddesire that he be designated as my custodial parent.

3.

I wish my [non-custodial parent] to havereasonable visitation rights.

4.

I hereby affirm that I have given this Affidavit under oath and that the statementscontained herein are true and accurate.

5.

I have made this election voluntarily and not because of any pressure or duress orbecause of any problems made known to me by either of my parents or any other person.

Affiant

Sworn to and subscribed before methis day of , 20 .

Notary Public

My Commission Expires:

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

ACKNOWLEDGMENT OF SERVICE AND SUMMONS

The undersigned Defendant hereby acknowledges service of the above Summons andComplaint for Divorce and states that he/she has received a copy of said Complaint, andDefendant hereby waives any further service of process.

This the day of , 20 .

Defendant pro se

Sworn to and subscribed before methis day of , 20 .

Notary PublicMy Commission Expires:

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

DEFENDANT’S ACKNOWLEDGMENT OF SERVICEAFFIDAVIT OF WAIVER OF VENUE AND PERSONAL JURISDICTION

I, , the named Defendant in theabove-styled case, after being duly sworn do hereby depose and say that I am a resident of County, (State), and that thePlaintiff in the above-styled case is a resident of County, Georgia.I affirm that I have received a copy of said Petition/Complaint, and I hereby waive any and allfurther notice, service, and issuance of process.

After being duly informed that I have a constitutional right to a trial by judge or jury onthe above matter in the county of my residence, and with that knowledge, I hereby expresslywaive my right to venue in the county of my residence, and consent to venue and personaljurisdiction in the county of this superior court.

This day of , 20 .

Affiant

Notary Public

Sworn to and subscribed before methis day of , 20 .

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

CUSTODY AGREEMENT

This is an agreement by and between ,(hereinafter referred to as “Father”) and ,(hereinafter referred to as“Mother”).

WHEREAS, the parties desire to settle between themselves all questions regarding childcustody, visitation, child support, and all other rights and obligations arising out of their formermarital relationship:

NOW, THEREFORE, in consideration of the mutual covenants hereinafter contained, theparties agree as follows:

1.

Non-interference with Parental Relationships

The parties agree that the welfare of the child(ren) is of paramount importance and eachagrees to foster and encourage a feeling of affection between themselves and the child(ren).Neither party shall do anything to hamper the natural development of the children’s love andrespect for the other party.

2.

Legal and Physical Custody (Check a, b, or c)

a) The Father/Mother shall have the temporary and permanent legal andphysical custody of the minor child (ren) born as issue of the marriage.

b) The Father and Mother shall share joint legal custody of the minor child(ren). Theparties shall share decision-making concerning the children; however, the Father/Mother shallhave the right to make the final decision in the event the parties cannot agree.

Primary physical custody of the minor child (ren) shall be with the Father/Mother asfollows:

Secondary physical custody shall be with the Father/Mother as follows:

The Father and Mother shall share joint legal custody and joint physical custody ofthe minor child (ren).

Physical custody shall be shared by the parties as follows:

The parties shall share decision making concerning the child (ren); however, in the eventthe parties cannot decide, the Father/Mother shall have the final decision concerning

3.

Visitation Schedule (Choose a or b)

a) The Father/Mother shall have the right of visitation with the minorchildren as follows:

b) The visitation schedule is attached hereto and incorporated herein.

4.

Cooperation and Consultation

This Agreement cannot provide for every possible detail with respect to the custody of theChild(ren). In that regard, the parties agree to cooperate and consult with each other so as to carryout visitation in a manner conducive to the best interests of the Child(ren). Neither party shallattempt to influence any of the Child(ren) not to love and respect the other parent. Each partyagrees to keep the other informed as to the health and whereabouts of the Child(ren) whilehaving custody of or visitation with the child(ren).

5.

Change of Residence

In the event of any change of residence on the part of either party herein so long as thecustody and visitation provisions of this Agreement are in effect, said party changing his or herresidence shall notify the other party at least one month in advance of the intent to changeresidence and of the location of the new residence and shall furnish to him or her the completenew address and, as soon as determined, the new telephone number at the new residence. Saidnotification shall be in writing with a copy of said writing retained by the other

CHILD SUPPORTPlease go to http://www.georgiacourts.org/csc/ and complete the

Child Support Worksheet.

