# Supreme Court of Florida

____________

No. SC21

- 1 174

____________

IN RE: AMENDMENTS TO FLORIDA FAMILY LAW RULES

OF PROCEDURE

— FORM 12.902( e ).

January 13, 2022

PER CURIAM.

This matter is before the Court for consideration of proposed

amendments to Florida Family Law Rule of Procedure Form

12.902(e) (Child Support Guidelines Worksheet). See Fla. R. Gen.

Prac. & Jud. Admin. 2.140(b)(1). We have jurisdiction. See art. V, §

2(a), Fla. Const.

The Florida Bar’s Family Law Rules C ommittee (Committee)

filed a report proposing amendments to form 12.902(e). The

Committee and the Board of Governors of The Florida Bar approved

the proposed amendments. The Committee published its proposal

for comment prior to filing it with the Court a nd received one

comment in support of the proposed amendments. After the

Committee filed its report, the Court published the proposal for

## - 2

- comment. One comment was received in support of the proposed

amendments, and the Committee filed a response.

Having considered the proposed amendments, the comment,

and the Committee’s response, the Court hereby amends Florida

Family Law Rule of Procedure Form 12.902(e) (Child Support

Guidelines Worksheet) as proposed by the Committee, with a minor

modification.

First, a sentence is added to the instructions for form

12.902(e) providing that if the parties’ combined monthly net

income is not listed on the Child Support Guidelines Chart, child

support is to be calculated as provided by law. However, we modify

the sentenc e to specifically reference section 61.30(6), Florida

Statutes (Child support guidelines; retroactive child support), which

explains how to calculate the child support amount if the obligor

parent’s net income is less than the amount in the guidelines

sche dule or if the parties’ combined monthly net income is greater

than the amount in the guidelines schedule

.

Additionally, throughout the form’s instructions, references to

the Rules of Judicial Administration are amended to reflect the

updated name, the Rul es of General Practice and Judicial

## - 3

- Administration. See In re Amends. to Fla. Rules of Jud. Admin.

—

2020 Regular

- Cycle Report , 310 So. 3d 374 (Fla. 2021).

Accordingly, Form 12.902(e) is hereby amended as set forth in

the appendix to this opinion. The form is fully engrossed and ready

for use. The form may also be accessed and downloaded from the

Florida State Courts’ website at

https://www.flcourts.org/Resources

- Services/Court

Improvement/Family

- Courts/Family

- Law

- Self

- Help

Information/Family

- Law

- Forms . T he amendments shall become

effective April 1, 2022, at 12:01 a.m.

It is so ordered.

CANADY, C.J., and POLSTON, LABARGA, LAWSON, MUÑIZ,

COURIEL, and GROSSHANS, JJ., concur.

THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER

THE EFFECTIVE DATE OF THESE AM ENDMENTS.

Original Proceeding

– Florida Family Law Rules of Procedure

Ashley Elizabeth Taylor, Chair, Family Law Rules Committee,

Tampa, Florida, Joshua E. Doyle, Executive Director, and Mikalla

Andies Davis, Staff Liaison, The Florida Bar, Tallahassee, Florida,

for Petitioner

Heather L. Apicella, Chair, Family Law Section of The Florida Bar,

Boca Raton, Florida, Kristin R.H. Kirkner, Co

- Chair, Rules and

Forms Committee, Family Law Section of The Florida Bar, Tampa,

## - 4

- Florida, and Jack A. Mo ring, Co

- Chair, Rules and Forms

Committee, Family Law Section of The Florida Bar, Crystal River,

Florida,

Responding with commentsInstructions for Florida Family Law Rules of Procedure Form 12.902(e), Ch ild Support Guidelines Worksheet ( 0 4 / 22 )



## - 5

- APPENDIX

**INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE**

**FORM 12.902(e)**

**CHILD SUPPORT GUIDELINES WORKSHEET (0 4**  **/22)**

**When should this form be used?**

You should complete this worksheet if child support is being requested in your case. If you know the

income of the other party , this worksheet should accompany your financial affidavit . If you do not know

the other party’s income, this form must be completed after the other party files his or her financi al

affidavit, and serves a copy on you.

