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IN THE CIRCUIT COURT OF THE IN AND FOR

JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division:

, Petitioner, and , Respondent. FINAL JUDGMENT FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. The following child(ren) are common to the parties: Name Birth date

SECTION I. ALIMONY 1. ( ) The Court denies the request(s) for alimony. OR ( ) The Court finds that there is a need for alimony and that Respondent has/had the ability to support Petitioner and has failed to do so. Respondent (hereinafter Obligor) has the present ability to pay alimony as follows: [all that apply] a. ___ Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} beginning {date} . This alimony shall continue until modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first.
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

b. ___ Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $ This amount shall be paid as follows:

.

c. ___ Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ________________________ beginning {date} . This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} _________________________, whichever occurs first. The rehabilitative plan presented demonstrated the following:

d. ___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ _____________ for the period of {date} , through {date} , which shall be paid pursuant to paragraph 3 below. 2. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in awarding/denying alimony: a. The standard of living established during the marriage; b. The duration of the marriage; c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and the marital assets and liabilities distributed to each; e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the Court has considered the following factors in reaching its decision:

______ Please indicate here if additional pages are attached. 3. Arrearage/Retroactive Alimony. [one only] a. There is no alimony arrearage at the time of this Final Judgment. b. Respondent shall pay to Petitioner the alimony arrearage of: $ for retroactive alimony, as of {date} .$ for previously ordered unpaid alimony, as of {date} . The total of $ in alimony arrearage shall be repaid in the amount of $ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} beginning {date} , until paid in full including statutory interest.

Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

4. Insurance. [all that apply] a. ___Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $ per month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit a request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. b. ___ Life Insurance (to secure payment of support). To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $ ____ and shall remain in effect until the obligation for alimony terminates. 5. Other provisions relating to alimony: _______________________________________________

. SECTION II. CHILD SUPPORT 1. The Court finds that there is a need for child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net monthly income is $ _____,(Child Support Guidelines %). The Father's net monthly income is $ , (Child Support Guidelines %). Monthly child care costs are $ . Monthly health/dental insurance costs are $ . 2. Amount. Obligor shall be obligated to pay child support in the amount of $ , per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain}: ______________________________________________________ , beginning {date} , and continuing ( ) until the first of the parties' minor children reaches the age of 18 or until one of the parties' children becomes emancipated, marries, dies, otherwise becomes self-supporting, at which time the child support shall be recomputed under the then current Child Support Guidelines OR ( ) until {date/event} {explain} If the child support ordered deviates from the guidelines by more than 5%, the factual findings
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

, .

which support that deviation are:

3. Arrearage/Retroactive Child Support. [one only] a. ___ There is no child support arrearage at the time of this Final Judgment. b. ___ The ( ) Mother ( ) Father shall pay to the other party the child support for previously ordered unpaid child support, as of {date} ____________. The total of $ child support arrearage shall be repaid in the amount of $ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _____________________________________________________ beginning {date} , until paid in full including statutory interest.

4. Insurance. [all that apply] a. ___ Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health and/or ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party. OR ( ) health ( ) dental insurance is not reasonably available at this time. b. ___ Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain}: As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $ , on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren) as the beneficiary(ies) OR naming ( ) Mother ( ) Father ( ) other {name}___________________________________________________________________as Trustee for the minor child(ren). The obligation to maintain the life insurance coverage shall continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes self-supporting. 6. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall be as follows: ___________________________________________________________________ . Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

this paragraph. 7. Other provisions relating to child support: ___________________________________________

SECTION III. METHOD OF PAYMENT Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows: 1. Central Governmental Depository. [if applies] a. ___ Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name} County, along with any depository service charge. b. ___ Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.08 or 61.13, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [ if applies] a. ___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. b. ___ Deferred. Income deduction is ordered this day, but it shall not be effective until a delinquency of $ , or, if not specified, an amount equal to one month=s obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} , AND ( ) there is proof of timely payment of a previously ordered obligation without an income deduction order in cases of modification, AND ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance OR ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. Bonus/one-time payments. ( ) All ( ) % ( ) No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above.

Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

4. Other provisions relating to method of payment. _____________________________________

SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY 1. ___ ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ____________________________________________________________ . 2. ___ The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $ in attorney fees, and $ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $ per hour and reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ___________________

SECTION V. OTHER PROVISIONS 1. Other Provisions: _______________________________________________________________

2. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on . CIRCUIT JUDGE A copy of the {name of document(s)} _____________________________________________ was [only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on {date}_____________ by {clerk of court or designee}______________________________________. Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other:

Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)