COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : q District Court q Juvenile Court : Index No. Calendar No. _________________________________________ County, Colorado Court Address: : JUDICIAL SUBPOENA Plaintiff(s) -against: In re the Parental Responsibilities concerning: ______________________________________________________ Petitioner: : v. : Respondent/Co-Petitioner: Defendant(s) : . . . Attorney or . . . . . Without .Attorney. (Name.and .Address). . . . . . . . . . . . . . . . . . . Party . . . . . . . . . . . . . . . . . . . . . . . : COURT USE ONLY Case Number: Phone Number: E-mail: THE PEOPLE OF THE STATE OF NEW YORK Division Courtroom Atty. Reg. #: PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT FAX Number: TO This form may be used by unmarried parents or other parties to address parental responsibility and child support issues. Please indicate below how this form is being used: GREETINGS:This is a parenting plan agreed to by the parties. q q This is the parenting plan requested by ____________________________________ (name of party). WE COMMAND YOU, that all business and excuses being laid aside, youthe parenting plan. If disputed q There q are q are not any remaining disputed issues concerning and each of you attend before the Honorableissues, please indicate the section number of the disputed issue(s) ___________________________ , at the Court located at County of inThis form DOES ,NOTthe room on include every possible issue 20 may want to address. An "Other Terms" section has been day of , you , at o'clock in the noon, and at any recessed orprovided fordate, toyou would like toevidenceyouaneed more space thanon the part ofattach additional pages to the adjourned items testify and give add. If as witness in this action is provided, the form. If the form includes issues that do not apply to your situation, write "Not Applicable" or "N/A" in that section. However, you MUST submit to the Court some form of WRITTEN Permanent Parenting Plan addressing all of the issues which are relevant to the facts of your case. If you do not, the Court MUST enter its own plan, and this may not be the plan you think is in the best interests of you as a for your child(ren).andWhenmake Court either Your failure to comply with this subpoena is punishable or contempt of court will the you liable to approves your plan, or enters its own, the plan will become a Court Order. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result INFORMATIONto comply. of your failure ABOUT THE PARTIES 1. The Witness, Honorable Petitioner is the child(ren)’s: , one of the Justices of the q Mother County, Court in day of , 20 q Father q Other (state relationship to children) ___________________________________________________ The Respondent/Co-Petitioner is the child(ren)’s: (Attorney must sign above and type name below) q Mother q Father q Other (state relationship to children) ___________________________________________________ Attorney(s) for 2. INFORMATION ABOUT THE CHILD(REN) Name Present Address Sex Date of Birth Soc. Sec. No. Office and P.O. Address JDF 1421 9/03 Telephone No.: Facsimile No.: E-Mail Address: Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 1 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 3. PARENTING TIME : Index No. Calendar No. A. WEEKDAY AND WEEKEND SCHEDULE : Plaintiff(s) The child(ren) will be in the care of the q Petitioner (list days ofJUDICIAL times): the week and SUBPOENA -against- : ____________________________________________________________________________________ ____________________________________________________________________________________ : ____________________________________________________________________________________ : q Respondent/Co-Petitioner (list days of the week and times): Defendant(s) : ...................................................... The child(ren) will be in the care of the ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK Transportation arrangements will be: TO ____________________________________________________________________________________ ____________________________________________________________________________________ GREETINGS: B. SUMMER SCHEDULE q COMMAND and weekend schedule above will apply for aside, calendar months, with no before WE The weekday YOU, that all business and excuses being laid all 12 you and each of you attend specific , the Honorablechanges during the summer. at the Court located at County of OR in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, tothe summergive evidence as a witness be this actionthe the Petitioner (list days of the week and testify and months, the child(ren) will in in care of on q part of the q During times): ________________________________________________________________________________ ________________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ________________________________________________________________________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. AND Court in Witness, Honorable , one of the Justices of the q During the summer months, the child(ren) will be in care of the q Respondent/Co-Petitioner (list days County, of the week and times):day of , 20 ________________________________________________________________________________ (Attorney must sign above and type name below) ________________________________________________________________________________ ________________________________________________________________________________ C. CHILD(REN)’S TRAVEL Attorney(s) for q The parties agree that should either of them travel away from home with the child(ren), each party will q keep the other party informed of travel plans, address(es), and telephone number(s) where that party and the child(ren) can be reached. Office and agreements The parties do not agree or the parties have additional travelP.O. Address regarding the children, as follows: _________________________________________________________________________________ Telephone No.: _________________________________________________________________________________ Facsimile No.: _________________________________________________________________________________ E-Mail Address: JDF 1421 9/03 Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 2 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. D. HOLIDAYS, VACATIONS, SPECIAL OCCASIONS, AND RELIGIOUS EVENTS : Calendar No. The following schedule will take priority over the regular weekday, weekend, and summer schedules : discussed above. Please check all that apply and indicate the time and place of exchange, which party JUDICIAL SUBPOENA Plaintiff(s) the child(ren) will spend time with, and the schedule, i.e. even/odd years, alternating events, etc. -against- Event Time : Place Name of party spending time with child(ren) : Schedule q New Year’s Eve q New Year’s Day : Defendant(s) : . . . . . . q . Spring.Vacation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... ....... q Mother’s Day q Memorial Day THE PEOPLE OF THE STATE OF NEW YORK q Father’s Day TO q July 4th q Labor Day q Thanksgiving GREETINGS: Break q WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Thanksgiving , the Honorable at the Court Day located at County of q Winter Break in room , on the day of , 20 , at o'clock in the noon, and at any recessed q Family to testify or adjourned date, Birthdays and give evidence as a witness in this action on the part of the q Children’s q Parties q Religious Events Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to q Holiday behalf the party on whoseEvents this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. q Other Parenting Time Arrangements: Witness, Honorable , one of the Justices of the _______________________________________________________________________________________ Court _______________________________________________________________________________________ in County, day of , 20 _______________________________________________________________________________________ _______________________________________________________________________________________ (Attorney must sign above and type name below) _______________________________________________________________________________________ Attorney(s) for ONCE FILED, THE PARTIES MAY MAKE SUBSTANTIAL, PERMANENT MODIFICATIONS TO THIS PARENTING PLAN ONLY BY WRITTEN AGREEMENT, SIGNED BY BOTH PARTIES AND FILED WITH THE COURT. MINOR, NON-PERMANENT CHANGES MAY BE MADE ANY TIME IF BOTH PARTIES AGREE TO THE CHANGES. IF APPROPRIATE, A WRITTEN and P.O. Address MAY BE PREPARED TO Office MEMORANDUM DOCUMENT THE MINOR, NON-PERMANENT CHANGES FOR BOTH PARTIES TO SIGN AND ACKNOWLEDGE. JDF 1421 9/03 Telephone No.: Facsimile No.: E-Mail Address: Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 3 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : E. TELEPHONE ACCESS : Index No. Calendar No. q Each party may have reasonable telephone contact with the child(ren) during the child(ren)’s normal waking hours. OR Plaintiff(s) -against- : JUDICIAL SUBPOENA : q Other: ___________________________________________________________________________ : F. ACCESS TO RECORDS : THE LAW PROVIDES THAT BOTH PARTIES HAVE ACCESS TO THE RECORDS OF THE Defendant(s) CHILD(REN) INCLUDING SCHOOL, MEDICAL, DENTAL AND MENTAL HEALTH RECORDS UNLESS : . . . . . . . . ACCESS. IS .LIMITED .BY .THE. COURT. . .IF . YOU .BELIEVE THAT THERE ARE VALID REASONS TO ....... .. ....... .. ... ....... . .... .... LIMIT THE OTHER PARTIES ACCESS TO RECORDS, YOU MUST ASK THE COURT TO LIMIT ACCESS, AND OBTAIN AN ORDER THAT DOES SO (§14-10-123.8, C.R.S.) THE PEOPLE OF THE STATE OF NEW YORK 4. DECISION-MAKING TO This parenting plan form reflects decision-making on major issues other