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Page 1 IN THE SUPERIOR COURT OF DOUGLAS COUNTY STATE OF GEORGIA Petitioner: VS. Civil Action File Respondent: FINAL JUDGMENT AND DECREE Upon consideration of this case, upon evidence submitted as provided by law, it is the judgment of the Court that a total divorce be granted, that is to say, a divorce a vinculo matrimonii, between the parties to the above stated case upon legal principles. It is considered, ordered, and decreed by the Court that the marriage contract heretofore entered into between the parties to this case, from and after this date, be and is set aside and dissolved as fully and effectively as if no such contract had ever been made or entered into. Petitioner and Respondent in the future shall be held and considered as separate and distinct persons altogether unconnected by any nuptial union or civil contract whatsoever and both shall have the right to remarry. The Court restores to (Petitioner/Respondent) her prior maiden name, to wit: The Court awards custody of the children of the parties as follows: The Court fixes alimony and support as follows: In determining child support, based on the evidence presented, including the Child Support Worksheet, Schedules through 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 ---PAGE BREAK--- Page 2 2. For purposes of calculating child support, the Court Orders that the Custodial Parent shall be: For purposes of calculating child support, the Court Orders that the Non-Custodial Parent shall be: 3. The Court finds as set on Schedule the gross income of the Father is: The Court finds as set on Schedule the gross income of the Mother is: 4. The Court finds as set on the “Child Support Worksheet” and Schedule the Non-Custodial Parent’s Adjusted Income is: The Court finds as set on the “Child Support Worksheet” and Schedule the Custodial Parent’s Adjusted Income is: The Court finds as set on the “Child Support Worksheet” and Schedule the parties’ Total Adjusted Income is: 5. The Court finds as set by the “Child Support Obligation Schedule Table” and as listed on the “Child Support Worksheet” the Basic Child Support Obligation is: 6. The Court finds as set on the “Child Support Worksheet”, the Basic Child Support Obligation of the Custodial Parent is: The Court finds as set on the “Child Support Worksheet”, the Basic Child Support Obligation of the Non-Custodial Parent is: 7. The Court finds that health insurance that provides for the health care needs of the child/children (is/is not) reasonably available at a reasonable cost. If provided, it will be provided by: 8. The Court finds as set on the “Child Support Worksheet” and Schedule the Presumptive Amount of Child Support for the Custodial Parent is: The Court finds as set on the “Child Support Worksheet” and Schedule the Presumptive Amount of Child Support for the Non-Custodial Parent is: ---PAGE BREAK--- Page 3 The Court finds as set on the “Child Support Worksheet” and Schedule the Presumptive Amount of Child Support due to the Custodial Parent is: 9. The Court finds that the child receives benefits under Title II of the Federal Social Security Act on the obligor’s account and the amount the child receives on a basis is: 10. The Court has considered the existence of Special Circumstances and as set forth in the “Child Support Worksheet” and Schedule has found the following special circumstances marked with an to be present in this case: a. High Income (Combined Adjusted Income above $30K/mo.) b. Low Income (either Parent’s Gross Income below $1,850/mo.) c. Other Health-Related Insurance (such as dental, vision, etc.) d. Life Insurance (on the life of either or both parents for the Benefit of the Child/children) e. Child and Dependent Care Tax Credit f. Travel Expenses (to exercise visitation) g. Alimony (not to be deducted from Gross Income, may be considered as a Deviation) h. Mortgage (or other shelter, such as providing a home) i. Permanent Plan or Foster Care Plan (for third party custody awards) j. Extraordinary Expenses 1. Educational Expenses expenses associated with special needs education, private school) 2. Special Expenses for Child Rearing in excess of 7% of Basic Child Support Obligation summer camp, music or art lessons, travel, school sponsored extracurricular activities such as band, clubs and athletics, and other activities intended to enhance the athletic, social or cultural development of a child) 3. Extraordinary Medical Expenses (of the Child, a Parent, or a Child of a Parent’s current family). k. Parenting Time l. Non-Specific Deviations (other) Based on the Deviations set forth above, the application of the Presumptive Amount of Child Support would be Unjust or Inappropriate ---PAGE BREAK--- Page 4 Deviation from the Presumptive Amount of Child Support will serve the Best Interest of the Child for whom Support is being Ordered because: Based upon the Deviations set forth above, the Presumptive Amount of Child Support should be increased/decreased by: 11.(a) The Court finds as set on the “Child Support Worksheet” the Final Amount of Child Support for the Custodial Parent is The Court finds as set on the “Child Support Worksheet” the Final Amount of Child Support for the Non-Custodial Parent is The Court find as set on the “Child Support Worksheet” the Final Amount of Child Support the Non-Custodial Parent shall pay the Custodial Parent is 12.(a) The Court finds as set on the “Child Support Worksheet” that the Custodial Parent’s allocated Uninsured Health Care Expenses based on their pro-rata responsibility is The Court finds as set on the “Child Support Worksheet” that the Non-Custodial Parent’s allocated Uninsured Health Care Expenses based on their pro rata responsibility is Based upon the above findings, the Non-Custodial Parent shall pay Child Support at per to the Custodial Parent, starting on 20__, and continuing until the child/children become 18 years of age, die, marry, or otherwise become emancipated, provided that the Court, in its sound discretion, directs/does not direct the Non-Custodial Parent to continue to pay child support for a child who has not previously married or become emancipated, who is enrolled in and attending high school, and who has attained the age of majority before completing his/her high school education, until the child graduates from high school, or until the child attains (not to exceed 20) years of age, whichever first occurs. IT IS SO ORDERED this day of JUDGE Superior Court of Douglas County