In Re: Amendments to Florida Family Law Rules of Procedure - Form 12.902(e)

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Supreme Court of Florida ____________ No. SC21-1174 ____________ IN RE: AMENDMENTS TO FLORIDA FAMILY LAW RULES OF PROCEDURE—FORM 12.902(e). January 13, 2022 PER CURIAM. This matter is before the Court for consideration of proposed amendments to Florida Family Law Rule of Procedure Form 12.902(e) (Child Support Guidelines Worksheet). See Fla. R. Gen. Prac. & Jud. Admin. 2.140(b)(1). We have jurisdiction. See art. V, § 2(a), Fla. Const. The Florida Bar’s Family Law Rules Committee (Committee) filed a report proposing amendments to form 12.902(e). The Committee and the Board of Governors of The Florida Bar approved the proposed amendments. The Committee published its proposal for comment prior to filing it with the Court and received one comment in support of the proposed amendments. After the Committee filed its report, the Court published the proposal for comment. One comment was received in support of the proposed amendments, and the Committee filed a response. Having considered the proposed amendments, the comment, and the Committee’s response, the Court hereby amends Florida Family Law Rule of Procedure Form 12.902(e) (Child Support Guidelines Worksheet) as proposed by the Committee, with a minor modification. First, a sentence is added to the instructions for form 12.902(e) providing that if the parties’ combined monthly net income is not listed on the Child Support Guidelines Chart, child support is to be calculated as provided by law. However, we modify the sentence to specifically reference section 61.30(6), Florida Statutes (Child support guidelines; retroactive child support), which explains how to calculate the child support amount if the obligor parent’s net income is less than the amount in the guidelines schedule or if the parties’ combined monthly net income is greater than the amount in the guidelines schedule. Additionally, throughout the form’s instructions, references to the Rules of Judicial Administration are amended to reflect the updated name, the Rules of General Practice and Judicial -2- Administration. See In re Amends. to Fla. Rules of Jud. Admin.— 2020 Regular-Cycle Report, 310 So. 3d 374 (Fla. 2021). Accordingly, Form 12.902(e) is hereby amended as set forth in the appendix to this opinion. The form is fully engrossed and ready for use. The form may also be accessed and downloaded from the Florida State Courts’ website at https://www.flcourts.org/Resources-Services/CourtImprovement/Family-Courts/Family-Law-Self-HelpInformation/Family-Law-Forms. The amendments shall become effective April 1, 2022, at 12:01 a.m. It is so ordered. CANADY, C.J., and POLSTON, LABARGA, LAWSON, MUÑIZ, COURIEL, and GROSSHANS, JJ., concur. THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE EFFECTIVE DATE OF THESE AMENDMENTS. Original Proceeding – Florida Family Law Rules of Procedure Ashley Elizabeth Taylor, Chair, Family Law Rules Committee, Tampa, Florida, Joshua E. Doyle, Executive Director, and Mikalla Andies Davis, Staff Liaison, The Florida Bar, Tallahassee, Florida, for Petitioner Heather L. Apicella, Chair, Family Law Section of The Florida Bar, Boca Raton, Florida, Kristin R.H. Kirkner, Co-Chair, Rules and Forms Committee, Family Law Section of The Florida Bar, Tampa, -3- Florida, and Jack A. Moring, Co-Chair, Rules and Forms Committee, Family Law Section of The Florida Bar, Crystal River, Florida, Responding with comments -4- APPENDIX INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(e) CHILD SUPPORT GUIDELINES WORKSHEET (04/22) When should this form be used? You should complete this worksheet if child support is being requested in your case. If you know the income of the other party, this worksheet should accompany your financial affidavit. If