than parenting time. In this plan, major decision-making does not include day-to-day decisions, which may be made by the current residential parent without the need to consult with the other party, unless you make such decisions a part of your plan. Day-to-day decisions include, but are not limited to, minor training or correction, minor medical and dental care, curfew, chores, allowance, and day-to-day decisions about clothing or hygiene during the time the child GREETINGS: is with you. TheWE COMMAND YOU, thatallows you toand excuses being laid aside, you and eachthatyou attend before division of decision-making all business make several choices. You may decide of one party should the Honorable of the major decisions alone. Or, youthe decide thatCourtand the other party will make all major , at may make all you decisions together. The third option at to address each major area of decision-making and decide which party located is County of will in room have the ,responsibility for which decision. , 20 on the day of , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the SELECT ONLY ONE OF THE THREE FOLLOWING OPTIONS: q 1. MAJOR DECISION-MAKING BY ONE PARTY ONLY The q Petitioner q Respondent/Co-Petitioner (check one) will make all will make you liable to Your failure to comply with this subpoena is punishable as a contempt of court and of the major decisions regarding the child(ren). You have the party on whose behalf this subpoena was issued now a maximum penalty of $50 plan.all damages sustained as a for selected a decision-making and Go directly to paragraphs 5, 6, 7, 8, and 9 below. result of your failure to comply. q 2. ALL MAJOR DECISION-MAKING BY BOTH PARTIES Both parties will make ALL major decisions regarding the child(ren) together. You have now Witness, Honorable , one of the Justices of the selected a decision-making plan. Court in County, day ofGo directly to, paragraphs 5, 6, 7, 8 and 9 below. 20 q 3. MAJOR DECISION-MAKING DIVIDED BETWEEN THE PARTIES Complete A, B, C, D and E below then complete paragraphs 5, 6, 7, 8, and 9 below. (Attorney must sign above and type name below) A. EDUCATIONAL DECISION-MAKING (includes daycare unless specifically excluded) q The parties will make all major educational Attorney(s) for decisions together. If the parties do not reach an agreement, then they shall use the dispute resolution procedure in this parenting plan. (paragraph 6) OR Office and P.O. Address q The q Petitioner q Respondent/Co-Petitioner (check one) shall have the final decision-making responsibility regarding all major education decisions. However, if such decision involves additional expenses, the parties shall agree on the division of those expenses or, if they cannot agree, shall use the dispute resolution procedure in this plan. (paragraph 6) JDF 1421 9/03 Telephone No.: Facsimile No.: E-Mail Address: Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 4 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. q Both parties may participate in school conferences, events, and activities, and may consult with : Calendar attendance only, the child(ren)’s teachers and other school personnel. For purposes of school No. residence will be with the q Petitioner q Respondent/Co-Petitioner. Plaintiff(s) : JUDICIAL SUBPOENA q Other arrangements as to educational decision-making: -against- : ________________________________________________________________________________ ________________________________________________________________________________ : ________________________________________________________________________________ : Defendant(s) B. MEDICAL, DENTAL AND MENTAL HEALTH DECISION-MAKING : ...................................................... NOTE: You must decide on the issue of payment of medical, dental and mental health expenses. If you do not use this form to express your decisions on these issues, then the Court will make that decision and order payment of these expenses as part of the child support calculation. If you make THE PEOPLE OF THE STATE OFmake sure that your include the expense in the child support calculation. these decisions here, NEW YORK q The parties will make the final decision regarding major medical/dental decisions for the child(ren) TO together. If the parties do not reach an agreement, then they shall use the dispute resolution procedures in this parenting plan. (paragraph 17) OR GREETINGS: q The q Petitioner q Respondent/Co-Petitioner (check one) shall have the final decision-making responsibility regarding major medical/dental decisions for you and each However, before WE COMMAND YOU, that all business and excuses being laid aside, the child(ren).of you attend if such decision involves additional expenses, the parties shall agree on the division of those expenses , the Honorable at the Court or, if they cannot agree, shall use the