6.

Child Support Amount

The Father/Mother shall pay to the Father/Mother, as support of the minor child(ren), thesum of $ * per week/bi-weekly/month, starting on ,and continuing per week/bi-weekly/month thereafter until each respective child reaches the ageof eighteen (18), or so long as the child is enrolled in and attending secondary school (not toexceed age twenty (20)), marries, dies, or becomes otherwise emancipated. The child supportobligation shall be reduced as follows as each child becomes emancipated:

* This amount was derived from Line 13 of the Child Support Worksheet, which is attachedhereto as Exhibit 1.

7.

Child Support Method of Payment (Check a or b)

a) All payments of child support shall be paid directly to the Father/Motherat the following address: .

No Income Deduction Order will be entered into at this time. However, when ever, inviolation of the terms of this Agreement, there shall have been a failure to make the supportpayments due hereunder so that the amount unpaid is equal to or greater than the amount payablefor one (1) month, the payments required to be made may be collected by the process ofcontinuing garnishment for support. In the event Father/Mother fails to pay any child supportobligation in this Agreement on a timely fashion on any three (3) occasions in any twelve (12)month period, the parties agree that an income deduction Order shall then be entered.

b) All payments of child support shall be paid to Georgia Child SupportEnforcement pursuant to an Income Deduction Order.

8.

Health Insurance

The Father/Mother shall maintain a policy of medical, dental, and hospitalizationinsurance for the benefit of the minor child(ren) for so long as the child support obligation setforth herein exists. Costs not covered under the insurance policy shall be divided between Fatherand Mother as follows:

The Father/Mother shall provide the Father/Mother with an insurance identification cardor such other acceptable proof of insurance coverage and shall cooperate with the Father/Motherin submitting claims under the policy.

BINDING AGREEMENT

9.

Voluntary Agreement

The parties acknowledge that they have entered into this Agreement freely and voluntarilyand that it is not the result of any duress or any undue influence.

10.

Entire Agreement

This Agreement constitutes the entire understanding of the parties. There are norepresentations, warranties, covenants, or undertaking other than those expressly set forth herein.

Plaintiff pro se

Sworn to and subscribed before methis day of , 20 .

Notary Public, State of Georgia

My Commission Expires:

Defendant pro se

Sworn to and subscribed before me this day of , 20 .

Notary Public, State of Georgia

My Commission Expires:

___________________________________________

Exhibit “ ”

VISITATION SCHEDULE

The non-custodial parent is .

The custodial parent is .

The non-custodial parent shall be entitled to exercise reasonable visitation with the minorchild with the following minimum provisions:

A. On every 1 , 3 , and 5 Friday at 6:00 p.m. until the following Sunday at 6:00st rd th

p.m.;

B. During even numbered years (2008, 2010, etc.), the non-custodial parent shallhave the right of visitation on the holidays delineated below:

1. Martin Luther King’s Birthday2. Memorial Day3. Labor Day4. Thanksgiving5. Second week of Christmas Vacation from 2:00 p.m. on December 25 until

New Year’s Eve.

C. During odd numbered years (2009, 2011, etc.,) the non-custodial parent shall havethe right of visitation on the holidays delineated below:

1. New Year’s Day2. Easter or Spring Break3. July 4th4. Halloween5. First Week of Christmas vacation, including Christmas Day until 2:00

p.m. on December 25.

D. During even numbered years (2008, 2010, etc.), the custodial parent shall have theminor child on the holidays delineated below:

1. New Year’s Day2. Easter or Spring Break3. July 4th4. Halloween5. First week of Christmas vacation, including Christmas Day until 2:00 p.m.

on December 25.

E. During odd numbered years (2009, 2011, etc.), the custodial parent shall have the

right of visitation on the holidays delineated below:

1. Martin Luther King’s Birthday2. Memorial Day3. Labor Day4. Thanksgiving5. Second week of Christmas vacation from 2:00 p.m. on December 25 until

New Year’s Eve.

