IN THE CIRCUIT COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA DIVISION: OBLIGOR CASE NUMBER 05 - DR - XXXX-XX CLOCK IN OBLIGEE NOTICE OF EXERCISE OF CHILD TIMESHARING I, privilege from Day/Month , do hereby certify that I exercised my timesharing , 20 Year to Day/Month , 20 Year in compliance w ith my current child support/parental responsibility. Please adjust my account accordingly. NOTICE: Please complete and return this notice. A copy of the notice w ill be provided to the obligee in this case. If the notice is not contested w ithin 20 days, your account w ill be adjusted to the terms of your current child support/parental responsibility order. Obligor' s Signature Obligor' s Name Typed(Printed) Obligor' s Street Address Obligor' s City/State/Zip Code Obligor' s Telephone Number Obligor' s E-Mail Address Law 543 Rev. 8-19-2014 American LegalNet, Inc. www.FormsWorkFlow.com Clerk of the Circuit and County Court P. O. Box 219, Titusville FL, 32781-0219 Brevard County, Florida Case Number: 05 - - DR - -XXXX-XX Please complete the enclosed Notice of Exercise of Child Timesharing Form and return it to the address shown above. Sincerely, SCOTT ELLIS CLERK OF COURTS Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com