dispute resolution procedure in this plan. (paragraph 6) located at County of in room , on parties agree of day that, under emergencyat , 20 , circumstances, it is sufficient for and at any recessed o'clock in the noon, either party to sign q Both the or adjourned date,legal releases give evidence as a witness in this action on the part measures. to testify and to get medical treatment or to take other necessary of the PLEASE CHECK YOUR CHOICES BELOW REGARDING THE MEDICAL, DENTAL AND MENTAL HEALTHaOF YOUR of court and will make you liable to Your failure to comply with this subpoena is punishable as contempt CHILD(REN). the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your q In the comply. a dispute about the necessity or type of medical treatment for the minor child(ren), failure to event of either party shall be allowed to obtain necessary medical treatment for the minor child(ren). Witness, Honorable agree to advise/inform the other party immediately regarding: , one of the Justices of the q Both parties Court in County, day of , 20 q emergency medical/dental care sought for the child(ren) q names, addresses, and telephone numbers of all medical/mental care practitioners q health matters pertaining to the child(ren). (Attorney must sign above and type name below) q Other arrangements as to medical and/or dental decision-making: _____________________________________________________________________________ _____________________________________________________________________________ Attorney(s) for _____________________________________________________________________________ C. RELIGIOUS DECISION-MAKING Office and P.O. Address q The parties will make all major religious decisions for the child(ren) together. If the parties do not reach an agreement, then they shall use the dispute resolution procedures in this parenting plan. Telephone No.: Facsimile No.: E-Mail Address: Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: OR JDF 1421 9/03 Page 5 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. q The q Petitioner q Respondent/Co-Petitioner (check one) will have the authority to make : Calendar No. decisions concerning the religious practices of the child(ren). q Other agreements regarding religious decisions: : Plaintiff(s) JUDICIAL SUBPOENA _____________________________________________________________________________ -against- : _____________________________________________________________________________ : _____________________________________________________________________________ : D. EXTRACURRICULAR AND RECREATIONAL ACTIVITIES Defendant(s) : . . . . . . . . . . . .q. .The . parties . . . . . make. .the . final. .decision . regarding extracurricular and recreational activities . . . . . . . . . will . . . . . . . . . . . . . . . . . . . together. OR THE PEOPLE OF THE STATE OF NEW YORK q The q Petitioner q Respondent/Co-Petitioner (check one) will have the right to make all decisions concerning extracurricular and recreational activities for the child(ren). However, if such decision involves additional expenses, the parties shall agree on the division of those expenses or, if they cannot agree, shall use the dispute resolution procedure in this plan. TO OR GREETINGS: q Each party has final decision-making authority for activities that occur only during that party’s parenting YOU, that all be solely responsible for transportation for and expenses of, participation WE COMMAND time and shall business and excuses being laid aside, you and each of you attend before in those activities that occur during that party’s parenting time. , the Honorable at the Court located at County of q Other agreements regarding extracurricular and recreational activities: in room , on the day of , 20 , at o'clock in the noon, and at any recessed _____________________________________________________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. 5. EMERGENCIES (OTHER THAN MEDICAL) Witness, Honorable , one of for either of the q Both parties agree that, under emergency circumstances, it is sufficient the Justicesparty to sign legal Court in releases or to take other necessary measures., 20 County, day of q Other: _______________________________________________________________________________________ (Attorney must sign above and type name below) _______________________________________________________________________________________ 6. RELOCATION Attorney(s) for Relocation refers to moving the child(ren)’s residence so that the geographic ties between the child(ren) and the other party are substantially changed. At the time of this agreement, the q Petitioner q Respondent/CoPetitioner q neither party is planning to relocate. Office and P.O. Address q The parties have agreed on the relocation plans for the child(ren) as follows: _________________________________________________________________________________ Telephone No.: _________________________________________________________________________________ Facsimile No.: E-Mail Address: Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: _________________________________________________________________________________ JDF 1421 9/03 Page 6 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar Court q The parties have not agreed on relocation plans, and request that the No. make that determination. : If the parties do not have a written agreement or Court Order, the child(ren) may not move out of this JUDICIAL SUBPOENA Plaintiff(s) state. -against- 7. : ADDITIONAL ARRANGEMENTS (Check all that apply and fill in appropriate information.) : q Each party will inform the other party of any changes of business or residential address and / or phone : number in advance OR within ____________ days/weeks of the change. Defendant(s) q Both parties will consult with one another in advance of any change to the schedule that would affect : . . . . . . . . either. party’s. access. to. the children. . Without .a . . . . . . agreement by both parties, with copies to each, no . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . signed . . such change which violates the Court Order will be honored by the Court. q Both parties agree that all communications regarding the child(ren) will be between the parties and that they will not use the child(ren) to convey information or to set up visitation changes. THE PEOPLE OF THE STATE OF NEW YORK q Both parties agree that they will not belittle or criticize the other party in front of the child(ren). TO 8. COMPLIANCE WITH STATE AND FEDERAL STATUTES The child(ren) named in this parenting plan is/are scheduled to reside the majority of the time with the q GREETINGS: Respondent/Co-Petitioner (check one). That party is designated the custodian of the child(ren) Petitioner q solely for the purposes of all federal and state statutes which require a designation or determination of custody. WE COMMAND YOU, that all business rights and being laid aside, you this parenting plan, or under This designation shall not affect either party’s and excusesresponsibilities under and each of you attend before theColorado law. If this designation is not what you at the you must specifically choose a party to be the “custodian” , Honorable Court want, for purposes of other statutes. Name the party here: ______________________________________________ located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 9. CHILD SUPPORT (A Child Support Obligation Worksheet must be filed.) q Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) The q to comply with this subpoena is punishable as a ________________ will make you liable to Your failurePetitioner q Respondent/Co-Petitioner q Othercontempt of court and (check one) shall pay child behalf to the q Petitioner q Respondent/Co-Petitioner of $50 ___________ (check one) in the party on whosesupport this subpoena was issued for a maximum penaltyq Otherand all damages sustained as a result of your the sum of $ ____________ per month pursuant to the Colorado Child Support Guidelines, beginning failure to comply. _________________ (date) and continuing until the child(ren) reach(es) the age of 19 or is/are emancipated at an earlier age, or the Court modifies child support. Witness, Honorable Court in q Child support payments willof paid to: (check one) County, day be , 20 , one of the Justices of the q Family Support Registry P. O. Box 2171, Denver, CO 80201-2171. q The Parties request that the Court order the payment to be made directly to the appropriate person. (Attorney must sign above and type name below) q Child support payments will be paid as follows: q Monthly q Bi-weekly q Weekly q Other _________________________________________ Attorney(s) for q Request for Deviation from Child Support Guidelines. The parties are requesting that the Court deviate from the Child Support guidelines pursuant to §14-10-115(3)(a), C.R.S. for the following reasons: (The decision for a deviation in child support is final ONLY upon the order of the Court.) ________________________________________________________________________________ Office and P.O. Address ________________________________________________________________________________ ________________________________________________________________________________ Telephone No.: Facsimile No.: q The parties do not agree on this issue. E-Mail Address: Mobile JDF 1421 9/03 PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 7 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. An income assignment will be activated immediately with the responsible party’s employer unless the : Calendar No. Court or delegate child support enforcement unit finds, in writing, that there is good cause not to require immediate activation of an income