Proposed Order (For Custody-Visitation-Support-Insurance)
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Proposed Order (For Custody-Visitation-Support-Insurance) Form. This is a Massachusetts form and can be use in Middlesex County.
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Tags: Proposed Order (For Custody-Visitation-Support-Insurance), Massachusetts County, Middlesex
COMMONWEALTH OF MASSACHUSETTS
THE TRIAL COURT
PROBATE AND FAMILY COURT
Middlesex Division
Docket No.
, Plaintiff
vs.
(Plaintiff's - Defendant's)
, Defendant
PROPOSED ORDER
Upon the Motion for
dated:
and filed with this Court on
20
.
After hearing and pending further order or judgment of this Court, IT IS ORDERED THAT
(Describe in detail the relief order you seek)
1)
shall have
custody of:
(shared / legal)
(plaintiff / defendant / plaintiff and defendant)
,
the minor child/ren of the parties,
child/ren.
2)
shall have the physical custody of said
(plaintiff / defendant)
shall have the following visitation rights:
(plaintiff / defendant)
.
3)
(plaintiff / defendant)
shall pay, as child support, the sum of $
each and every
hereafter, beginning
, 20
to the
(week / month)
by
(plaintiff / defendant / Mass DOR/CSE)
4)
.
(implemented wage assignment / suspended wage assignment)
shall obtain
(plaintiff / defendant)
insurance coverage for said child/ren
(medical / dental / optical)
and for the
.
(plaintiff / defendant)
5)
(plaintiff / defendant)
shall pay to the
% of the uninsured medical,
(plaintiff / defendant)
dental, hospital and optical expenses of the child/ren,
6) Other - Please specify
.
TEMPORARY ORDER
The Court hereby adopts this proposed order, the parties
shall comply with the terms and provisions thereof.
(Signature)
(PRINT NAME)
Address:
(city or town)
Date
Justice of the Probate Court
Telephone No:
(State)
(zip)
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