STATE OF MAINE SUPERIOR COURT , ss Docket No.: Plaintiff v. Defendant 1. This Child Support Order is made a part of the Divorce Judgment Protection from Abuse Order Parental Rights and Responsibilities Judgment Parentage Judgment Case Management Order Amended Judgment Guardianship Interim Hearing other of this date dated . 2. Pursuant to 19-A M.R.S. § 2006, the court has made certain findings of fact concerning the current parental support obligation as computed under the presumptive application guidelines. Those findings are contained within the child support worksheet that is attached and incorporated. 3. Name of Obligor the sum of $ Child's Name is ordered to pay to Name of Obligee per week/biweekly toward the support of: Date of Birth Child's Name Date of Birth CHILD SUPPORT ORDER Interim Final Amended Corrected DISTRICT COURT Location: Docket No.: 4. The child support payments are to start . If a child receives public assistance, the child support payments for that child shall be made to the State of Maine Department of Health & Human Services. 5. The Court finds that the child(ren) currently receive(s) dependent benefits as a result of the obligor's disability. In any month that the benefits received by the child(ren) meet or exceed the total monthly support obligation, the obligor shall receive a credit for the total amount of support due. To the extent that the monthly benefits received by the child(ren) do not satisfy the obligor's monthly support obligation, the obligor shall pay the monthly support obligation minus the credits received by the child(ren). The obligor shall not be given credit toward past or future obligations for benefits, which exceed the current monthly support obligation. 6. The child support obligation(s) shall remain in effect until any underlying Protection from Abuse Order, whichever occurs first). (further order or until expiration of 7. The child support obligation(s) shall continue for each child until that child reaches the age of 18; provided, however, that if the child has not graduated, withdrawn, or been expelled from secondary school as defined in Title 20-A, the child support shall continue until the child graduates or reaches the age of 19, whichever occurs first. 8. Beginning when old and is no longer eligible for child care expenses, the child support obligation will be reduced to $ week/biweekly. Beginning when old and is no longer eligible for child care expenses, the child support will be reduced to $ reaches the age of 12 years per reaches the age of 12 years per week/biweekly. 9. As long as there are children entitled to parental support, the obligor shall pay the sum of $ per week/biweekly. As long as there are children entitled to parental support, the obligor shall pay the sum of $ per week/biweekly. When child(ren) is/are entitled to parental support, the obligor shall pay the sum of $ per week/biweekly. FVI FM-132, Rev. 08/16 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 10. The amount(s) set forth above for child support constitute(s) a deviation from the presumptive amount required by the child support guidelines. In this case the court finds that a child support order based on the guidelines would be inequitable or unjust for the following reasons: (Set forth the reasons for the deviation.) 11. Plaintiff Defendant Either party (the party who can obtain health insurance FIRST at reasonable cost) shall obtain and maintain private health insurance for the benefit of the minor child(ren) if it is presently available at reasonable cost. If it is not presently available at reasonable cost then private health insurance for the benefit of the minor child(ren) shall immediately be obtained and maintained when it becomes available at reasonable cost. Proof of such insurance must be furnished to the other party within 15 days of receipt of a copy of this order, or if the insurance is not presently available, within 15 days of the date it becomes available. If the child(ren) is (are) recipients of public assistance, proof of such insurance shall be provided to the Department of Health & Human Services within 15 days. 12. Any uninsured medical expenses of the child(ren), in excess of $250 per calendar year, shall be paid in the following manner: __________% by the obligor and, __________% by the obligee. The first $250 of annual uninsured medical expenses shall be paid by the obligee. 13. The child support obligation is based on the fact that the parents are providing substantially equal care for their child(ren). Uninsured medical expenses shall be shared as follows: _______% to be paid by the higher income parent and ______% to be paid by the lower income parent. If the Maine Department of Health & Human Services provides support enforcement services and/or the obligor is required to pay child support to the Maine Department of Health & Human Services, the obligor shall notify the Department within 15 days of the date of this Order of the following: 1. The obligor's current address; 2. The name and address of the obligor's current employer, and 3. Whether the obligor has access to health insurance at a reasonable cost, and, if so, the health insurance policy information. Within 15 days of any change in the obligor's current address, any change in the name or address of the obligor's current employer, or any change in the health insurance policy information, the obligor shall notify the Department of the change. Failure to report a change of address or employer to the Department within 15 days of such change is a civil violation for which a forfeiture not to exceed $200 may be adjudged for each violation. Any party to this action may file with the court a Motion to Modify asking the court to review the amount of child support and if appropriate, to modify it in accordance with the state's child support guidelines. If it has been less than 3 years since the child support order was issued or modified, the party must prove a substantial change in circumstances. 14. This Order is subject to Immediate Income Withholding as of this date (See Notice below)(If not, see 15 below). Notice to Parties Regarding Immediate Income Withholding. Immediate income withholding can only be implemented by serving an attested copy of the support order, along with the notice required under § 2655, upon the obligor's payor of income. Notwithstanding this subsection, the department may implement immediate income withholding by serving the noti