Opinion
April 4, 2008.
In all cases involving permanent custody or custody modification (except when a parent seeks emergency relief for family violence), each parent shall prepare and submit a parenting plan, or the parties may jointly submit a parenting plan, as directed by the judge.
The parenting plan should be tailored to fit the needs of each individual family but must at a minimum contain the information required by OCGA section 19-9-1 (b) and be presented in substantially the following form:
[FORM FOLLOWS] PARENTING PLAN
() The parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the requirements of OCGA Section 19-9-1. The parties agree on the terms of the plan and affirm the accuracy of the information provided, as shown by their signatures at the end of this order.
() This plan has been prepared by the judge.
This plan () is a new plan.
() modifies an existing Parenting Plan dated ___________.
() modifies an existing Order dated __________________.
Child's Name Date of Birth
I. Custody and Decision Making:
A. Legal Custody shall be (choose one:)
() with the Mother
() with the Father
() JointB. Primary Physical Custodian
For each of the children named below the primary physical custodian shall be:
d/o/b: ( ) Mother ( ) Father ( ) Joint d/o/b: ( ) Mother ( ) Father ( ) Joint d/o/b: ( ) Mother ( ) Father ( ) Joint d/o/b: ( ) Mother ( ) Father ( ) Joint d/o/b: ( ) Mother ( ) Father ( ) JointWHERE JOINT PHYSICAL CUSTODY IS CHOSEN BY THE PARENTS OR ORDERED BY THE COURT, A DETAILED PLAN OF THE LIVING ARRANGEMENTS OF THE CHILD(REN) SHALL BE ATTACHED AND MADE A PART OF THIS PARENTING PLAN.
C. Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing with that parent, including any emergency decisions affecting the health or safety of a child.D. Major Decisions
Major decisions regarding each child shall be made as follows:
Educational decisions ( ) mother ( ) father ( ) joint Non-emergency health care ( ) mother ( ) father ( ) joint Religious upbringing ( ) mother ( ) father ( ) joint Extracurricular activities( ) mother ( ) father ( ) joint _____________________ ( ) mother ( ) father ( ) joint _____________________ ( ) mother ( ) father ( ) joint E. DisagreementsWhere parents have elected joint decision making in Section I.D above, please explain how any disagreements in decision-making will be resolved. ___________________________________________________________
II. Parenting Time/Visitation Schedules
A. Parenting Time/Visitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of parenting time/ visitation (choose an item):
() The weekend of the first and third Friday of each month.
() The weekend of the first, third, and fifth Friday of each month.
() The weekend of the second and fourth Friday of each month.
() Every other weekend starting on __________.
() Each _________ starting at _________a.m./p.m. and ending __________ a.m./p.m.
() Other: ______________________________________________________
() and weekday parenting time/ visitation on (choose an item):
() None
() Every Wednesday Evening
() Every other Wednesday during the week prior to a non-visitation weekend.
() Every ___________________ and _____________ evening.
() Other: ______________________________________________
_____________________________________________________
______________________________________________________
For purposes of this parenting plan, a weekend will start at ______ a.m./p.m. on [Thursday / Friday / Saturday / Other: _____________ ] and end at _______ a.m./p.m. on [Sunday / Monday / Other: _________________ ].
Weekday visitation will begin at _____ a.m./p.m. and will end [___p.m. / when the child(ren) return(s) to school or day care the next morning / Other:________ ].
This parenting schedule begins:
() ____________________ OR () date of the Court's Order
(day and time)
B. Major Holidays and Vacation Periods
Thanksgiving
The day to day schedule shall apply unless other arrangements are set forth:
_____________________________________________________
_____________________________________________________
beginning _____________________.
Winter Vacation
The () mother () father shall have the child(ren) for the first period from the day and time school is dismissed until December ______ at __________ a.m./p.m. in () odd numbered years () even numbered years () every year. The other parent will have the child(ren) for the second period from the day and time indicated above until 6:00 p.m. on the evening before school resumes. Unless otherwise indicated, the parties shall alternate the first and second periods each year.
Other agreement of the parents:
_______________________________________.
Summer Vacation
Define summer vacation period: _______________________________________________ The day to day schedule shall apply unless other arrangements are set forth: ______________________________________________________________ beginning _____________________.
Spring Vacation (if applicable)
Define:____________________________________________ The day to day schedule shall apply unless other arrangements are set forth: _______________________________________________________________ beginning _____________________.
