q District Court _________________________________________ County, Colorado Court Address: In Re: Petitioner: Respondent/Co-Petitioner: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Case Number: Phone Number: E-mail: FAX Number: Atty. Reg.#: Division Courtroom VERIFIED MOTION FOR DEVIATION FROM THE PRESUMED AMOUNT OF CHILD SUPPORT The q Petitioner q Respondent/Co-Petitioner submits the following statements, under oath, supporting deviation from the Child Support Guidelines. Following the Child Support Guidelines would result in an amount of child support q greater than q less than the amount of child support presumed by the Child Support Guidelines: 1. I have a monthly expense for extraordinary medical expenses incurred for: q My treatment Amount: $_____________ q Treatment of the other parent Amount: $_____________ Please explain: 2. I have a monthly expense associated with a substantial non-income producing asset. Please explain: 3. My monthly gross income includes overtime at a primary job or gross income earned from secondary employment. Amount: $ 4. JDF 1311 ) is grossly disparate from that gross monthly income earned by the other party ($ 5. My gross monthly income ($ ). Please explain any other reason justifying deviation from the presumed amount of child support: R7/00 VERIFIED MOTION FOR DEVIATION FROM THE PRESUMED AMOUNT OF CHILD SUPPORT PAGE 1 OF 2 2002 © American LegalNet, Inc. For the reasons stated above, the q Petitioner q Respondent/Co-Petitioner (check one) requests this court to deviate from the Child Support Guidelines, pursuant to the attached Child Support Worksheet, and order that child support be paid in the amount of $ per month. Date: q Petitioner OR q Respondent/Co-Petitioner Address City, State, Zip Code (Area Code) Telephone Number (home and work) Date: q Petitioner OR q Respondent/Co-Petitioner Address City, State, Zip Code (Area Code) Telephone Number (home and work) STATE OF COLORADO COUNTY OF ____________________________ Signed and sworn to before me by q Petitioner q Respondent/Co-Petitioner on this date: My commission expires: q Notary Public q [Deputy] Clerk of Court Notary’s Address Notary’s City, State, Zip [Seal] CERTIFICATE OF SERVICE I certify that on (date) the original and one copy of this document were filed with the court; and, a true and accurate copy of the MOTION FOR DEVIATION FROM THE PRESUMED AMOUNT OF CHILD SUPPORT was served on the other party by q Hand Delivery OR q Faxed to this number OR q by placing it in the United States mail, postage pre-paid, and addressed to the following: TO: ____________________________________ ____________________________________ ____________________________________ JDF 1311 R7/00 VERIFIED MOTION FOR DEVIATION FROM THE PRESUMED AMOUNT OF CHILD SUPPORT ______________________________________ (Your signature) PAGE 2 OF 2 2002 © American LegalNet, Inc.