assignment pursuant to §14-14-111.5(3)(a)(II), C.R.S. Plaintiff(s) : JUDICIAL SUBPOENA 10. FUTURE CHILD SUPPORT MODIFICATION AND EXCHANGE OF FINANCIAL INFORMATION -against- : The Court must enter an Order for any modification to be effective. The provisions of any Order regarding : child support may be modified only upon a showing of changed circumstances that are substantial and continuing. Income changes that result in more than a 10% change in the amount of child support due may be considered by the Court to be substantial and continuing. : Defendant(s) q The parties q will q will not (check one) exchange financial information, including updated financial : . . . . . . . . . . . .affidavits. and . verification. of .insurance . and .its. costs. for the purposes of modifying the child support ...... ... ........ .. ....... ... . .... order without a hearing. q The parties will exchange financial information in the following manner and time period: THE PEOPLE OF THE STATE OF NEW YORK ________________________________________________________________________________ TO ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ GREETINGS: ________________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the HonorableThe parties do not agree on this issue. the at Court q located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or11. MEDICAL/DENTAL INSURANCE FOR CHILD(REN) in this action on the part of the adjourned date, to testify and give evidence as a witness q Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to q Petitioner _____________________________________ (name) shall provide qmedical qdental the party on whose behalf this subpoena was issued for a maximum all children, please all damages names of thea insurance for the child(ren) until emancipation. If not penalty of $50 and identify the sustained as result of your children you will be providing insurance for. ______________________________________________ failure to comply. q Respondent/Co-Petitioner ________________________ (name) shall provide qmedical qdental Witness, Honorable , one of the Justices of the insurance for the child(ren) until emancipation. If not all children, please identify the names of the Court in day of , ______________________________________________ children County, be providing insurance for.20 you will q The parties do not agree on this issue. (Attorney must sign above and type name below) A support order for deduction of health insurance shall be entered by the Court and served Attorney(s) for upon the responsible party’s employer. 12. EXTRAORDINARY / UNINSURED MEDICAL, DENTAL OR MENTAL HEALTH EXPENSES FOR Office and P.O. Address CHILD(REN) q Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) Telephone No.: q Extraordinary/uninsured medical, dental or mental health expenses for the child(ren) shall be Facsimile No.: divided, with Petitioner paying ______ % and Respondent/Co-Petitioner paying ______ % of every expense. E-Mail Address: JDF 1421 9/03 Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 8 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : OR : Index No. Calendar No. q Extraordinary/uninsured medical expenses for the child(ren) shall be divided in proportion to each party’s income. OR Plaintiff(s) -against- : JUDICIAL SUBPOENA : q Other: __________________________________________________________________________ : q The parties do not agree on this issue. : 13. OTHER EXTRAORDINARY EXPENSES FOR CHILD(REN) (expenses not covered under Basic Child Defendant(s) : . . . . . Support. Guidelines) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... .......... q Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) Are there any other extraordinary expenses for the child(ren), not covered under the Basic Child Support Guidelines, which OF NEW YORK THE PEOPLE OF THE STATEyou would like to address at this time? TO ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ GREETINGS: WE The parties doYOU, that on this issue. excuses being laid aside, you and each of you attend before q COMMAND not agree all business and , the Honorable at the Court located at County of 14. EDUCATION in room , on the day of , 20 , at o'clock in the noon, and at any recessed A. Private school expenses: or adjourned date, to testify and give evidence as a witness in this action on the part of the q Both parties agree to the private school expenses. q Private education expenses for the child(ren) shall be divided with Petitioner paying ____ % Respondent/Co-Petitioner paying _____ % of every expense. Private education expenses Your failure shall include: this subpoena is punishable as a contempt of court and will make you liable to to comply with q this subpoena any ceilings or maximum ____________________________________ the party on whose behalfTuition (indicatewas issued for arestrictions) penalty of $50 