Fall Vacation (if applicable)
Define: ____________________________________
The day to day schedule shall apply unless other arrangements are set forth: _________________________________________________________ beginning _____________________.
C. Other Holiday Schedule (if applicable)Indicate if child(ren) will be with the parent in ODD or EVEN numbered years or indicate EVERY year: MOTHER FATHER Martin Luther King Day _________________ __________________ Presidents' Day _________________ __________________ Mother's Day _________________ __________________ Memorial Day _________________ __________________ Father's Day _________________ __________________ July Fourth _________________ __________________ Labor Day _________________ __________________ Halloween _________________ __________________ Child(ren)'s Birthday(s) Mother's Birthday _________________ __________________ Father's Birthday _________________ __________________ Religious Holidays: _________________ __________________ ________________ ________________ ________________ ________________ Other: ________________ _________________ __________________ _________________ __________________ _________________ __________________ _________________ __________________ Other: ________________ _________________ __________________ Other: ________________ _________________ __________________ _________________ __________________
D. Other extended periods of time during school, etc. (refer to the school schedule)
___________________________________________________________
___________________________________________________________
___________________________________________________________
E. Start and end dates for holiday visitation
For the purposes of this parenting plan, the holiday will start and end as follows (choose one):
() Holidays that fall on Friday will include the following Saturday and Sunday
() Holidays that fall on Monday will include the preceding Saturday and Sunday
() Other: _______________________________________________________
F. Coordination of Parenting Schedules
Check if applicable:
() The holiday parenting time/visitation schedule takes precedence over the regular parenting time/visitation schedule.
() When the child(ren) is/are with a parent for an extended parenting time/visitation period (such as summer), the other parent shall be entitled to visit with the child(ren) during the extended period, as follows:
___________________________________________________________
___________________________________________________________
G. Transportation Arrangements
For visitation, the place of meeting for the exchange of the child(ren) shall be:
___________________________________________________________
___________________________________________________________
The ___________ will be responsible for transportation of the child at the beginning of visitation.
The ___________ will be responsible for transportation of the child at the conclusion of visitation.
Transportation costs, if any, will be allocated as follows:
________________________________________________________
________________________________________________________
__________________________
Other provisions: __________________________________________
H. Contacting the child
When the child or children are in the physical custody of one parent, the other parent will have the right to contact the child or children as follows:
() Telephone
() Other:________________________________________________
() Limitations on contact: ___________________________________________________________
I. Supervision of Parenting Time (if applicable)
() Check here if Applicable
Supervised parenting time shall apply during the day-to-day schedule as follows:
Place: _______________________________________________________
Person/Organization supervising: _________________________________
Responsibility for cost:
( ) father ( ) both equally
J. Communication Provisions
Please check:
() Each parent shall promptly notify the other parent of a change of address, phone number or cell phone number. A parent changing residence must give at least 30 days notice of the change and provide the full address of the new residence.
() Due to prior acts of family violence, the address of the child(ren) and victim of family violence shall be kept confidential. The protected parent shall promptly notify the other parent, through a third party, of any change in contact information necessary to conduct visitation.III. Access to Records and Information
Rights of the Parents
Absent agreement to limitations or court ordered limitations, pursuant to O.C.G.A. § 19-9-1 (b) (1) (D), both parents are entitled to access to all of the child(ren)'s records and information, including, but not limited to, education, health, extracurricular activities, and religious communications. Designation as a non-custodial parent does not affect a parent's right to equal access to these records.
Limitations on access rights:______________________________
___________________________________________________________
___________________________________________________________
Other Information Sharing Provisions:
IV. Modification of Plan or Disagreements
Parties may, by mutual agreement, vary the parenting time/visitation; however, such agreement shall not be a binding court order. Custody shall only be modified by court order.
Should the parents disagree about this parenting plan or wish to modify it, they must make a good faith effort to resolve the issue between them.
V. Special Considerations
Please attach an addendum detailing any special circumstances of which the Court should be aware (e.g., health issues, educational issues, etc.) ___________________________________________________________
VI. Parents' Consent
Please review the following and initial:
1. We recognize that a close and continuing parent-child relationship and continuity in the child's life is in the child's best interest.
Mother's Initials: ___________ Father's Initials:
____________
2. We recognize that our child's needs will change and grow as the child matures; we have made a good faith effort to take these changing needs into account so that the need for future modifications to the parenting plan are minimized.
