The child support payments are to start ~~~·JLoo9 'If a childreceives public assistance, the child support payments for hat child shall be made to theState of Maine Department .of Health & Human.Services,

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STATE OF MAINEDISTRICT COURT (\Location Q\;)t-\\.'!M ...~Docket No. F-M-....O 8 .'S\.O

·=t=~cr ~~Plaintiff

v. CHILD SUPPORT ORDER

lAc~_~~Defendant

This Child Support Order is made a part of the (Divorce Judgment) (Preccction fLORl

~YS8 Qa<as3f) (PaX:8atal Ri~ft~!! afta Respeftai19iliEies J.u.QgmeRt;~~PaeerJlit::y--dudgmeR~ase.~tldgeltlel1L Otded (Other~of this date [] dated _

Pursuant to 19-A MRSA Section 2006, the court has made certain findings of factconcerning the current parental support obligation as computed under the presumptiveapplication of the guidelines. Those findings are contained within the child supportworksheet which is attached and incorporated.

1:.?C(" Mn\.\'l\",,-.=-~..:--.\) __Name of obligor

the sum of $ \ \ 3.'ilo

is ordered to pay to Lo ~\ ~t~Name of obligee

per week toward the support of:

\ Nale of Child-N''-\0- ~G.. ~\:.\)

Date of Birth\\~~j'OCo

[] The Court finds that the child(ren) currently receive(s) dependent benefits as aresult of the obligor's disability. In any month that the benefits received by thech~ld(ren) meet or exceed the total monthly support obligation, the obligor shall receivea credit for the total amount of support due. To the extent that the monthly benefitsreceived by the child(ren) do not satisfy the obligor's monthly support obligation, theobligor shall pay the monthly support obligation minus the credits received by thechild (ren). The obligor shall not be given credit toward past or future obligations forbenefits which exceed the current monthly support obligation.

[] The child support obligation shall remain in effect until --------------------------(further order or until expiration of any underlying Protection from Abuse Order,·whichever occurs first).

']( ()b\,,~ shall maintain health insurance for the benefit

~ The child support obligation shall continue for each child until that child reachesthe age of 18; provided, however~ that if the child has not graduated, withdrawn/ or beenexpelled from secondary school as defined in Title 20-A, the child support shall continueuntil the child graduates or reaches the age of 19, whichever occurs first.

FM-132, Rev. 09/2005 Page 1 of 3

FM-132, Rev. 09/2005 page 2 of 3

of the minor child(~) if it is available at a reasonable cost, which means healthinsurance. that is employment-related or other group health insurance. Proof of suchinsurance must be furnished to the other party within 15 days. If the child(·~ is(~recipients of public assistance, proof of such insurance shall be provided to theDepartment of Health & Human Services within 15 days.

~ Any uninsured medical and dental expenses of the child(ren), in excess of $250 percalendar year, shall be paid in the following manner: ~~ % by the obligor and·:1~ % by the obligee. The first $250 of annual uninsured medical expenses shall bepaid by the obligee.

[] The child support obligation is based on the fact the parents are providingsubstantially equal care for their child(ren). Day care costs, health· insurance premiums,and uninsured medical expenses shall be shared as follows: % to be paid by thehigher income parent and % to be paid by the lower income parent. [] The childsupport amount set forth above has been adjusted to reflect each party's proportionateshare of these costs. (] Each party's proportionate share will be paid as follows:

If the Maine Department of Health & Human Services provides support enforcementservices and/or if the obligor is required to pay child support to the Maine Department ofHealth & Human Services, the obligor shall notify the Department within 15 days of thedate of this Order of the following: 1. The obligor's current address. 2. The name andaddress of the obligor's current employer, and 3. Whether the obligor has access tohealth insurance at a reasonable cost, and, if so, the health insurance policyinformation.

Within 15 days of any change in the obligor's current address, any change in the name oraddress of the obligor's current employer, or any change in the health insurance policyinformation, the obligor shall notify the Department of the change.

Failure to report a change of address or employer to the Departmentwithin 15 days of such change is a civil violation for which aforfeiture not to exceed $200 may be adjudged for each violation.

Any party to this action may ask the court to review the amount of child support andif appropriate, to modify it in accordance with the state's child support guidelines. Tostart this process, a party must file with the court a Motion to Modify. If it has beenless than 3 years since the child support order was issued or modified, the party mustprove a substantial change in circumstances.

[] ~here is(are) child (ren) who is (are) 10 or 11 years of age, Beginning_ when reaches the age of 12

years, the child support will be $ per week. Beginning _when reaches the age of 12 years, .the child support will be$------ per week.

[] All of the minorchdLdzen entitled to

.there are

children are age 12 or older. As long as there are _parental support, that sum is $ per week. As long as

children entitled to parental support, that sum is$ per week. When only one child is entitled to parental support, the sumis $ per week.

FM-132, Rev. 09/2005 Page 3 of 3

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[] The amount(s) set forth above for child support constitute{s) a deviation from thepresumptive amount required by the child support guideline~. In this case the court findsthat a child support order based on the guidelines would be inequitable or unjust for thefollowing reasons: (See forth the reasons for the deviation.)

j8( The-Immediate Income Withholding Order of this date attached hereto is incorporated byreference.[] No Immediate Income Withholding Order shall issue because:[] The court finds there is good cause not to issue such an order for the followingreasons:

[J The parties· have submitted and the court has approved a written agreement providingfor an alternative arrangement.

The clerk is directed to make the following entry in the civil docket pursuantto M.R.Civ.P. 79{a). "Child Support Order filed. 2\.~rJ\.te- .ordered to pay child support of $ \\~.9l\o per week. This Order isincorporated into the docket by reference at the specific direction of thecourt."

Date: \ ~- }-~-~~~Judg / J~a!i9trate

A True Copy. Attest _Clerk

Important Notice to the PartiesAny party who wishes to appeal a Magistrate's final order shallfile an objection to the final order in the District Cour~ within21 days of ·theentry of that order. The court c~erk's office has aform available for this purpose. If no objection is filed, theparties are deemed to have waived their right to object and toappeal, and the Magistrate's final order shall become the judgmentof the court and have the same effect as any final judgment signedby a District Court judge. No appeal may be taken from a judgmententered without objection to the final order of a Magistrate. Anappeal from a judgment entered after objection shall be taken inaccordance with the Maine Rules of Appellate ·Procedure.Any party who wishes to appeal a final order of a judge or justiceshall file a Notice of Appeal within 21 days.

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