This form should be typed or printed in black ink. You should file this document with the clerk of the

circuit court in the county where your case is filed and keep a copy for your records.



### What should I do next?

A copy of this form must be filed with the court and served on the other party or his or her attorney. The

copy you are serving to the other party must be either mailed, emailed, or hand

- delivered to the opposing

party or his or her attorney on the same d ay indicated on the certificate of service. If it is mailed, it must

be postmarked on the date indicated in the certificate of service. Service must be in accordance with

Florida Rule of General Practice and Judicial Administration 2.516.



### IMPORTANT INFORMATION REGARDING E

**- FILING** 

The Florida Rules of General Practice and Judicial Administration now require that all petitions,

pleadings, and documents be filed electronically except in certain circumstances. Self

- represented

litigants may fil e petitions or other pleadings or documents electronically; however, they are not

required to do so. If you choose to file your pleadings or other documents electronically, you must do so

in accordance with Florida Rule of General Practice and Judicial Adm inistration 2.525, and you must

follow the procedures of the judicial circuit in which you file. The rules and procedures should be

carefully read and followed.



### IMPORTANT INFORMATION REGARDING E

**- SERVICE ELECTION** 

After the initial service of process of t he petition or supplemental petition by the Sheriff or certified

process server, the Florida Rules of General Practice and Judicial Administration now require that all

documents required or permitted to be served on the other party must be served by electr onic mail (e

mail) except in certain circumstances. You must strictly comply with the format requirements set forth

in the Florida Rules of General Practice and Judicial Administration . If you elect to participate in

electronic service, which means serving or receiving pleadings by electronic mail (e

- mail), or through the

Florida Courts E

- Filing Portal, you must review Florida Rule of General Practice and Judicial

Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of GeneralInstructions for Florida Family Law Rules of Procedure Form 12.902(e), Ch ild Support Guidelines Worksheet ( 0 4 / 22 )



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- Practice and Judicial Administration provided under either Family Law Forms: Getting Started, or Rules

of Court in the A

- Z Topical Index.

SELF

- REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E

- MAIL; HOWEVER, THEY ARE NOT

REQUIRED TO DO SO. If a self

- represented litigant elects to serve and receive documents by email, the

procedures must always be followed once the initial election is made.

To serve and receive documents by e

- mail, you must designate your e

- mail addresses by using the

Designatio n of Current Mailing and E

- mail Address , Florida Supreme Court Approved Family Law Form

12.915, and you must provide your e

- mail address on each form on which your signature appears.

Please CAREFULLY read the rules and instructions for: Certificate of Serv ice (General), Florida Supreme

Court Approved Family Law Form 12.914; Designation of Current Mailing and E

- mail Address , Florida

Supreme Court Approved Family Law Form 12.915; and Florida Rule of General Practice and Judicial

Administration 2.516.



### Where **can I look for more information?**

Before proceeding, you should read “General Information for Self

- Represented Litigants” found at the

beginning of these forms. The words that are in “ bold underline ” in these instructions are defined there.

For further i nformation, see section 61.30, Florida Statutes.



### Special notes. . .

If you want to keep your address confidential because you have been found by a judge to be the victim

of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravat ed battery or

domestic violence, do not enter the address, telephone, and fax information at the bottom of this form.

Instead, file Request for Confidential Filing of Address , Florida Supreme Court Approved Family Law

Form 12.980(h).

The chart below contains the guideline amounts that you should use when calculating child support. This

amount is based on the number of children and the combined income of the parents, and it is divided

between the parents in direct proportion to their i ncome or earning capacity. From time to time, some

of the amounts in the child support guidelines chart will change. Be sure you have the most recent version

of the chart before using it.

If the parties’ combined monthly net income is not listed on the below chart, then calculate child support

as provided by law in section 61.30(6), Florida Statutes.