Mother's Initials: ____________ Father's Initials:
____________
3. We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions while the child is residing with such parent.
Mother's Initials: __________ Father's Initials:
_____________
() We knowingly and voluntarily agree on the terms of this Parenting Plan. Each of us affirms that the information we have provided in this Plan is true and correct.
___________________ ______________________ Father's Signature Mother's Signature
ORDER
The Court has reviewed the foregoing Parenting Plan, and it is hereby made the order of this Court.
This Order entered on _____________________________________, 20 _____.
__________________________________
JUDGE
___________ COUNTY SUPERIOR COURTFAMILY VIOLENCE TWELVE MONTH PROTECTIVE ORDER
A hearing was held on this matter on _____________________, _____ for which the Respondent had notice as required by law and at which the Respondent appeared and/or had the opportunity to be heard and the Petitioner requested that the Protective Order entered in this case be continued. Having heard the evidence presented, reviewed the petition and the entire record concerning this case and for good cause shown, IT IS HEREBY ORDERED AND ADJUDGED:
1. That these proceedings be filed in the office of the Clerk of this Court.
2. That this Order applies in every county throughout the state and it shall be the duty of every court and every law enforcement official to enforce and carry out the provisions of this Order pursuant to O.C.G.A. § 19-13-4(d). Law Enforcement officers may use their arrest powers pursuant to O.C.G.A. §§ 19-13-6 and 17-4-20 to enforce the terms of this Order.
3. This Order shall be in effect for up to twelve (12) months from ________________, 20____ until ____________________, 20_____.
1. That the Respondent has violated the Family Violence Act, at O.C.G.A. § 19-13-1
pco 01 et seq., by committing family violence, has placed the Petitioner in reasonable fear for Petitioner's safety, and represents a credible threat to the physical safety of Petitioner and/or Petitioner's child/ren. Respondent is hereby enjoined and restrained from doing, or attempting to do, or threatening to do, any act of injury, maltreating, molesting, following, harassing, harming, or abusing the Petitioner and/or the minor child/ren in any manner. Respondent is not to interfere with Petitioner's travel, transportation, or communication. Respondent shall not follow, place under surveillance, or contact the Petitioner at any place of the Petitioner for the purpose of harassing and intimidating the Petitioner.
5. That the Respondent is enjoined and restrained from doing or attempting to do, or pco 02 threatening to do, any act of injury, maltreating, molesting, harassing, harming, or abusing the Petitioner's family or household.
6. That this Court determined that it had jurisdiction over the parties and the subject matter under the laws of the State of Georgia and Respondent received reasonable notice and had the opportunity to be heard before this Order was issued sufficient to protect the Respondent's due process rights and this Order shall be presumed valid and pursuant to18 U.S.C. § 2265(a) shall be accorded full faith and credit by any other state or local jurisdiction and shall be enforced as if an Order of the enforcing state or jurisdiction.
ONLY THE FOLLOWING THAT ARE INITIALED BY THE JUDGE SHALL APPLY
_____ 7. Petitioner is awarded sole and exclusive possession of the residence at _________
pco3_______________________________________________________
_____8. Respondent is ordered to leave the family residence immediately and law enforcement ________________ (sheriff or police department) is ordered to assist Petitioner in returning to the family residence and the removal of the Respondent. Respondent shall immediately surrender to law enforcement _________________ (sheriff or police department) all and any keys, garage door openers and other security devices to the family residence and law enforcement shall insure that these are given to the Petitioner.
_____9. Respondent is ordered to stay away from Petitioner's and Petitioner's child/ren's
pco 04 residence and workplace and/or school and any subsequent residence or workplace or school of Petitioner and/or Petitioner's minor child/ren.
_____10. Respondent is ordered to provide suitable alternate housing for Petitioner and/or Petitioner's children by _______________________________.
_____11. That Respondent is restrained and enjoined from approaching within 100 yards
pco 01, pco 04 of Petitioner and/or Petitioner's minor children.
_____12. Respondent is ordered not to have any contact, direct, indirect or through
pco 05 another person with Petitioner, by telephone, pager, fax, e-mail or any other means of communication except as specified in this Order.
_____13. That Petitioner is awarded temporary custody of the minor child/ren, namely:
___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______
Respondent is ordered not to interfere with the physical custody of the minor child/ren.