you do not know the other party’s income, this form must be completed after the other party files his or her financial affidavit, and serves a copy on you. This form should be typed or printed in black ink. You should file this document with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be filed with the court and served on the other party or his or her attorney. The copy you are serving to the other party must be either mailed, emailed, or hand-delivered to the opposing party or his or her attorney on the same day indicated on the certificate of service. If it is mailed, it must be postmarked on the date indicated in the certificate of service. Service must be in accordance with Florida Rule of General Practice and Judicial Administration 2.516. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of General Practice and Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of General Practice and Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of General Practice and Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (email) except in certain circumstances. You must strictly comply with the format requirements set forth in the Florida Rules of General Practice and Judicial Administration. If you elect to participate in electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of General Practice and Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of General Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -5- Practice and Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by email, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of General Practice and Judicial Administration 2.516. Where can I look for more information? Before proceeding, you should read “General Information for Self-Represented Litigants” found at the beginning of these forms. The words that are in “bold underline” in these instructions are defined there. For further information, see section 61.30, Florida Statutes. Special notes. . . If you want to keep your address confidential because you have been found by a judge to be the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery or domestic violence, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h). The chart below contains the guideline amounts that you should use when calculating child support. This amount is based on the number of children and the combined income of the parents, and it is divided between the parents in direct proportion to their income or earning capacity. From time to time, some of the amounts in the child support guidelines chart will change. Be sure you have the most recent version of the chart before using it. If the parties’ combined monthly net income is not listed on the below chart, then calculate child support as provided by law in section 61.30(6), Florida Statutes. Because the guidelines are based on monthly amounts, it may be necessary to convert some income and expense figures from other frequencies to monthly. You should do this as follows: If payment is twice per month Payment amount x 2 = Monthly amount If payment is every two weeks Payment amount Yearly amount x ÷ 26 12 = = Yearly amount due Monthly amount Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -6- If payment is weekly Weekly amount Yearly amount x ÷ 52 12 = = Yearly amount due Monthly amount If you or the other parent request that the court award an amount that is different than the guideline amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -7- CHILD SUPPORT GUIDELINES CHART Combined Monthly Available Income One Child Two Children Three Children Four Children Five Children Six Children 800.00 850.00 900.00 950.00 1000.00 1050.00 1100.00 1150.00 1200.00 1250.00 1300.00 1350.00 1400.00 1450.00 1500.00 1550.00 1600.00 1650.00 1700.00 1750.00 1800.00 1850.00 1900.00 1950.00 2000.00 2050.00 2100.00 2150.00 2200.00 2250.00 2300.00 2350.00 