Parenting Plan Part B – Support – Page 1 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
EXHIBIT NO. __________
IN THE CIRCUIT COURT OF _____________________, MISSOURI
(County where court is located)
_________________ _____________ ____________________ _________ (First) (Middle) (Last) (Jr./Sr./III)
Petitioner/Plaintiff, Case No. ____________
-and-
Division No. ____________ _________________ _____________ ____________________ _________ (First) (Middle) (Last) (Jr./Sr./III)
Respondent/Defendant.
PARENTING PLAN
Part B – Support of the Children
1. Identification of Parties
Check one and only one of the following two boxes.
Mother is the Petitioner/Plaintiff. Father is the Respondent/Defendant.
Father is the Petitioner/Plaintiff. Mother is the Respondent/Defendant.
2. Plan Author(s)
Check all applicable boxes.
Court
Mother
Father
Guardian ad Litem
_________________________
3. Names and Ages of Children
Enter the total number of children to whom this parenting plan is applicable: ___________.
The names and ages of the children (hereinafter referred to simply as “the children”) are as follows:
Full Name of Child Child’s Age
If this parenting plan is filed after
the case has been filed, you
MUST enter the Case Number.
Parenting Plan Part B – Support – Page 2 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Child Support Calculations
Child Support
Child support is an amount of money paid by one parent to the other parent for the support of the children. In addition
to a regular monthly child support payment, other expenses of the children may be divided between the parents as child
support. Part B of the Parenting Plan contains the calculation of child support and the allocation of the children’s
expenses.
Form 14
Form 14 is a form used to calculate a presumed amount of child support. Form 14 is part of this parenting plan and is
found on Part B, Page 8. The court will usually follow Form 14, however, if the court finds that the child support
calculated pursuant to Form 14 is unjust or inappropriate, it will set child support at a different amount.
Parents must also determine the allocation and amount of other expenses of the children such as medical and dental
insurance, uncovered medical and dental expenses, day care, and other extraordinary expenses. These expenses constitute
part of the child support obligations of each parent. These other expenses may be included in the Form 14 calculation, or
they may be paid independently of the child support payment.
Parents may agree on an amount of child support and the allocation of expenses. The court does not have to accept
this agreement and can set different support amounts. Even if the parents have agreed on an amount of child support,
THEY MUST STILL CALCULATE A FORM 14 FOR THE COURT. As they work through this parenting plan, they
will also be entering the information that is required for Form 14.
Missouri law further provides that “An award of joint physical custody does not preclude an award of child support
pursuant to Section 452.340 and applicable supreme court rules in determining an amount reasonable or necessary for the
support of the child.” §452.375.12, RSMo. Child support may be appropriate even if both parties have custody of the
children an equal amount of time.
4. Party to Pay Child Support
One party must be called the “parent paying support” and one person must be called the “parent receiving support”.
This is true even if no child support is going to be paid.
You must check one and only one of the following four boxes.
Mother will pay regular monthly child support to Father.
Mother is referred to as “person paying support” and Father is referred to as “person receiving support”.
Father will pay regular monthly child support to Mother.
Father is referred to as “person paying support” and Mother is referred to as “person receiving support”.
No regular monthly child support will be paid by either parent.
Mother will be referred to as “person paying support” and Father will be referred to as “person receiving support”
for the purpose of the Form 14 child support calculation only.
No regular monthly child support will be paid by either parent.
Father will be referred to as “person paying support” and Mother will be referred to as “person receiving support”
for the purpose of the Form 14 child support calculation only.
Parenting Plan Part B – Support – Page 3 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Medical and Dental Insurance for the Children
Cost of Medical or Dental Insurance for the Children
The cost of medical or dental insurance for the children is the monthly amount of any premium paid. If the parent’s
employer deducts the amount of premium from his or her pay, then the cost of medical or dental insurance includes the
amount of the premium paid. It does not include the cost of medical or dental insurance for the parent, the parent’s spouse,
or other children that are not covered by this parenting plan. The cost of medical or dental insurance for the children is
included on Line 6c of Form 14.
Form 14 states: “If the amount of the actual health insurance costs for the children who are the subject of this
proceeding is not available or cannot be verified, the amount of the health insurance costs attributable to the children who
are the subject of this proceeding shall be calculated by dividing the total monthly costs for the policy of health insurance
by the total number of persons for whom the costs are paid or to be paid and then multiplying the resulting figure by the
number of children insured under the policy who are the subject of this proceeding.”
