Judge Colleen A. Falkowski Lake County Court of Common Pleas Domestic Relations Division Child Support Deviation Worksheet Findings of Fact and Conclusions of Law Name:_________________________ 1. Case No.: _________________________ The child support obligation pursuant to the statutory schedule is $__________ per month, per child, when private health insurance IS being provided, or $__________ per month, per child, when private health insurance IS NOT being provided. 3. The parties seek a deviation to the amount of $__________ per month, per child, when private health insurance IS being provided, or $__________ per month, per child, when private health insurance IS NOT being provided. 5. The Court recommends a deviation to the amount of $__________ per month, per child, when private health insurance IS being provided, or $__________ per month, per child, when private health insurance IS NOT being provided. 6. The reasons for the deviation are based on the following findings of fact: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. If the deviation is based on in-kind contributions, the value of the in-kind contribution is $__________ per month, per child. 8. Based upon these facts, the Court approves the deviation and finds that it would be unjust or inappropriate, and not in the best interests of the children, to apply the child support obligation pursuant to statute. The deviation is approved. _____________________________ Obligor _____________________________ Date (Exhibit 2) _____________________________ Obligee _____________________________ Date 12/09/13 American LegalNet, Inc. www.FormsWorkFlow.com