2400.00 2450.00 2500.00 2550.00 2600.00 2650.00 2700.00 2750.00 2800.00 190 202 213 224 235 246 258 269 280 290 300 310 320 330 340 350 360 370 380 390 400 410 421 431 442 452 463 473 484 494 505 515 526 536 547 557 568 578 588 597 607 211 257 302 347 365 382 400 417 435 451 467 482 498 513 529 544 560 575 591 606 622 638 654 670 686 702 718 734 751 767 783 799 815 831 847 864 880 896 912 927 941 213 259 305 351 397 443 489 522 544 565 584 603 623 642 662 681 701 720 740 759 779 798 818 839 859 879 899 919 940 960 980 1000 1020 1041 1061 1081 1101 1121 1141 1160 1178 216 262 309 355 402 448 495 541 588 634 659 681 702 724 746 768 790 812 833 855 877 900 923 946 968 991 1014 1037 1060 1082 1105 1128 1151 1174 1196 1219 1242 1265 1287 1308 1328 218 265 312 359 406 453 500 547 594 641 688 735 765 789 813 836 860 884 907 931 955 979 1004 1029 1054 1079 1104 1129 1154 1179 1204 1229 1254 1279 1304 1329 1354 1379 1403 1426 1448 220 268 315 363 410 458 505 553 600 648 695 743 790 838 869 895 920 945 971 996 1022 1048 1074 1101 1128 1154 1181 1207 1234 1261 1287 1314 1340 1367 1394 1420 1447 1473 1500 1524 1549 Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -8- Combined Monthly Available Income One Child Two Children Three Children Four Children Five Children Six Children 2850.00 2900.00 2950.00 3000.00 3050.00 3100.00 3150.00 3200.00 3250.00 3300.00 3350.00 3400.00 3450.00 3500.00 3550.00 3600.00 3650.00 3700.00 3750.00 3800.00 3850.00 3900.00 3950.00 4000.00 4050.00 4100.00 4150.00 4200.00 4250.00 4300.00 4350.00 4400.00 4450.00 4500.00 4550.00 4600.00 4650.00 4700.00 4750.00 4800.00 4850.00 4900.00 4950.00 616 626 635 644 654 663 673 682 691 701 710 720 729 738 748 757 767 776 784 793 802 811 819 828 837 846 854 863 872 881 889 898 907 916 924 933 942 951 959 968 977 986 993 956 971 986 1001 1016 1031 1045 1060 1075 1090 1105 1120 1135 1149 1164 1179 1194 1208 1221 1234 1248 1261 1275 1288 1302 1315 1329 1342 1355 1369 1382 1396 1409 1423 1436 1450 1463 1477 1490 1503 1517 1530 1542 1197 1215 1234 1252 1271 1289 1308 1327 1345 1364 1382 1401 1419 1438 1456 1475 1493 1503 1520 1536 1553 1570 1587 1603 1620 1637 1654 1670 1687 1704 1721 1737 1754 1771 1788 1804 1821 1838 1855 1871 1888 1905 1927 1349 1370 1391 1412 1433 1453 1474 1495 1516 1537 1558 1579 1599 1620 1641 1662 1683 1702 1721 1740 1759 1778 1797 1816 1835 1854 1873 1892 1911 1930 1949 1968 1987 2006 2024 2043 2062 2081 2100 2119 2138 2157 2174 1471 1494 1517 1540 1563 1586 1608 1631 1654 1677 1700 1723 1745 1768 1791 1814 1837 1857 1878 1899 1920 1940 1961 1982 2002 2023 2044 2064 2085 2106 2127 2147 2168 2189 2209 2230 2251 2271 2292 2313 2334 2354 2372 1573 1598 1622 1647 1671 1695 1720 1744 1769 1793 1818 1842 1867 1891 1915 1940 1964 1987 2009 2031 2053 2075 2097 2119 2141 2163 2185 2207 2229 2251 2273 2295 2317 2339 2361 2384 2406 2428 2450 2472 2494 2516 2535 Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -9- Combined Monthly Available Income One Child Two Children Three Children Four Children Five Children Six Children 5000.00 5050.00 5100.00 5150.00 5200.00 5250.00 5300.00 5350.00 5400.00 5450.00 5500.00 5550.00 5600.00 5650.00 5700.00 5750.00 5800.00 5850.00 5900.00 5950.00 6000.00 6050.00 6100.00 6150.00 6200.00 6250.00 6300.00 6350.00 6400.00 6450.00 6500.00 6550.00 6600.00 6650.00 6700.00 6750.00 6800.00 6850.00 6900.00 6950.00 7000.00 7050.00 7100.00 1000 1006 1013 1019 1025 1032 1038 1045 1051 1057 1064 1070 1077 1083 1089 1096 1102 1107 1111 1116 1121 1126 1131 1136 1141 1145 1150 1155 1160 1165 1170 1175 1179 1184 1189 1193 1196 1200 1204 1208 1212 1216 1220 1551 1561 1571 1580 1590 1599 1609 1619 1628 1638 1647 1657 1667 1676 1686 1695 1705 1713 1721 1729 1737 1746 1754 1762 1770 1778 1786 1795 1803 1811 1819 1827 1835 1843 1850 1856 1862 1868 1873 1879 1885 1891 1897 1939 1952 1964 1976 1988 2000 2012 