_____ pco06 Initial here only if Respondent is awarded temporary custody of the child/ren.
_____ 14. The _____________ shall pay to the _______________, for the support of the minor child/ren, the sum of ______________________ Dollars ($___________________)
per _____________________, beginning _____________________, 20____.
All payments are to be made by or to: ____ income deduction order child support receiver by mail directly to the Petitioner or _____________________________
___ 15. Respondent is ordered to pay temporary support for the Petitioner in the amount of $________ every ______beginning ____________.
All payments are to be made by or to: ____ income deduction order _____ child support receiver ____ by mail directly to the Petitioner or _____________________________
_____16. Respondent shall have visitation with the minor child/ren according to the following schedule, beginning__________________:
____ no visitation
____ no visitation until ____________________________
____ supervised visitation, supervised by a third party as follows: _________________________________________________
____ visitation every other weekend from Friday at 6 p.m. until Sunday at 6 p.m beginning__________________, ___________
____ other visitation _________________________________________
circumstances concerning how Respondent shall pick up and return the minor
child/ren shall be _______________________________
Strict compliance with this visitation provision shall not be a violation of the restraining provisions of this Order.
_____ 17. Respondent, only when accompanied by local law enforcement, shall be able to
remove his/her clothing and personal items from the residence as follows:_________ ____________________________________________________________ On ______, 20___ at ______ m.
_____ 18. (Respondent)(Petitioner) (both Respondent and Petitioner) [strike through appropriate] is/are ordered not to sell, encumber, trade, damage, contract to sell, or otherwise dispose of or remove from the jurisdiction of this Court any of the property or pets of the Petitioner or joint property or pets of the parties except in the ordinary course of business.
_____ 19. (Respondent)(Petitioner) (both Respondent and Petitioner) [strike through appropriate] is/are ordered not to disconnect or have disconnected home utilities, change or have changed and/or cancel or have canceled auto, health or life insurance for Respondent, Petitioner, and/or Petitioner's child/ren or interfere with Respondent, Petitioner's and/or Petitioner's child/ren's mail.
_____ 20. Petitioner shall have sole, exclusive temporary possession of the vehicle: Make_____
Model ____________Year__________Color __________. Respondent shall
immediately surrender all keys, proof of insurance, and registration to this vehicle to law enforcement and law enforcement shall immediately turn over said items to Petitioner.
_____21. Petitioner shall be allowed to remove the following property from the family residence for Petitioner and/or Petitioner's child/ren's use _____________________
_____________________________________. On ___________, 20___ at ______ and law enforcement______________________ (sheriff or police department) is hereby ordered to assist the Petitioner during this removal.
_____22. Respondent is ordered to undergo alcohol/drug abuse evaluation and follow the recommended treatment.
_____23. That Respondent shall be required to return the following property for Petitioner and/or Petitioner's child/ren's use ______________________________ ________________________________________________ on ___________, 20___ at __________and law enforcement _____________________________ (sheriff or police department) is hereby ordered to assist the Petitioner during this return.
_____24. Petitioner is awarded costs and attorney fees in the amount of _______________.
____25. Petitioner/protected party is either a spouse, former spouse, parent of a common
pco 07 child, Petitioner's child, child of Respondent, cohabitates or has cohabited with Respondent and qualifies for 18 U.S.C. 922(g). It is further ordered that the Respondent shall not possess or purchase a firearm or ammunition as restricted by federal law under 18 U.S.C. 922(g)(8).
_____26. FAMILY VIOLENCE INTERVENTION PROGRAM
It is further Ordered that the Respondent shall make arrangements to begin a pco 08 certified family violence intervention program (FVIP) within fourteen (14) days of the signing of this Order, or if appropriate within fourteen (14) days upon release from incarceration. A list of local certified agencies will be given to the Respondent with this
Order. Furthermore, Respondent shall appear before this court on, 20 at .m. for a hearing on the status of his/her application, attendance and/or completion of the FVIP. At that hearing, Respondent is ordered to present to this court a written status report from the agency providing the certified FVIP. The status report shall detail Respondent's application, attendance and/or completion of or failure to apply, attend and/or complete the FVIP and shall be signed by an officer of the agency.OR
______ Respondent is ordered to undergo a certified family violence intervention program and comply with the attached compliance form.