5. Parent Responsible for Medical Insurance
You must check one and only one of the following three boxes.
Neither party is required to maintain medical insurance for the benefit of the children. A health benefit plan is not
available at reasonable cost through either parent’s employer or union. No support rights have been assigned to the state
of Missouri and the Family Support Division is not providing support enforcement services to either party.
Father shall maintain and pay the cost of medical insurance for the benefit of the children.
Mother shall maintain and pay the cost of medical insurance for the benefit of the children.
6. Parent Responsible for Dental Insurance
You must check one and only one of the following three boxes.
Neither party is required to maintain dental insurance for the benefit of the children. A health benefit plan is not
available at reasonable cost through either parent’s employer or union. No support rights have been assigned to the state
of Missouri and the Family Support Division is not providing support enforcement services to either party.
Father shall maintain and pay the cost of dental insurance for the benefit of the children.
Mother shall maintain and pay the cost of dental insurance for the benefit of the children.
7. Medical and Dental Insurance for the Children
The total cost of medical and dental insurance paid by Father for the children is ___________ per month. The total
cost of medical and dental insurance paid by Mother for the children is ___________ per month.
You must enter an amount on both lines, even if you enter “0”. These amounts should also be entered on line 6c of Form
14.
In the event either parent is required to maintain medical or dental insurance, the parent providing the health benefit
plan shall provide to the other parent an insurance identification card.
If support rights have been assigned to the state of Missouri or the Family Support Division is providing support
enforcement services to either party, the person paying support shall notify the Family Support Division regarding the
availability of medical insurance coverage through an employer or a group plan, provide the name of the insurance
provider when coverage is available, and inform the division of any change in access to such insurance coverage.
Parenting Plan Part B – Support – Page 4 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Health Expenses Not Covered by Insurance
8. Medical, Dental, Vision, or Psychological Expenses not Covered by Insurance
You must check one and only one of the following four boxes.
The person receiving support will pay all reasonable and necessary medical and dental expenses of the children not
covered by insurance and the person paying support will reimburse the person receiving support for _______ percent of all
such expenses that are actually paid by the person receiving support and are in excess of $250 per year per child. This
does not include the uninsured extraordinary costs set forth in paragraph 9 below. No reimbursement of uncovered
medical and dental expenses of the children will be allowed unless the person receiving support submits proof of such
expenses to the person paying support in writing within 120 days of the date said expenses were incurred. Except for good
cause, no legal proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said
expenses were incurred.
Medical and dental expenses are defined by §213(d)(1)(A) of the Internal Revenue Code.
(§454.633.3, RSMo provides that if you have checked this first box in Paragraph 8 and you have not provided a
percentage, then each parent will be responsible for one-half of all reasonable and necessary medical or dental expenses
of the children not covered by insurance except as set forth in Paragraph 9 below.)
The person paying support does not have the financial resources to contribute to the payment of medical or dental
expenses of the children not covered by insurance. The person receiving support will be responsible for all reasonable and
necessary medical or dental expenses of the children not covered by insurance. This does not apply to the medical costs
listed in Paragraph 9 below. §454.603.5(2) RSMo.
All reasonable and necessary medical or dental expenses of the children are covered by insurance.
§454.603.5(1), RSMo.
The person receiving support has not substantially complied with the terms of the health benefit coverage. The person
receiving support will be responsible for all reasonable and necessary medical or dental expenses of the children not
covered by insurance. This does not apply to the medical costs listed in Paragraph 9 below. §454.603.5(3), RSMo.
9. Payment of Uninsured Extraordinary Medical Costs
Extraordinary medical costs are predictable and recurring, such as expenses for dental treatment, orthodontic
treatment, asthma treatment and physical therapy. These expenses MAY be included in the Form 14 calculation. (If no
extraordinary medical costs are to be included on Form 14, you may leave this information blank.)