2024 2037 2049 2061 2073 2085 2097 2109 2122 2134 2144 2155 2165 2175 2185 2196 2206 2216 2227 2237 2247 2258 2268 2278 2288 2299 2309 2317 2325 2332 2340 2347 2355 2362 2370 2378 2188 2202 2215 2229 2243 2256 2270 2283 2297 2311 2324 2338 2352 2365 2379 2393 2406 2418 2429 2440 2451 2462 2473 2484 2495 2506 2517 2529 2540 2551 2562 2573 2584 2595 2604 2613 2621 2630 2639 2647 2656 2664 2673 2387 2402 2417 2432 2447 2462 2477 2492 2507 2522 2537 2552 2567 2582 2597 2612 2627 2639 2651 2663 2676 2688 2700 2712 2724 2737 2749 2761 2773 2785 2798 2810 2822 2834 2845 2854 2863 2872 2882 2891 2900 2909 2919 2551 2567 2583 2599 2615 2631 2647 2663 2679 2695 2711 2727 2743 2759 2775 2791 2807 2820 2833 2847 2860 2874 2887 2900 2914 2927 2941 2954 2967 2981 2994 3008 3021 3034 3045 3055 3064 3074 3084 3094 3103 3113 3123 Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 10 - Combined Monthly Available Income One Child Two Children Three Children Four Children Five Children Six Children 7150.00 7200.00 7250.00 7300.00 7350.00 7400.00 7450.00 7500.00 7550.00 7600.00 7650.00 7700.00 7750.00 7800.00 7850.00 7900.00 7950.00 8000.00 8050.00 8100.00 8150.00 8200.00 8250.00 8300.00 8350.00 8400.00 8450.00 8500.00 8550.00 8600.00 8650.00 8700.00 8750.00 8800.00 8850.00 8900.00 8950.00 9000.00 9050.00 9100.00 9150.00 9200.00 9250.00 1224 1228 1232 1235 1239 1243 1247 1251 1255 1259 1263 1267 1271 1274 1278 1282 1286 1290 1294 1298 1302 1306 1310 1313 1317 1321 1325 1329 1333 1337 1341 1345 1349 1352 1356 1360 1364 1368 1372 1376 1380 1384 1388 1903 1909 1915 1921 1927 1933 1939 1945 1951 1957 1963 1969 1975 1981 1987 1992 1998 2004 2010 2016 2022 2028 2034 2040 2046 2052 2058 2064 2070 2076 2082 2088 2094 2100 2106 2111 2117 2123 2129 2135 2141 2147 2153 2385 2393 2400 2408 2415 2423 2430 2438 2446 2453 2461 2468 2476 2483 2491 2498 2506 2513 2521 2529 2536 2544 2551 2559 2566 2574 2581 2589 2597 2604 2612 2619 2627 2634 2642 2649 2657 2664 2672 2680 2687 2695 2702 2681 2690 2698 2707 2716 2724 2733 2741 2750 2758 2767 2775 2784 2792 2801 2810 2818 2827 2835 2844 2852 2861 2869 2878 2887 2895 2904 2912 2921 2929 2938 2946 2955 2963 2972 2981 2989 2998 3006 3015 3023 3032 3040 2928 2937 2946 2956 2965 2974 2983 2993 3002 3011 3020 3030 3039 3048 3057 3067 3076 3085 3094 3104 3113 3122 3131 3141 3150 3159 3168 3178 3187 3196 3205 3215 3224 3233 3242 3252 3261 3270 3279 3289 3298 3307 3316 3133 3142 3152 3162 3172 3181 3191 3201 3211 3220 3230 3240 3250 3259 3269 3279 3289 3298 3308 3318 3328 3337 3347 3357 3367 3376 3386 3396 3406 3415 3425 3435 3445 3454 3464 3474 3484 3493 3503 3513 3523 3532 3542 Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 11 - Combined Monthly Available Income One Child Two Children Three Children Four Children Five Children Six Children 9300.00 9350.00 9400.00 9450.00 9500.00 9550.00 9600.00 9650.00 9700.00 9750.00 9800.00 9850.00 9900.00 9950.00 10000.00 1391 1395 1399 1403 1407 1411 1415 1419 1422 1425 1427 1430 1432 1435 1437 2159 2165 2171 2177 2183 2189 2195 2201 2206 2210 2213 2217 2221 2225 2228 2710 2717 2725 2732 2740 2748 2755 2763 2767 2772 2776 2781 2786 2791 2795 3049 3058 3066 3075 3083 3092 3100 3109 3115 3121 3126 3132 3137 3143 3148 3326 3335 3344 3353 3363 3372 3381 3390 3396 3402 3408 3414 3420 3426 3432 3552 3562 3571 3581 3591 3601 3610 3620 3628 3634 3641 3647 3653 3659 3666 Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 12 - IN THE CIRCUIT COURT OF THE IN AND FOR and Petitioner, JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: , , Respondent. NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET PLEASE TAKE NOTICE, that {name} _______, is filing his/her Child Support Guidelines Worksheet attached and labeled Exhibit 1. CERTIFICATE OF SERVICE I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was [check all used]: ( ) e-mailed ( ) mailed ( ) faxed ( ) hand delivered to the person(s) listed below on {date} __________. Other party or his/her attorney: Name: _____________________________ Address: ____________________________ City, State, Zip: _______________________ Telephone Number: ___________________ Fax Number: _________________________ E-mail Address(es): ____________________ Signature of Party or his/her Attorney Printed Name: _________________________ Address: ______________________________ City, State, Zip: _________________________ Telephone Number: _____________________ Fax Number: ___________________________ E-mail Address(es): ______________________ Florida Bar Number: _____________________ Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 13 - CHILD SUPPORT GUIDELINES WORKSHEET A. PETITIONER B. RESPONDENT % % 1. Present Net Monthly Income Enter the amount from line 27, Section I of Florida Family Law Rules of Procedure Form 12.902(b) or (c), Financial Affidavit. 2. Basic Monthly Obligation There is (are) {number}_____ minor child(ren) common to the parties. Using the total amount from line 1, enter the appropriate amount from the child support guidelines chart. 3. Percent of Financial Responsibility Divide the amount on line 1A by the total amount on line 1 to get Petitioner’s percentage of financial responsibility. Enter answer on line 3A. Divide the amount on line 1B by the total amount on line 1 to get Respondent’s percentage of financial responsibility. Enter answer on line 3B. 4. Share of Basic Monthly Obligation Multiply the number on line 2 by the percentage on line 3A to get Petitioner’s share of basic obligation. Enter answer on line 4A. Multiply the number on line 2 by the percentage on line 3B to Respondent’s share of basic obligation. Enter answer on line 4B. Additional Support — Health Insurance, Child Care & Other Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 14 - TOTAL CHILD SUPPORT GUIDELINES WORKSHEET A. PETITIONER B. RESPONDENT 5. a. 100% of Monthly Child Care Costs [Child care costs should not exceed the level required to provide quality care from a licensed source. See section 61.30(7), Florida Statutes, for more information.] b. Total Monthly Child(ren)’s Health Insurance Cost [This is only amounts actually paid for health insurance on the child(ren).] c. Total Monthly Child(ren)’s Noncovered Medical, Dental and Prescription Medication Costs d. Total Monthly Child Care & Health Costs [Add lines 5a + 5b +5c.] 6. Additional Support Payments Multiply the number on line 5d by the percentage on line 3A to determine the Petitioner’s share. Enter answer on line 6A. Multiply the number on line 5d by the percentage on line 3B to determine the Respondent’s share. Enter answer on line 6B. Statutory Adjustments/Credits 7. a. Monthly child care payments actually made. b. Monthly health insurance payments actually made. Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 15 - TOTAL CHILD SUPPORT GUIDELINES WORKSHEET A. PETITIONER B. RESPONDENT TOTAL c. Other payments/credits actually made for any noncovered medical, dental and prescription medication expenses of the child(ren) not ordered to be separately paid on a percentage basis. (See section 61.30 (8), Florida Statutes.) 8. Total Support Payments actually made (Add 7a though 7c.) 9. MINIMUM CHILD SUPPORT OBLIGATION FOR EACH PARENT [Line 4 plus line 6; minus line 8.] Substantial Time-Sharing (GROSS UP METHOD) If each parent exercises time-sharing at least 20 percent of the overnights in the year (73 overnights in the year), complete Nos. 10 through 21. 10. Basic Monthly Obligation x 150% [Multiply line 2 by 1.5] 11. Increased Basic Obligation for each parent. Multiply the number on line 10 by the percentage on line 3A to determine the Petitioner’s share. Enter answer on line 11A. Multiply the number on line 10 by the percentage on line 3B to determine the Respondent’s share. Enter answer on line 11B. Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 16 - CHILD SUPPORT GUIDELINES WORKSHEET A. PETITIONER B. RESPONDENT % % 12. Percentage of overnight stays with each parent. The child(ren) spend(s) ____overnight stays with the Petitioner each year. Using the number on the above line, multiply it by 100 and divide by 365. Enter this number on line 12A. The child(ren) spend(s) _____ overnight stays with the Respondent each year. Using the number on the above line, multiply it by 100 and divide by 365. Enter this number on line 12B. 13. Parent’s support multiplied by other Parent’s percentage of overnights. [Multiply line 11A by line 12B. Enter this number in 13A. Multiply line 11B by line 12A. Enter this number in 13B.] Additional Support — Health Insurance, Child Care & Other 14. a. Total Monthly Child Care Costs [Child care costs should not exceed the level required to provide quality care from a licensed source. See section 61.30(7), Florida Statutes, for more information.] b. Total Monthly Child(ren)’s Health Insurance Cost. [This is only amounts actually paid for health insurance on the child(ren).] c. Total Monthly Child(ren)’s Noncovered Medical, Dental and Prescription Medication Costs. d. Total Monthly Child Care & Health Costs [Add lines 14a + 14b + 14c.] Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 17 - TOTAL CHILD SUPPORT GUIDELINES WORKSHEET A. PETITIONER B. RESPONDENT 15. Additional Support Payments. Multiply the number on line 14d by the percentage on line 3A to determine the Petitioner’s share. Enter answer on line 15A. Multiply the number on line 14d by the percentage on line 3B to determine the Respondent’s share. Enter answer on line 15B. Statutory Adjustments/Credits 16. a. Monthly child care payments actually made. b. Monthly health insurance payments actually made. c. Other payments/credits actually made for any noncovered medical, dental and prescription medication expenses of the child(ren) not ordered to be separately paid on a percentage basis. [See section 61.30(8), Florida Statutes.] 17. Total Support Payments actually made [Add 16a though 16c.] 18. Total Additional Support Transfer Amount [Line 15 minus line 17; enter any negative number as zero.] 19. Total Child Support Owed from Petitioner to Respondent [Add line 13A plus 18A.] 20. Total Child Support Owed from Respondent to Petitioner. [Add line 13B plus line 18B.] Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 18 - TOTAL CHILD SUPPORT GUIDELINES WORKSHEET A. PETITIONER 21. Presumptive Child Support to Be Paid. [Comparing lines 19 and 20, Subtract the smaller amount owed from the larger amount owed and enter the result in the column for the parent that owes the larger amount of support.] ] B. RESPONDENT TOTAL $ ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent is requesting the Court to award a child support amount that is more or less than the child support guidelines, you must complete and file Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943. [check one only] a. ____ Deviation from the guidelines amount is requested. The Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is attached. b. ____ Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is not attached. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] This form was prepared for the: {choose only one} ____ Petitioner ____ Respondent This form was completed with the assistance of: {name of individual} , {name of business} ____________________________________________________________, {address} ____________________________________________________________________, {city} __________________, {state} ____, {zip code} ______, {telephone number} _________ Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 19 -

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