OR
______ Respondent is ordered to undergo a certified family violence intervention program.
OR
_______ Respondent is not ordered to undergo a certified family violence intervention program and the following reasons exist: _________________________________________________________________
_____ 27. It is further Ordered: _________________________________________________________________
pco 08 __________________________________________________________
___________________________________________________________
___________________________________________________________
SO ORDERED this _____ day of ___________________, ____.
___________________________ JUDGE, SUPERIOR COURT
__________________ County _________________________
Print or stamp Judge's name
Violation of the above Order may be punishable by arrest.
RESPONDENT'S IDENTIFYING FACT SHEET (please complete as much as possible; one of these must be provided to have the order placed in the National Crime Information Center registry: Respondent's date of birth, social security number, or driver's license number) Respondent's social security number is _______________, date of birth is _________, sex ___, color of hair __________, color of eyes ______________, height _______, weight _____. Respondent's race is ______, ethnic background ____________. Respondent has distinguishing marks (tattoos, scars, etc.) _____________________. Respondent drives a _____________________, license tag no: ____________(Expires:___) and has a ____(state) driver's license no: ______________(Expires:___). Respondent's home address ____________________________ _________________ and is employed by________________ at ___________________________ and works from ____ to ____ on (days)___________. Respondent has the following known aliases: ___________________________. PROTECTED PARTIES' IDENTIFYING INFORMATION Petitioner: ___________________________ DOB ____ sex ____ race ______ Other: ___________________________ DOB ____ sex ____ race ______ Other: ___________________________ DOB ____ sex ____ race ______ Other: ___________________________ DOB ____ sex ____ race ______"Transmitted to Georgia Protective Order Registry Date _______ Clerk ________
Pursuant to O.C.G.A.§ 19-13-3, Petitioner assisted by Name: ______________________________ Address: ____________________________ ____________________________________ Phone: ______________________________ Note to Judges: This form is promulgated as a Uniform Superior Court Rule under the auspices of O.C.G.A. § 19-13-53. To order a specific provision, please initial in the space provided. The court should delete or otherwise make inoperative any provision in the standardized form which is not supported by the evidence in the case and in order to comply with the court's application of the law and facts to an individual case.
FAMILY VIOLENCE THREE YEAR/PERMANENT PROTECTIVE ORDER
A hearing was held on this matter on __________, 20 ___ for which the Respondent had notice as required by law and at which the Respondent appeared and/or had the opportunity to be heard and the Petitioner requested that the Protective Order entered in this case be converted to a Permanent Family Violence Protective Order. This Court has determined that it had jurisdiction over the subject matter and the parties. Having heard the evidence presented, reviewed the Motion and the entire record concerning this case and for good cause shown, IT IS HEREBY ORDERED AND ADJUDGED:
1. That these proceedings be filed in the office of the Clerk of this Court.
That this Order applies in every county throughout the state and it shall be the duty of every court and every law enforcement official to enforce and carry out the provisions of this Order pursuant to O.C.G.A. § 19-13-4(d). Law Enforcement officers may use their arrest powers pursuant to O.C.G.A. §§ 19-13-6 and 17-4-20 to enforce the terms of this Order.
3. This Order and the Order issued __________, 20 ___ shall be permanent pursuant to O.C.G.A. § 19-13-4(c) and have NO expiration date.
OR
4. That the Respondent has violated the Family Violence Act, at O.C.G.A. § 19-13-1 pco 01 et seq., by committing family violence, has placed the Petitioner in reasonable fear for Petitioner's safety, and represents a credible threat to the physical safety of Petitioner and/or Petitioner's child/ren. Respondent is hereby enjoined and restrained from doing, or attempting to do, or threatening to do, any act of injury, maltreating, molesting, following, harassing, harming, or abusing the Petitioner and/or the minor child/ren in any manner. Respondent is not to interfere with Petitioner's travel, transportation, or communication. Respondent shall not follow, place under surveillance, or contact the Petitioner at any place of the Petitioner for the purpose of harassing and intimidating the Petitioner.
5. That the Respondent is enjoined and restrained from doing or attempting to do, or pco 02 threatening to do, any act of injury, maltreating, molesting, harassing, harming, or abusing the Petitioner's family or household.