Uncovered Extraordinary Medical Costs to be Paid by
Father INCLUDED on Form 14 Amount of Expense
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
The total cost of these uncovered extraordinary medical costs of the children is $___________ per
month. This amount HAS been included in the child support calculation pursuant to Form 14. (You must
include this amount on Form 14 - Line 6d)
Uncovered Extraordinary Medical Costs to be Paid by
Mother INCLUDED on Form 14 Amount of Expense
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
The total cost of these uncovered extraordinary medical costs of the children is $___________ per
month. This amount HAS been included in the child support calculation pursuant to Form 14. (You must
include this amount on Form 14 - Line 6d)
Paid by Father
Paid by Mother
Parenting Plan Part B – Support – Page 5 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Child Care Expenses
Child care expenses related to employment are expenses incurred by a parent during periods of time while the parent
is working and the children are in his or her physical custody.
10. Work-Related Child Care Costs
You must check one and only one of the following five boxes
There are no reasonable work-related child care expenses incurred by the parties.
The reasonable work-related child care costs of the children to be paid by Father are $___________ per month. This
amount has been included in the child support calculation pursuant to Form 14. The reasonable work-related child care
costs of the children to be paid by Mother are $___________ per month. This amount has also been included in the child
support calculation pursuant to Form 14.
(You must include these amounts on Form 14 - Line 6a(1) for the parent receiving support or Line 6b for the parent
paying support.)
Mother will pay all reasonable work-related child care expenses. The cost of reasonable work-related child care
expenses has NOT been included in the child support calculation pursuant to Form 14. Father will reimburse Mother for
_______ percent of all reasonable work-related child care expenses actually paid by Mother. Mother will not be entitled to
reimbursement from Father unless said payments are appropriately reported to the Internal Revenue Service. No
reimbursement of reasonable work-related child care expenses will be allowed unless Mother submits proof of such
expense to Father in writing within 120 days of the date said expenses were incurred. Except for good cause, no legal
proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said expenses were
incurred.
Father will pay all reasonable work-related child care expenses. The cost of reasonable work-related child care
expenses has NOT been included in the child support calculation pursuant to Form 14. Mother will reimburse Father for
_______ percent of all reasonable work-related child care expenses actually paid by Father. Father will not be entitled to
reimbursement from Mother unless said payments are appropriately reported to the Internal Revenue Service. No
reimbursement of reasonable work-related child care expenses will be allowed unless Father submits proof of such
expense to Mother in writing within 120 days of the date said expenses were incurred. Except for good cause, no legal
proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said expenses were
incurred.
Each parent will pay his or her own reasonable work-related child care expenses related to his or her employment.
The cost of reasonable work-related child care expenses has NOT been included in the child support calculation pursuant
to Form 14. Neither parent will reimburse the other parent for any portion of the child care expenses.
11. Child Care Expenses Unrelated to Employment
Incidental child care costs not related to employment are to be paid by the party with physical custody at the time the
child care costs are incurred.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Parenting Plan Part B – Support – Page 6 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Extraordinary Child-Rearing Costs of the Children
Including College Costs
Extraordinary Child-Rearing Costs
Extraordinary child-rearing costs may include, but are not limited to, the following expenses:
Educational expenses for college or post-secondary education,
Special, private or parochial elementary and secondary schooling expenses,
Tutoring sessions,
Camps,
Lessons,
Athletic activities,
Travel and other activities intended to enhance the athletic, social or cultural development of a child.
12. Educational Expenses for College or Post-Secondary Education
As used herein, educational expenses for college or post-secondary education (also referred to as college expenses)
include tuition, fees, books, dormitory cost for room and board. It does not include room and board while residing with
either parent. This term shall be the actual cost to the child. In the event the child receives a scholarship or other aid
which reduces the tuition, fees, books, or dormitory costs for room and board, then the educational expenses for college or
post-secondary education does not include the amount of such scholarship or aid. For this purpose, loans to the student
shall not be considered ‘scholarship or other aid’.
The maximum educational expenses for college or post-secondary education, as defined herein, shall not exceed the
cost for tuition, fees, books, and dormitory costs for room and board at the University of Missouri at Columbia, regardless
of what institution the child attends.
Responsibility for educational expenses for college or post-secondary education shall not exceed more than eight
semesters at a college or university.