F. The Mother shall have the minor child on Mother’s Day.

G. The Father shall have the minor child on Father’s Day.

H. The non-custodial parent shall have the right to visit with the minor child for twoconsecutive weeks in the summer between June 15 and August 15. During thisperiod, the custodial parent shall have the minor child on the first (1 ) weekendst

from 6:00 p.m. Friday until 6:00 p.m. Sunday. The non-custodial parent shall givethe custodial parent a minimum of thirty (30) days written notice of the intent toexercise this visitation.

I. Holiday visitation shall take precedence over week-end visitation.

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF MOTHER

1. AFFIANT’S NAME: Age

Spouse’s Name: Age

Date of Marriage: Date of Separation

Names and birth dates of children for whom support is to be determined in this action:

Name Date of Birth Resides with

Names and birth dates of affiant’s other children:

Name Date of Birth Resides with

2. SUMMARY OF AFFIANT’S INCOME AND NEEDS

(a) Gross monthly income (from item 3A) $

(b) Net monthly income (from item 3C) $

(c) Average monthly expenses (item 5A) $

Monthly payments to creditors + Total monthly expenses and payments to credits (item 5C) $

(subsections (d) & (e) deleted)

3. A AFFIANT’S GROSS MONTHLY INCOME(complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receipt.)

Salary or Wage $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS

Commissions, Fees, Tips $

Income from self-employment, partnership, close corporations,and independent contracts (gross receipts minus ordinary andnecessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $

Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $

Bonuses $

Overtime Payments $

Severance Pay $

Recurring Income from Pensions or Retirement Plans $

Interest and Dividends $

Trust Income $

Income from Annuities $

Capital Gains $

Social Security Disability or Retirement Benefits $

Workers’ Compensation Benefits $

Unemployment Benefits $

Judgments from Personal Injury or Other Civil Cases $

Gifts (cash or other gifts that can be converted to cash) $

Prizes/Lottery Winnings $

Alimony and maintenance from persons not in this case $

Assets which are used for support of family $

Fringe Benefits (if significantly reduce living expenses) $

Any other income (do NOT include means-tested Public assistance, such as TANF or food stamps) $

GROSS MONTHLY INCOME $ (prior section B deleted)

3. B Affiant’s Net Monthly Income from employment(deducting only state and federal taxes and FICA) $

Affiant’s pay period (i.e., weekly, monthly, etc.)

Number of exemptions claimed

4. ASSETS

(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portionunder the appropriate spouse’s column and state the amount and the basis: premarital, gift,inheritance, source of funds, etc.)

Description Value Separate Asset Separate Asset Basis of theof the Husband of the Wife Claim

Cash $

Stocks, bonds $

CD’s/Money Market $ Accounts

Bank Accounts(list each account):

$ $ $

Retirement Pensions, 401K, IRA, or $ Profit Sharing

Money owed you: $

Tax Refundowed you: $ Real Estate:

home: $

debt owed: $

other: $

debt owed: $

Automobiles/Vehicles: Vehicle 1: $ debt owed: $

Vehicle 2: $ debt owed: $

Life Insurance(net cash value): $

Furniture/furnishings: $

Jewelry: $

Collectibles: $

Other Assets: $ $ $ $

Total Assets: $

5. A AVERAGE MONTHLY EXPENSES

HOUSEHOLDMortgage or rent payments $ Cable TV $

Property taxes $ Misc. household andgrocery items $

Homeowner/Renter Insurance $ Meals outside the home $

Electricity $ Other $

Water $ AUTOMOBILEGasoline and Oil $

Garbage and Sewer $ Repairs $ Auto Tags and license $

Telephone: $ Insurance $ residential line: $ cellular telephone: $

Gas $ OTHER VEHICLES (boats, trailers, RVs, etc.)