Because the guidelines are based on monthly amounts, it may be necessary to convert some income and

expense figures from other frequencies to monthly. You should do this as follows:

If payment is twice per month Payment amount x 2 = Monthly amount

If payment is every two weeks Payment amount x 26 = Yearly amount due

Yearly amount ÷ 12 = Monthly amountInstructions for Florida Family Law Rules of Procedure Form 12.902(e), Ch ild Support Guidelines Worksheet ( 0 4 / 22 )



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- If payment is weekly Weekly amo unt x 52 = Yearly amount due

Yearly amount ÷ 12 = Monthly amount

If you or the other parent request that the court award an amount that is different than the guideline

amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines , Florida

Supreme Court Approved Family Law Form 12.943.

Reme mber, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these

forms, that person must give you a copy of a Disclosure from Nonlawyer , Florida Family Law Rules of

Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also

must put his or her name, address, and telephone number on the bottom of the last page of every form

he or she helps you complete.Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet

( 0 4 / 22 )



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- **CHILD SUPPORT GUIDELINES CHART**

Combined

Monthly

Available

Income One

Child Two

Children Three

Children Four

Children Five

Children Six

Children

800.00 190 211 213 216 218 220

850.00 202 257 259 262 265 268

900.00 213 302 305 309 312 315

950.00 224 347 351 355 359 363

1000.00 235 365 397 402 406 410

1050.00 246 382 443 448 453 458

1100.00 258 400 489 495 500 505

1150.00 269 417 522 541 547 553

1200.00 280 435 544 588 594 600

1250.00 290 451 565 634 641 648

1300.00 300 467 584 659 688 695

1350.00 310 482 603 681 735 743

1400.00 320 498 623 702 765 790

1450.00 330 513 642 724 789 838

1500.00 340 529 662 746 813 869

1550.00 350 544 681 768 836 895

1600.00 360 560 701 790 860 920

1650.00 370 575 720 812 884 945

1700.00 380 591 740 833 907 971

1750.00 390 606 759 855 931 996

1800.00 400 622 779 877 955 1022

1850.00 410 638 798 900 979 1048

1900.00 421 654 818 923 1004 1074

1950.00 431 670 839 946 1029 1101

2000.00 442 686 859 968 1054 1128

2050.00 452 702 879 991 1079 1154

2100.00 463 718 899 1014 1104 1181

2150.00 473 734 919 1037 1129 1207

2200.00 484 751 940 1060 1154 1234

2250.00 494 767 960 1082 1179 1261

2300.00 505 783 980 1105 1204 1287

2350.00 515 799 1000 1128 1229 1314

2400.00 526 815 1020 1151 1254 1340

2450.00 536 831 1041 1174 1279 1367

2500.00 547 847 1061 1196 1304 1394

2550.00 557 864 1081 1219 1329 1420

2600.00

2650.00

2700.00

2750.00

2800.00 568

578

588

597

607 880

896

912

927

941 1101

1121

1141

1160

1178 1242

1265

1287

1308

1328 1354

1379

1403

1426

1448 1447

1473

1500

1524

1549Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet

( 0 4 / 22 )