Continued Eligibility for Child Support when Child is in College
§452.340.5, RSMo provides that “[t]o remain eligible for such continued parental support, at the beginning of each
semester the child
shall submit to each parent a transcript or similar official document provided by the institution of
vocational or higher education which includes the courses the child is enrolled in and has completed for each term, the
grades and credits received for each such course, and an official document from the institution listing the courses which
the child is enrolled in for the upcoming term and the number of credits for each such course.”
The child must carry a minimum number of credit hours each semester.
13. Extraordinary Child-Rearing Costs
Extraordinary child-rearing costs incurred by the parents may be included on Form 14, or the parents may agree to
divide these costs on some percentage basis. The extraordinary child-rearing costs are to be paid as set forth in the next
paragraph. (Paragraph 14 of this Parenting Plan)
Parenting Plan Part B – Support – Page 7 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
14. Payment of Extraordinary Child-Rearing Costs of the Children
a. Extraordinary Child-Rearing Costs INCLUDED on Form 14
Extraordinary Child-Rearing Costs Paid by
Father INCLUDED on Form 14 Amount of Expense
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
The total cost of these extraordinary child-rearing costs of the children is $___________ per month.
This amount HAS been included in the child support calculation pursuant to Form 14. (You must include
this amount on Form 14 - Line 6e)
Extraordinary Child-Rearing Costs Paid by
Mother INCLUDED on Form 14 Amount of Expense
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
_______________________________________________________ $___________ per month
The total cost of these extraordinary child-rearing costs of the children is $___________ per month.
This amount HAS been included in the child support calculation pursuant to Form 14. (You must include
this amount on Form 14 - Line 6e)
b. Extraordinary Child-Rearing Costs NOT INCLUDED on Form 14
Extraordinary Child-Rearing Costs Paid by
Father NOT INCLUDED on Form 14 Percentage to be Paid by
Mother to Father
_______________________________________________________ _______%
_______________________________________________________ _______%
_______________________________________________________ _______%
Mother will reimburse Father for the percentage amount of each of these extraordinary child-rearing costs
of the children so long as they are actually paid by Father. No reimbursement of extraordinary child-
rearing costs of the children will be allowed unless Father submits proof of such expense to Mother in
writing within 120 days of the date said expenses were incurred. Except for good cause, no legal
proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said
expenses were incurred.
Extraordinary Child-Rearing Costs Paid by
Mother NOT INCLUDED on Form 14 Percentage to be Paid by
Father to Mother
_______________________________________________________ _______%
_______________________________________________________ _______%
_______________________________________________________ _______%
Father will reimburse Mother for the percentage amount of each of these extraordinary child-rearing costs
of the children so long as they are actually paid by Mother. No reimbursement of extraordinary child-
rearing costs of the children will be allowed unless Mother submits proof of such expense to Father in
writing within 120 days of the date said expenses were incurred. Except for good cause, no legal
proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said
expenses were incurred.
Paid by Mother
Paid by Father
Paid by Mother
Paid by Father
Parenting Plan Part B – Support – Page 8 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
FORM NO.14 CHILD SUPPORT AMOUNT CALCULATION WORKSTATION
FATHER / MOTHER is the “Parent Paying Support”
Total Number of Children: _______________ PARENT
RECEIVING
SUPPORT PARENT
PAYING
SUPPORT COMBINED
1. MONTHLY GROSS INCOME
1a. Monthly court-ordered maintenance being received
2. ADJUSTMENTS
2a. Other monthly child support being paid under court or administrative order
2b. Monthly court-ordered maintenance being paid
2c. Monthly support obligation for other children.
(1) Number of other children primarily residing in each parent’s custody
(2) Each parent’s support obligation from support schedule using the parent’s
Line 1 monthly gross income
(3) Monthly child support received under court or administrative order for
children included in line 2c(1)
2c. TOTAL adjustment [Line 2c(2) minus Line 2c(3)]
3. ADJUSTED MONTHLY GROSS INCOME (sum of lines 1 and 1a, minus lines 2a,
2b and 2c).
4. PROPORTIONATE SHARE OF COMBINED ADJUSTED MONTHLY GROSS
INCOME (Each parent’s line 3 income divided by combined line 3 income).
5. BASIC CHILD SUPPORT AMOUNT
(From support chart using combined line 3 income).
6. ADDITIONAL CHILD-REARING COSTS OF PARENTS
6a. Child Care Costs of Parent Receiving Support
(1) Reasonable work-related child care costs of the parent receiving support.