6. That this Court determined that it had jurisdiction over the parties and the subject matter under the laws of the State of Georgia and Respondent received reasonable notice and had the opportunity to be heard before this Order was issued sufficient to protect the Respondent's due process rights and this Order shall be presumed valid and pursuant to18 U.S.C. § 2265(a) shall be accorded full faith and credit by any other state or local jurisdiction and shall be enforced as if an Order of the enforcing state or jurisdiction.
ONLY THE FOLLOWING THAT ARE INITIALED BY THE JUDGE SHALL APPLY
_____7. Respondent is ordered to stay away from Petitioner's and Petitioner's child/ren's
pco 04 residence and workplace and/or school and any subsequent residence or workplace or school of Petitioner and/or Petitioner's minor child/ren.
_____8. That Respondent is restrained and enjoined from approaching within 100 yards
pco 01, pco 04 of Petitioner and/or Petitioner's minor children.
_____9. Respondent is ordered not to have any contact, direct, indirect or through
pco 05 another person with Petitioner, by telephone, pager, fax, e-mail or any other means of communication except as specified in this Order.
_____10. That Petitioner is awarded custody of the minor child/ren, namely:
___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______
Respondent is ordered not to interfere with the physical custody of the minor child/ren.
_____ pco06 Initial here only if Respondent is awarded temporary custody of the child/ren.
_____ 11. The _____________ shall pay to the _______________, for the support of the minor child/ren, the sum of ______________________ Dollars ($___________________)
per _____________________, beginning _____________________, 20____.
All payments are to be made by or to: ____ income deduction order
child support receiver
by mail directly to the Petitioner
or ____ _____________________________
In determining child support the Court finds as follows:
The Father's gross monthly income (before taxes) is $__________;
The Mother's gross monthly income (before taxes) is $________________.
Number of children — The number of children for whom support is being provided under this order is _____________________.
Deviations:
() It has been determined that none of the Deviations allowed under OCGA § 19-6-15 applies in this case. OR
() It has been determined that one or more of the Deviations allowed under OCGA § 19-6-15 applies in this case, as shown by the attached Schedule E. The Presumptive Amount of Child Support that would have been required under OCGA § 19-6-15 if the deviations had not been applied is $________________ per month, as shown on the attached Child Support Worksheet. The attached Schedule E explains the reasons for the deviation, how the application of the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support, and how the best interest of the child/ren who is/are subject to this child support determination is served by deviation from the presumptive amount of child support.
The Child Support Order Addendum is attached and made a part of this Order.
_____12. Respondent is ordered to pay support for the Petitioner in the amount of $________ every ______beginning ____________.
All payments are to be made by or to: ____ income deduction order
_____ child support receiver
____ by mail directly to the Petitioner
or ____ _____________________________
_____13. Respondent shall have visitation with the minor child/ren according to the
following schedule, beginning__________________:
____ no visitation
____ no visitation until______________________
____ supervised visitation, supervised by a third party as follows:
______________________________________________________________________
____ visitation every other weekend from Friday at 6 p.m. until Sunday at 6 p.m beginning__________________, ___________
____ other visitation _________________________________________
circumstances concerning how Respondent shall pick up and return the minor
child/ren shall be _______________________________
Strict compliance with this visitation provision shall not be a violation of the restraining provisions of this Order.
_____ 14. (Respondent)(Petitioner) (both Respondent and Petitioner) [strike through appropriate] is/are ordered not to sell, encumber, trade, damage, contract to sell, or otherwise dispose of or remove from the jurisdiction of this Court any of the property or pets of the Petitioner or joint property or pets of the parties except in the ordinary course of business.
_____ 15. (Respondent)(Petitioner) (both Respondent and Petitioner) [strike through appropriate] is/are ordered not to disconnect or have disconnected home utilities, change or have changed and/or cancel or have canceled auto, health or life insurance for Respondent, Petitioner, and/or Petitioner's child/ren or interfere with Respondent, Petitioner's and/or Petitioner's child/ren's mail.
_____ 16. Petitioner is awarded costs and attorney fees in the amount of _______________.
____ 17. Petitioner/protected party is either a spouse, former spouse, parent of a common
pco 07 child, Petitioner's child, child of Respondent, cohabitates or has cohabited with Respondent and qualifies for 18 U.S.C. 922(g). It is further ordered that the Respondent shall not possess or purchase a firearm or ammunition as restricted by federal law under 18 U.S.C. 922(g)(8).
_____ 18. It is further Ordered: ___________________________________________________________
pco 08_____________________________________________________
SO ORDERED this _____ day of ___________________, _____.