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-

Combined

Monthly

Available

Income One

Child Two

Children Three

Children Four

Children Five

Children Six

Children

2850.00 616 956 1197 1349 1471 1573

2900.00 626 971 1215 1370 1494 1598

2950.00 635 986 1234 1391 1517 1622

3000.00 644 1001 1252 1412 1540 1647

3050.00 654 1016 1271 1433 1563 1671

3100.00 663 1031 1289 1453 1586 1695

3150.00 673 1045 1308 1474 1608 1720

3200.00 682 1060 1327 1495 1631 1744

3250.00 691 1075 1345 1516 1654 1769

3300.00 701 1090 1364 1537 1677 1793

3350.00 710 1105 1382 1558 1700 1818

3400.00 720 1120 1401 1579 1723 1842

3450.00 729 1135 1419 1599 1745 1867

3500.00 738 1149 1438 1620 1768 1891

3550.00 748 1164 1456 1641 1791 1915

3600.00 757 1179 1475 1662 1814 1940

3650.00 767 1194 1493 1683 1837 1964

3700.00 776 1208 1503 1702 1857 1987

3750.00 784 1221 1520 1721 1878 2009

3800.00 793 1234 1536 1740 1899 2031

3850.00 802 1248 1553 1759 1920 2053

3900.00 811 1261 1570 1778 1940 2075

3950.00 819 1275 1587 1797 1961 2097

4000.00 828 1288 1603 1816 1982 2119

4050.00 837 1302 1620 1835 2002 2141

4100.00 846 1315 1637 1854 2023 2163

4150.00 854 1329 1654 1873 2044 2185

4200.00 863 1342 1670 1892 2064 2207

4250.00 872 1355 1687 1911 2085 2229

4300.00 881 1369 1704 1930 2106 2251

4350.00 889 1382 1721 1949 2127 2273

4400.00 898 1396 1737 1968 2147 2295

4450.00 907 1409 1754 1987 2168 2317

4500.00 916 1423 1771 2006 2189 2339

4550.00 924 1436 1788 2024 2209 2361

4600.00 933 1450 1804 2043 2230 2384

4650.00 942 1463 1821 2062 2251 2406

4700.00 951 1477 1838 2081 2271 2428

4750.00 959 1490 1855 2100 2292 2450

4800.00 968 1503 1871 2119 2313 2472

4850.00 977 1517 1888 2138 2334 2494

4900.00 986 1530 1905 2157 2354 2516

4950.00 993 1542 1927 2174 2372 2535Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet

( 0 4 / 22 )



## - 10

-

Combined

Monthly

Available

Income One

Child Two

Children Three

Children Four

Children Five

Children Six

Children

5000.00 1000 1551 1939 2188 2387 2551

5050.00 1006 1561 1952 2202 2402 2567

5100.00 1013 1571 1964 2215 2417 2583

5150.00 1019 1580 1976 2229 2432 2599

5200.00 1025 1590 1988 2243 2447 2615

5250.00 1032 1599 2000 2256 2462 2631

5300.00 1038 1609 2012 2270 2477 2647

5350.00 1045 1619 2024 2283 2492 2663

5400.00 1051 1628 2037 2297 2507 2679

5450.00 1057 1638 2049 2311 2522 2695

5500.00 1064 1647 2061 2324 2537 2711

5550.00 1070 1657 2073 2338 2552 2727

5600.00 1077 1667 2085 2352 2567 2743

5650.00 1083 1676 2097 2365 2582 2759

5700.00 1089 1686 2109 2379 2597 2775

5750.00 1096 1695 2122 2393 2612 2791

5800.00 1102 1705 2134 2406 2627 2807

5850.00 1107 1713 2144 2418 2639 2820

5900.00 1111 1721 2155 2429 2651 2833

5950.00 1116 1729 2165 2440 2663 2847

6000.00 1121 1737 2175 2451 2676 2860

6050.00 1126 1746 2185 2462 2688 2874

6100.00 1131 1754 2196 2473 2700 2887

6150.00 1136 1762 2206 2484 2712 2900

6200.00 1141 1770 2216 2495 2724 2914

6250.00 1145 1778 2227 2506 2737 2927

6300.00 1150 1786 2237 2517 2749 2941

6350.00 1155 1795 2247 2529 2761 2954

6400.00 1160 1803 2258 2540 2773 2967

6450.00 1165 1811 2268 2551 2785 2981

6500.00 1170 1819 2278 2562 2798 2994

6550.00 1175 1827 2288 2573 2810 3008

6600.00 1179 1835 2299 2584 2822 3021

6650.00 1184 1843 2309 2595 2834 3034

6700.00 1189 1850 2317 2604 2845 3045

6750.00 1193 1856 2325 2613 2854 3055

6800.00 1196 1862 2332 2621 2863 3064

6850.00 1200 1868 2340 2630 2872 3074

6900.00 1204 1873 2347 2639 2882 3084

6950.00 1208 1879 2355 2647 2891 3094

7000.00 1212 1885 2362 2656 2900 3103

7050.00 1216 1891 2370 2664 2909 3113

7100.00 1220 1897 2378 2673 2919 3123Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet

