IN THE DISTRICT COURT OF COUNTY STATE OF OKLAHOMA In Re the Marriage of: ) ) ) ) Case No.: ) ) ) Judge: ) ) ) Family Group No. (FGN): ) ) ) ) ) ) CHILD SUPPORT ORDER On child support issues. Child Support Services (CSS): evidences its agreement with this Order through the signature of its attorney, or is not a necessary party under 43 O.S. § 112(F) and has disclaimed interest in this proceeding. Petitioner is the Mother or Father, and appears: , this matter came before the Court to determine in person, pro se; in person, with counsel by telephone; not; not, being in default; not, having previously signed this Order; or not, represented by counsel . ; Form 03ES010E 8/26/2014 Page 1 of 13 American LegalNet, Inc. www.FormsWorkFlow.com Respondent is the Mother or Father, and appears: ; in person, pro se; in person, with counsel by telephone; not; not, being in default; not, having previously entered an appearance and waiver; or not, represented by counsel Other persons appear . . The Court, being informed by evidence presented and hearing from the parties, finds that it has jurisdiction over the parties and the subject matter of this action. The Court, therefore, FINDS, ORDERS, AND DECREES AS FOLLOWS: 1. THE FOLLOWING CHILD(REN) IS THE SUBJECT OF THIS ACTION: Name 1. 2. 3. 4. 5. 6. 2. CURRENT CHILD SUPPORT. Petitioner Respondent is the child support Date of birth Sex Obligor and has a duty to provide support for the minor child(ren) who is the subject of this action and current support in the amount of per month, in accordance with the attached Support Computation Sheet (line 27). Payment shall begin and continue on the same day of each month thereafter, until the child(ren) reach(es) eighteen years of age. Provided, that if the last minor child residing with the custodian reaches eighteen years of age and is still attending high school, child support shall continue until twenty years of age, as long as the child is regularly enrolled in and attending high school, including other means of high school education or an alternative high school education program. Form 03ES010E 8/26/2014 Page 2 of 13 American LegalNet, Inc. www.FormsWorkFlow.com The child support obligation is set in accordance with the Child Support Guidelines without deviation and a copy of the Child Support Computation Sheet is attached hereto. The Court deviates from the Child Support Guidelines as they result in an amount that is inequitable, unreasonable under the circumstances, and/or not in the best interests of the child(ren), and in support of the deviation the Court finds the following: 3. MEDICAL SUPPORT. A. Medical Support Definitions. "Reasonable in cost" means dependent coverage does not exceed five percent of the party's gross income. "Reasonable in cost" for Father is an amount not to exceed "Reasonable in cost" for Mother is an amount not to exceed per month. per month. "Accessible" means there are available providers appropriate to meet the child(ren)'s individual health care needs within 60 miles one-way from the primary residence of the child(ren). B. Medical Support Orders. (Choose one from options 1, 2, or 3.) Option 1: Employer-sponsored or other group medical insurance is available and is ordered. Petitioner Respondent has dependent health insurance in effect or available through an employer-sponsored or other group plan and shall provide the insurance until further Order of the Court. The employer-sponsored or other group medical insurance premium exceeds the five percent reasonable cost standard. However, the Court orders coverage in excess of the standard based on the agreement of the parties or in the child(ren)'s best interests. Petitioner Respondent shall provide the insurance until further Order of the Court. Form 03ES010E 8/26/2014 Page 3 of 13 American LegalNet, Inc. www.FormsWorkFlow.com Option 2: Alternative health coverage ordered. Petitioner, Respondent, or other, specify name and relationship to child(ren): has alternative health coverage for the child(ren) in effect or available as described below and is ordered to maintain the coverage as long as the child(ren) continues to be eligible. a. Indian Health Services. Child(ren) is eligible or believed to be eligible for Indian Health Services. The parents shall cooperate fully to enroll the child(ren) in the tribe and, if CSS is a necessary party, provide a copy of the card or other documentation to the child support office. Tribal affiliation: . If the child(ren) is determined eligible for Indian Health Services, other health care coverage for the child(ren) is required is not required. b. Department of Defense (DOD). Child(ren) is believed to be eligible for or enrolled in the DOD managed health care program. The name of the DOD sponsor is . The parents shall cooperate fully in enrolling the child(ren) in the Defense Enrollment Eligibility Reporting System (DEERS) and, if CSS is a necessary party, provide a copy of the identification card to the child support office. Whenever DEERS coverage ceases to be available, health insurance shall be provided by Petitioner Respondent through an accessible employer-sponsored or other group plan at a cost not to exceed per month. c. Step-parent health insurance. Child(ren) is covered under health coverage through current spouse of Petitioner and provided by Respondent. In the event that health Petitioner , coverage is no longer being provided by the step-parent, Respondent shall provide accessible health insurance coverage at a cost not to exceed per month. Form 03ES010E 8/26/2014 Page 4 of 13 American LegalNet, Inc. www.FormsWorkFlow.com d. Other alternative coverage. shall provide health coverage for the minor child(ren) in this case through the following coverage type Option 3: Cash medical. There is no information regarding available insurance coverage; There is no insurance coverage available; or The available insurance coverage is not: reasonable in cost; OR accessible to the minor child(ren). a. The Court orders in the amount of Petitioner Respondent to pay Cash Medical Support per month. The Cash Medical Support is included . in the child support amount ordered above. b. All Cash Medical Support is paid through the Oklahoma Centralized Support Registry as outlined below OR the Cash Medical Support shall be paid to the other parent as part of the child support payment ordered above. The Cash Medical amount shall be discontinued when health insurance becomes available at a reasonable c