Repairs and maintenance: $ Gasoline and oil $ Repairs $

Lawn Care $ Tags and license $ Insurance $

Pest Control $

CHILDREN’S EXPENSES AFFIANT’S OTHER EXPENSESChild care (total monthly cost) $ Dry cleaning/laundry $

School tuition $ Clothing $

Tutoring $ Medical, dental, prescription

(out of pocket/uncovered expenses)

$ Private lessons (e.g., music, dance) $ Affiant’s gifts $

(special holidays)

School supplies/expenses $ Entertainment $

Lunch Money $ Recreational Expen. $ (e.g., fitness)

Other Educational Expenses (list) Vacations $

$ Travel Exp/Visitation $

$ Publications $

Allowance $ Dues, clubs $

Clothing $ Religious and charities $

Diapers $ Pet expenses $

Medical, dental, prescription Alimony paid to(out of pocket/uncovered expenses) $ former spouse $

Child support paid for otherGrooming, hygiene $ children $

Gifts from children to others $ Date of initial Order:

Entertainment $ Other (attach sheet) $

Activities (including extra-curricular, $ school, religious, cultural, etc.)

Summer Camps $

OTHER INSURANCEHealth $

Child(ren)’s portion: $ Dental $

Child(ren)’s portion: $ Vision $

Child(ren)’s portion: $ Life $

Relationship of Beneficiary:

Disability $

Other(specify): $

TOTAL ABOVE EXPENSES $

B. PAYMENTS TO CREDITORS(please check one)

(please check one)

To Whom: Balance Due Monthly Joint Plaintiff DefendantPayment

TOTAL MONTHLY PAYMENTS TO CREDITORS: $

C. TOTAL MONTHLY EXPENSE: $

This day of , 20 .

Affiant

Notary Public

My Commission expires:

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF FATHER

1. AFFIANT’S NAME: Age

Spouse’s Name: Age

Date of Marriage: Date of Separation

Names and birth dates of children for whom support is to be determined in this action:

Name Date of Birth Resides with

Names and birth dates of affiant’s other children:

Name Date of Birth Resides with

2. SUMMARY OF AFFIANT’S INCOME AND NEEDS

(a) Gross monthly income (from item 3A) $

(b) Net monthly income (from item 3C) $

(c) Average monthly expenses (item 5A) $

Monthly payments to creditors + Total monthly expenses and payments to credits (item 5C) $

(subsections (d) & (e) deleted)

3. A AFFIANT’S GROSS MONTHLY INCOME(complete this section or attach Child Support Schedule A) (All income must be entered based on monthly average regardless of date of receipt.)

Salary or Wage $ ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS

Commissions, Fees, Tips $

Income from self-employment, partnership, close corporations,and independent contracts (gross receipts minus ordinary andnecessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $

Rental Income (gross receipts minus ordinary and necessary expenses required to produce income) ATTACH SHEET ITEMIZING YOUR CALCULATIONS $

Bonuses $

Overtime Payments $

Severance Pay $

Recurring Income from Pensions or Retirement Plans $

Interest and Dividends $

Trust Income $

Income from Annuities $

Capital Gains $

Social Security Disability or Retirement Benefits $

Workers’ Compensation Benefits $

Unemployment Benefits $

Judgments from Personal Injury or Other Civil Cases $

Gifts (cash or other gifts that can be converted to cash) $

Prizes/Lottery Winnings $

Alimony and maintenance from persons not in this case $

Assets which are used for support of family $

Fringe Benefits (if significantly reduce living expenses) $

Any other income (do NOT include means-tested Public assistance, such as TANF or food stamps) $

GROSS MONTHLY INCOME $ (prior section B deleted)

3. B Affiant’s Net Monthly Income from employment(deducting only state and federal taxes and FICA) $

Affiant’s pay period (i.e., weekly, monthly, etc.)

Number of exemptions claimed

4. ASSETS

(If you claim or agree that all or part of an asset is non-marital, indicate the non-marital portionunder the appropriate spouse’s column and state the amount and the basis: premarital, gift,inheritance, source of funds, etc.)