( 0 4 / 22 )



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-

Combined

Monthly

Available

Income One

Child Two

Children Three

Children Four

Children Five

Children Six

Children

7150.00 1224 1903 2385 2681 2928 3133

7200.00 1228 1909 2393 2690 2937 3142

7250.00 1232 1915 2400 2698 2946 3152

7300.00 1235 1921 2408 2707 2956 3162

7350.00 1239 1927 2415 2716 2965 3172

7400.00 1243 1933 2423 2724 2974 3181

7450.00 1247 1939 2430 2733 2983 3191

7500.00 1251 1945 2438 2741 2993 3201

7550.00 1255 1951 2446 2750 3002 3211

7600.00 1259 1957 2453 2758 3011 3220

7650.00 1263 1963 2461 2767 3020 3230

7700.00 1267 1969 2468 2775 3030 3240

7750.00 1271 1975 2476 2784 3039 3250

7800.00 1274 1981 2483 2792 3048 3259

7850.00 1278 1987 2491 2801 3057 3269

7900.00 1282 1992 2498 2810 3067 3279

7950.00 1286 1998 2506 2818 3076 3289

8000.00 1290 2004 2513 2827 3085 3298

8050.00 1294 2010 2521 2835 3094 3308

8100.00 1298 2016 2529 2844 3104 3318

8150.00 1302 2022 2536 2852 3113 3328

8200.00 1306 2028 2544 2861 3122 3337

8250.00 1310 2034 2551 2869 3131 3347

8300.00 1313 2040 2559 2878 3141 3357

8350.00 1317 2046 2566 2887 3150 3367

8400.00 1321 2052 2574 2895 3159 3376

8450.00 1325 2058 2581 2904 3168 3386

8500.00 1329 2064 2589 2912 3178 3396

8550.00 1333 2070 2597 2921 3187 3406

8600.00 1337 2076 2604 2929 3196 3415

8650.00 1341 2082 2612 2938 3205 3425

8700.00 1345 2088 2619 2946 3215 3435

8750.00 1349 2094 2627 2955 3224 3445

8800.00 1352 2100 2634 2963 3233 3454

8850.00 1356 2106 2642 2972 3242 3464

8900.00 1360 2111 2649 2981 3252 3474

8950.00 1364 2117 2657 2989 3261 3484

9000.00 1368 2123 2664 2998 3270 3493

9050.00 1372 2129 2672 3006 3279 3503

9100.00 1376 2135 2680 3015 3289 3513

9150.00 1380 2141 2687 3023 3298 3523

9200.00 1384 2147 2695 3032 3307 3532

9250.00 1388 2153 2702 3040 3316 3542Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet

( 0 4 / 22 )



## - 12

-

Combined

Monthly

Available

Income One

Child Two

Children Three

Children Four

Children Five

Children Six

Children

9300.00 1391 2159 2710 3049 3326 3552

9350.00 1395 2165 2717 3058 3335 3562

9400.00 1399 2171 2725 3066 3344 3571

9450.00 1403 2177 2732 3075 3353 3581

9500.00 1407 2183 2740 3083 3363 3591

9550.00 1411 2189 2748 3092 3372 3601

9600.00 1415 2195 2755 3100 3381 3610

9650.00 1419 2201 2763 3109 3390 3620

9700.00 1422 2206 2767 3115 3396 3628

9750.00 1425 2210 2772 3121 3402 3634

9800.00 1427 2213 2776 3126 3408 3641

9850.00 1430 2217 2781 3132 3414 3647

9900.00 1432 2221 2786 3137 3420 3653

9950.00 1435 2225 2791 3143 3426 3659

10000.00 1437 2228 2795 3148 3432 3666Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 13

- IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,

IN AND FOR COUNTY, FLORIDA

Case No.:

Division:

, Petitioner,

and

, Respondent.



## NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET

PLEASE TAKE NOTICE, that {name}

_ ______ , is filing his/her Child

Support Guidelines Worksheet attached and labeled Exhibit 1.



## CERTIFICATE OF SERVICE

I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was

[ check all used ]: ( ) e

- mailed ( ) mailed ( ) faxed ( ) hand delivered to the person(s) listed

below on {date}

__________ .

Other party or his/her attorney:

Name: _____________________________

Address:

____________________________ City, State, Zip: _______________________

Telephone Number: ___________________

Fax Number: _________________________

E

- mail Address(es): ____________________

Signature of Party or his/her Attorney

Printed Name:

_________________________ Address: ______________________________

City, State, Zip: _________________________

Telephone Number: _____________________

Fax Number: ___________________________

E

- mail Address(es): ______________________

Florida Bar Number: __

___________________Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 14

- CHILD SUPPORT GUIDELINES WORKSHEET

A . PETITIONER B. RESPONDENT TOTAL

1. Present Net Monthly Income

Enter the amount from line 27,

Section I of Florida Family Law

Rules of Procedure Form

12.902(b) or (c), Financial

Affidavit.

2. Basic Monthly Obligation

There is (are) {number}

_____ minor child(ren) common to the

parties. Using the total amount

from line 1, enter the appropriate

amount from the child support

guidelines chart.

3. Percent of Financial Responsibility

Divide the amount on line 1A by

the total amount on line 1 to get

Petitioner’s percentage of

financial responsibility. Enter

answer on line 3A. Divide the

amount on line 1B by the total

amount on line 1 to get

Respondent’s percentage

of financial responsibility. Enter

answer on line 3B. % %

4. Share of Basic Monthly Obligation

Multiply the number on line 2 by

the percentage on line 3A to get

Petitioner’s share of basic

obligation. Enter answer on line

4A. Multiply the number on line 2

by the percentage on line 3B to

Respondent’s share of basic

obligation.

Enter answer on line 4B.

Additional Support

— Health Insurance, Child Care & OtherFlorida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 15

- CHILD SUPPORT GUIDELINES WORKSHEET

A . PETITIONER B. RESPONDENT TOTAL

5. a. 100% of Monthly Child Care

Costs

[Child care costs should not exceed

the level required to provide quality

care from a licensed source. See

section 61.30(7), Florida Statutes,

for more information.]

b. Total Monthly Child(ren)’s Health

Insurance Cost

[This is only amounts actually paid

for health insurance on the

child(ren).]

c. Total Monthly Child(ren)’s

Noncovered Medical, Dental and

Prescription Medication Costs

d. Total Monthly Child Care & Health

Costs

[Add lines 5a + 5b +5c.]

6 . Additional Support Payments

Multiply the number on line 5d by

the percentage on line 3A to

determine the Petitioner’s share.

Enter answer on line 6A. Multiply the

number on line 5d by the percentage

on line 3B to determine the

Respondent’s share.

Enter answer on line 6B.

Statutory Adjustments/Credits

7

. a. Monthly child care payments

actually made

.

b. Monthly health insurance

payments actually ma de.Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 16

- CHILD SUPPORT GUIDELINES WORKSHEET

A . PETITIONER B. RESPONDENT TOTAL

c. Other payments/credits actually

made for any noncovered

medical, dental and prescription

medication expenses of the

child(ren) not ordered to be

separately paid on a percentage

basis. (See section 61.30 (8),

Florida Statutes.)

8 . Total Support Payments actually made

(Add 7a though 7c.)

9. MINIMUM CHILD SUPPORT

OBLIGATION FOR EACH PARENT

[Line 4 plus line 6; minus line 8.]