___________________________ JUDGE, SUPERIOR COURT __________________ County ___________________________ Print or stamp Judge's name
Violation of the above Order may be punishable by arrest.
RESPONDENT'S IDENTIFYING FACT SHEET
(please complete as much as possible; one of these must be provided to have the order placed in the National Crime Information Center registry: Respondent's date of birth, social security number, or driver's license number) Respondent's social security number is _______________, date of birth is _________, sex ___, color of hair __________, color of eyes ______________, height _______, weight _____. Respondent's race is ______, ethnic background ____________. Respondent has distinguishing marks (tattoos, scars, etc.)_____________________. Respondent drives a _____________________, license tag no:____________(Expires:___) and has a ____(state) driver's license no: ______________(Expires:___). Respondent's home address _____________________________________________ and is employed by________________ at ___________________________________ and works from ____ to ____ on (days)___________. Respondent has the following known aliases: ___________________________.PROTECTED PARTIES' IDENTIFYING INFORMATION
Petitioner: ___________________________ DOB ____ sex ____ race ______ Other: ___________________________ DOB ____ sex ____ race ______ Other: ___________________________ DOB ____ sex ____ race ______ Other: ___________________________ DOB ____ sex ____ race ______"Transmitted to Georgia Protective Order Registry Date _______ Clerk ________ Pursuant to O.C.G.A.§ 19-13-3,
Petitioner assisted by
Name: ______________________________
Address: ____________________________
____________________________________
Phone: ______________________________
Note to Judges: This form is promulgated as a Uniform Superior Court Rule under the auspices of O.C.G.A. § 19-13-53. To order a specific provision, please initial in the space provided. The court should delete or otherwise make inoperative any provision in the standardized form which is not supported by the evidence in the case and in order to comply with the court's application of the law and facts to an individual case.
CHILD SUPPORT ADDENDUM TO FAMILY VIOLENCE PROTECTIVE ORDER
This Addendum is entered in conjunction with the Family Violence Protective Order dated __________________________ and supersedes any contradictory language in that order. This Addendum is intended to fulfill the requirements of O.C.G.A. § 19-6-15.
_____ 1. The Respondent is ordered to pay to the Petitioner support for the minor child/ren in the amount of $________ every _______________ beginning the _______ of ______________, _____.
All payments are to be made by or to: ____ income deduction order
____ child support receiver
____ by mail directly to the Petitioner
or ____ _______________________
In determining child support the Court finds as follows: The gross income of the father is $________ yearly or $_______ monthly. The gross income of the mother is $_______ yearly or $_______ monthly. Child support is being determined for ___ child/ren.
_____ 2. Social Security benefits of $_____ per month received by the child/ren on behalf of the Respondent have reduced the Respondent's presumptive child support obligation from $______to $______ per month.
_____ 3. Health insurance is available at a reasonable cost to Petitioner/Respondent (circle one). Petitioner/Respondent (circle one) shall provide health insurance for the parties' minor child/ren. The parent who maintains the insurance shall provide the other parent with an insurance identification card or other acceptable proof of insurance coverage and shall cooperate with the other parent in submitting claims under the policy.
_____ 4. The Respondent shall be responsible for ___% and Petitioner shall be responsible for ___% of the uninsured health care expenses for the minor child/ren.
_____ 5. The following deviation(s) to the child support calculations as outlined in O.C.G.A. § 19-6-15 applies in this case: ________________________________
___________________________________________________________
The reason for such deviation(s) is/are: ________________________________
___________________________________________________________
The presumptive amount of child support required under O.C.G.A. § 19-6-15 if the deviation had not been applied is $______ per month; however, the guidelines would be unjust or inappropriate considering the relative ability of each parent to provide support and it is in the best interest of these child/ren to deviate from the Presumptive Amount of Child Support because ____________
___________________________________________________________
Deviation from the presumptive amount of child support would not seriously impair the ability of the custodial parent to maintain minimally adequate housing, food, clothing, and other basic necessities for the child/ren being supported by this order.
_____ 6. The Respondent's parenting time as set forth in the visitation paragraph of the main order is ____days per year.
_____ 7. It is further ordered____________________________
__________________________________________________________
SO ORDERED this ____ day of ______________________, _____.
_______________________ SUPERIOR COURT JUDGE
_______________ County ________________________
Print or stamp Judge's name