and all damages sustained as a result of your failure to comply. and Board q Room q Books q Fees Witness, Honorable , one of the Justices of the q Travel Court in County, day of , 20 q Other: _________________________________________________________________ q The parties do not agree to the private school expenses. (Attorney must sign above and type name below) B. Post-secondary education expenses cannot be ordered by the Court without an agreement. If you agree that they should be paid by the parties, please indicate the terms of agreement below: q Post-secondary education expenses for the child(ren) shall be divided with Petitioner paying Attorney(s) for _______ % Respondent/Co-Petitioner paying _______ % of every expense. Post-secondary expenses shall include: q Tuition (indicate any ceilings or restrictions)_______________________________________ q Room and Board q Books Office and P.O. Address q Fees q Travel q Other: ____________________________________________________________________ JDF 1421 9/03 Telephone No.: Facsimile No.: E-Mail Address: Mobile PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 9 of 10 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 15. TAX DEDUCTION : Index No. Calendar No. Only one party may claim a deduction for each child on his/her income tax return in accordance with §14-10: 115(14.5), C.R.S. See instructions to IRS Form 1040. JUDICIAL SUBPOENA q Plaintiff(s) The parties agree that: -against: q Petitioner will claim __________________________________________________________ : q Respondent/Co-petitioner will claim _____________________________________________ q The parties do not agree on this issue. : Defendant(s) : . .16. . OTHER . TERMS . (add. .any. other . items. regarding. .the . child(ren) you would like to include in your parenting .. ...... ...... ... .. .... .... ....... .. ..... plan). (Use additional sheets if necessary). _______________________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK _______________________________________________________________________________________ TO _______________________________________________________________________________________ _______________________________________________________________________________________ GREETINGS: CONFLICT RESOLUTION 17. FUTURE If the parties cannot reach an agreement inand excuses on any issue involving the parenting attendor child WE COMMAND YOU, that all business the future being laid aside, you and each of you plan before support, they q agree q do not agree to enter into q mediationCourt q arbitration. , the Honorable at the located at County of If in room the parties, agree, mediation of on the day and/or arbitration will ,be conducted by ________________________ .If that , 20 at o'clock in the noon, and at any recessed mediator/arbitrator is unavailable, and the parties cannot agree on another mediator/arbitrator, they will use or adjourned date, to testify and give evidence as a witness in this action on the part of the the State Office of Dispute Resolution at 303.861.1111. Any alternative dispute resolution shall be paid _______ % by _____________________________________________(name of party) and _______% by ______________________________________ (name of party). If the mediation fails, the final decision will be made by the Court. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing document and that theof the Justices of the Witness, Honorable , one information provided/agreement set forth therein is true and correct to the best of my knowledge. Your signature below indicates that you have Court in County, day of , 20 read and agree with everything in this document. If both parties agree to this plan, both parties must sign. _______________________________________ __________________________________________ Petitioner Signature Co-Petitioner/Respondent Signature Date (Attorney must sign above and type name below) Date ______________________________________ __________________________________________ Petitioner’s Attorney Signature, if any Co-Petitioner’s/Respondent’s Attorney Signature, if any Date Date Attorney(s) for Subscribed and affirmed, or sworn to before me Subscribed and affirmed, or sworn to before me in the County of ________________________, in the County of _________________________, State of ____________________, this _______ State of ____________________, this ________ day of ________________. 20 ____. day of ________________. 20 ____. My commission expires: __________________ My commission expires: __________________ Office and P.O. Address Telephone No.: Facsimile No.: _____________________________________ _____________________________________ Notary Public Notary Public Address: E-Mail Mobile JDF 1421 9/03 PARENTING PLAN/CHILD SUPPORT OBLIGATION AGREEMENT Tel. No.: Page 10 of 10 American LegalNet, Inc. www.USCourtForms.com