Description Value Separate Asset Separate Asset Basis of theof the Husband of the Wife Claim

Cash $

Stocks, bonds $

CD’s/Money Market $ Accounts

Bank Accounts(list each account):

$ $ $

Retirement Pensions, 401K, IRA, or $ Profit Sharing

Money owed you: $

Tax Refundowed you: $ Real Estate:

home: $

debt owed: $

other: $

debt owed: $

Automobiles/Vehicles: Vehicle 1: $ debt owed: $

Vehicle 2: $ debt owed: $

Life Insurance(net cash value): $

Furniture/furnishings: $

Jewelry: $

Collectibles: $

Other Assets: $ $ $ $

Total Assets: $

5. A AVERAGE MONTHLY EXPENSES

HOUSEHOLDMortgage or rent payments $ Cable TV $

Property taxes $ Misc. household andgrocery items $

Homeowner/Renter Insurance $ Meals outside the home $

Electricity $ Other $

Water $ AUTOMOBILEGasoline and Oil $

Garbage and Sewer $ Repairs $ Auto Tags and license $

Telephone: $ Insurance $ residential line: $ cellular telephone: $

Gas $ OTHER VEHICLES (boats, trailers, RVs, etc.)

Repairs and maintenance: $ Gasoline and oil $ Repairs $

Lawn Care $ Tags and license $ Insurance $

Pest Control $

CHILDREN’S EXPENSES AFFIANT’S OTHER EXPENSESChild care (total monthly cost) $ Dry cleaning/laundry $

School tuition $ Clothing $

Tutoring $ Medical, dental, prescription

(out of pocket/uncovered expenses)

$ Private lessons (e.g., music, dance) $ Affiant’s gifts $

(special holidays)

School supplies/expenses $ Entertainment $

Lunch Money $ Recreational Expen. $ (e.g., fitness)

Other Educational Expenses (list) Vacations $

$ Travel Exp/Visitation $ $ Publications $

Allowance $ Dues, clubs $

Clothing $ Religious and charities $

Diapers $ Pet expenses $

Medical, dental, prescription Alimony paid to(out of pocket/uncovered expenses) $ former spouse $

Child support paid for otherGrooming, hygiene $ children $

Gifts from children to others $ Date of initial Order:

Entertainment $ Other (attach sheet) $

Activities (including extra-curricular, $ school, religious, cultural, etc.)

Summer Camps $

OTHER INSURANCEHealth $

Child(ren)’s portion: $ Dental $

Child(ren)’s portion: $ Vision $

Child(ren)’s portion: $ Life $

Relationship of Beneficiary:

Disability $

Other(specify): $

TOTAL ABOVE EXPENSES $

B. PAYMENTS TO CREDITORS(please check one)

(please check one)

To Whom: Balance Due Monthly Joint Plaintiff DefendantPayment

TOTAL MONTHLY PAYMENTS TO CREDITORS: $

C. TOTAL MONTHLY EXPENSE: $

This day of , 20 .

Affiant

Notary Public

My Commission expires:

IN THE SUPERIOR COURT OF COUNTY

STATE OF GEORGIA

, §Plaintiff,

§v. Civil Action

§ File No. ,

Defendant. §

FINAL JUDGMENT AND DECREEMODIFICATION OF CUSTODY

The Custody Agreement entered into between the parties and filed with the court on the day of , 20 , is hereby incorporated intoand made a part of this Final Judgment and Decree of Change of Custody. The original Order forcustody, Civil Action File No. , which was issued on the day of , 20 , is hereby modified as follows:

Based on the evidence presented, including the Child Support Worksheet, Schedules “A”through “E,” incorporated by reference, and specifically the Child Support Worksheet andSchedule “E” attached hereto, and where applicable, Special Interrogatories also attached hereto,the Court finds as follows:

1. Children for whom support is being determined:

Child Date of Birth

2. (a) For purposes of Calculating Child Support, the Court Orders that theCustodial Parent shall be .

(b) For purposes of Calculating Child Support the Court Orders that theNon-custodial Parent shall be .

(c) The Court finds that the amount of the Non-custodial Parent’s parentingtime as set forth in the Order of Visitation is days.