Substantial Time

- Sharing (GROSS UP METHOD) If each parent exercises time

- sharing at

least 20 percent of the overnights in the year (73 overnights in the year), complete Nos. 10

through 21.

10 . Basic Monthly Obligation x 150%

[Multiply line 2 by 1.5]

11 . Increased Basic Obligation for each

parent. Multiply the number on line

10 by the percentage on line 3A to

determine the Petitioner’s share.

Enter answer on line 11A. Multiply

the number on line 10 by the

percentage on line 3B to

determine the Respondent’s share.

Enter answer on line 11B.Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 17

- CHILD SUPPORT GUIDELINES WORKSHEET

A . PETITIONER B. RESPONDENT TOTAL

12. Percentage of overnight stays with

each parent. The child(ren) spend(s)

____overnight stays with the

Petitioner each year. Using the

number on the above line, multiply it

by 100 and divide by 365. Enter this

number on line 12A. The child(ren)

spend(s) _____ overnight stays with

the Respondent each year. Using the

number on the above line, multiply it

by 100 and divide by 365.

Enter this number on line 12B. % %

13 . Parent’s support multiplied by other

Parent’s percentage of overnights.

[Multiply line 11A by line 12B. Enter

this number in 13A. Multiply line 11B

by line 12A. Enter this number in

13B.]

Additional Support

— Health Insurance, Child Care & Other

14. a. Total Monthly Child Care Costs

[Child care costs should not

exceed the level required to

provide quality care from a

licensed source. See section

61.30(7), Florida Statutes, for

more information.]

b. Total Monthly Child(ren)’s Health

Insurance Cost. [This is only

amounts actually paid for

health insurance on the

child(ren).]

c. Total Monthly Child(ren)’s

Noncovered Medical, Dental and

Prescription Medication Costs.

d. Total Monthly Child Care & Health

Costs [Add lines 14a + 14b + 14c.]Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 18

- CHILD SUPPORT GUIDELINES WORKSHEET

A . PETITIONER B. RESPONDENT TOTAL

15 . Additional Support Payments.

Multiply the number on line 14d by

the percentage on line 3A to

determine the Petitioner’s share.

Enter answer on line 15A. Multiply

the number on line 14d by the

percentage on line 3B to determine

the Respondent’s share. Enter

answer on line 15B.

Statutory Adjustments/Credits

16. a. Monthly child care payments

actually made.

b. Monthly health insurance

payments actually made.

c. Other payments/credits

actually made for any

noncovered medical, dental and

prescription medication

expenses of the child(ren) not

ordered to be separately paid

on a percentage basis. [See

section 61.30(8), Florida

Statutes.]

17 . Total Support Payments actually

made [Add 16a though 16c.]

18 . Total Additional Support Transfer

Amount [Line 15 minus line 17;

enter any negative number as

zero.]

19 . Total Child Support Owed from

Petitioner to Respondent [Add line

13A plus 18A.]

20. Total Child Support Owed from

Respondent to Petitioner. [Add line

13B plus line 18B.]Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (0 4 /22)



## - 19

- CHILD SUPPORT GUIDELINES WORKSHEET

A . PETITIONER B. RESPONDENT TOTAL

21. Presumptive Child Support to Be

Paid. [Comparing lines 19 and 20,

Subtract the smaller amount owed from

the larger amount owed and enter the

result in the column for the parent that

owes the larger amount of support.]

] $

ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent is requesting the Court to award a

child support amount that is more or less than the child support guidelines, you must complete and file

Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form

12.943.

[check one only]

a. ____ Deviation from the guidelines amount is requested. The Motion to Deviate from Child

Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is attached.

b. ____ Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child

Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is not attached.

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the: {choose only one } ____ Petitioner ____ Respondent

This form was completed with the assistance of:

{name of individual}

, {name of business}

____________________________________________________________, {address} ____________________________________________________________________

, {city}

__________________, {stat e} ____

, {zip code}

______, {telephone number} _________