3. (a) The Court finds as set on Schedule “A,” the gross income of the father is $

(b) The Court finds as set on Schedule “A,” the gross income of the Motheris $

4. (a) The Court finds as set on the “Child Support Worksheet” and Schedule“B” the Non-custodial Parent’s Adjusted Income is $

(b) The Court finds as set on the “Child Support Worksheet” and Schedule“B,” the Custodial Parent’s Adjusted Income is $

(c) The Court finds as set on the “Child Support Worksheet” and Schedule“B,” the Parties’ Total Adjusted Income $

5. The Court finds as set by the “Child Support Obligation Schedule Table” and aslisted on the “Child Support Worksheet” the Basic Child Support Obligation is $

6. (a) The Court finds as set on the “Child Support Worksheet,” the BasicChild Support Obligation for the Custodial Parent is $

%

(b) The Court finds as set on the “Child Support Worksheet,” the BasicChild Support Obligation for the Non-custodial Parent is $

%

7. The Court finds that health insurance that provides for the health care needs of thechild is/is not reasonably available at a reasonable cost. If provided, it will beprovided by .

8. (a) The Court finds as set on the “Child Support Worksheet” and Schedule“D,” the Presumptive Amount of Child Support for the Custodial Parent is $

(b) The Court finds as set on the “Child Support Worksheet” and Schedule“D,” the Presumptive Amount of Child Support due to the CustodialParent is $

(c) The Court finds as set on the “Child Support Worksheet” and Schedule“D,” the Presumptive Amount of Child Support due to the CustodialParent is $

9. The Court finds that the child receives benefits under Title II of the FederalSocial Security Act on the obligor’s account and the amount the child receives ona monthly basis is $

10. The Court has considered the existence of special circumstances and as set forthon the “Child Support Worksheet” and Schedule “E,” has found the followingspecial circumstances marked with an [“X”] to be present in this case.

Note: Refer to Schedule “E” and, where applicable, “Special Interrogatories” attached hereto for an

explanation for the reasons for the deviation, how the application of the Presumptive Amount of Child Support

would have been unjust and how the best interest of the child for whom support is being determined will be

served by a deviation from the Presumptive Amount of Child Support.

A. High Income B. Low Income C. Other Health-Related Insurance D. Life Insurance E. Child and Dependant Care Tax Credit F. Travel Expenses G. Alimony H. Mortgage I. Permanent Plan or Foster Care Plan J. Extraordinary Expenses K. Parenting Time L. Non-Specific Deviations (Other)

11. (a) The Court finds as set on the “Child Support Worksheet” the FinalAmount of Child Support for the Custodial Parent is $

(b) The Court finds as set on the “Child Support Worksheet” the Finalof Child Support for the Non-custodial Parent is $

(c) The Court finds as set on the “Child Support Worksheet” the FinalAmount of Child Support the Non-custodial Parent shall Pay the CustodialParent is $

12. (a) The Court finds as set on the “Child Support Worksheet” that theCustodial Parent’s allocated Uninsured Health Care Expenses based ontheir pro rata responsibility is $

%

(b) The Court finds as set on the “Child Support Worksheet” that the Non-custodial Parent’s allocated Uninsured Health Care Expenses based ontheir pro rata responsibility is $

%

The Non-custodial parent, , shallpay Child Support for each of the minor child(ren) at $ per month,for a total of $ per month to the Custodial parent, starting , and continuing until each minor child reaches the age ofmajority, dies, marries, becomes emancipated, whichever first occurs, provided however, theCourt, in the exercise of its sound discretion, directs (or does not direct) the Non-custodial Parentto continue to pay child support for a Child who has not previously married or becomeemancipated, who is enrolled in and attending a secondary school, and who has attained the ageof majority before completing his or her secondary school education, until that child graduatesfrom high school, or until the child attains years of age (not to exceed 20 years),whichever first occurs. Each party is hereby restrained and enjoined from molesting or harrassing the other party.

SO ORDERED, this _______ day of ________________________________, 20______.

JUDGE, Superior Courts ____________Judicial Circuit