(2) Child Care Tax Credit (See Form 14 Directions)
6a. TOTAL adjusted Child Care Costs [Line 6a(1) minus Line 6a(2)]
6b. Reasonable work-related child care costs of the parent paying support
6c. Health insurance costs for the children who are subjects of this proceeding
6d. Uninsured agreed-upon or court-ordered extraordinary medical costs
6e. Other agreed-upon or court-ordered extraordinary child-rearing costs
7. TOTAL ADDITIONAL CHILD-REARING COSTS (Enter sum of lines 6a, 6b, 6c,
6d and 6e).
8. TOTAL COMBINED CHILD SUPPORT COSTS (Sum of line 5 and line 7).
9. EACH PARENT’S SUPPORT OBLIGATION (Multiply line 8 by each parent’s line
4)
10. CREDIT FOR ADDITIONAL CHILD-REARING COSTS (Line 7 of parent paying
support).
11. ADJUSTMENT FOR A PORTION OF THE AMOUNTS EXPENDED DURING
PERIODS OF OVERNIGHT VISITATION OR CUSTODY. (See Form 14
Directions) (Multiply line 5 by ___________ %).
12. PRESUMED CHILD SUPPORT AMOUNT (Line 9 minus lines 10 and 11).
Parenting Plan Part B – Support – Page 9 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Amount of Child Support
15. Presumed Monthly Amount of Child Support
Complete all applicable amounts. The court-ordered support amount is set forth in Part B, Paragraph 17.
The presumed child support amount calculated pursuant to Form 14 for six children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for five children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for four children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for three children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for two children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for one child is: ____________.
16. Should the court order the child support pursuant to Missouri Child Support Guidelines?
You must check one and only one of the following two boxes.
Yes. The court-ordered child support is the same as the presumed children support amount. The presumed
child support amount as calculated herein is not rebutted as being unjust and inappropriate.
No. The court-ordered child support is different than the presumed children support amount. After
consideration of all relevant factors pursuant to §452.340.8, RSMo and Form 14, the child support as calculated
herein is rebutted as being unjust and inappropriate.
NOTE: Court-ordered child support will be set at the time of the court proceeding. The court is not bound by
the suggestions of the parties and may set an amount greater or lesser than the suggested amounts of court-
ordered child support set forth in this parenting plan. If the court approves and adopts this plan, then the
support provisions herein will become the order of the court.
17. Court-Ordered Child Support
This is the amount of child support that actually will be paid by the parent paying support.
You must check all applicable boxes.
Six or More Children - The person paying support is to pay to the person receiving support
____________ per month when the person receiving support is entitled to support for six or more children
covered by this parenting plan.
Five Children - The person paying support is to pay to the person receiving support ____________ per
month when the person receiving support is entitled to support for five children covered by this parenting plan.
Four Children – The person paying support is to pay to the person receiving support ____________ per
month when the person receiving support is entitled to support for four children covered by this parenting plan.
Three Children - The person paying support is to pay to the person receiving support ____________ per
month when the person receiving support is entitled to support for three children covered by this parenting plan.
Two Children - The person paying support is to pay to the person receiving support ____________ per
month when the person receiving support is entitled to support for two children covered by this parenting plan.
One Child - The person paying support is to pay to the person receiving support ____________ per month
when the person receiving support is entitled to support for one child covered by this parenting plan.
NOTE: You should check each box that applies. For example, if this parenting plan pertains to three
children, then you should check the boxes for three children, two children and one child. You should also enter
an amount of support for three children, two children, and one child respectively. You must attach a Form 14
for each level. For example, if you have three children, then you must attach one Form 14 for three children,
one Form 14 for two children, and one Form 14 for one child.
If you check one of the boxes above, you must check all the boxes below it. Once again, if you only check
the box for two children and do not check the box for one child, then no support is owed when only one child
remains.
Parenting Plan Part B – Support – Page 10 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
18. Starting Date for Child Support
You must check one and only one of the following two boxes if either party is paying child support in Part B,
Paragraph 17.
The first child support payment is due on the date of the entry of the judgment.
The first child support payment is due on _______________________.
Notification by the Person Receiving Support when Child Support Changes
Missouri law provides that “[u]nless otherwise agreed in writing or expressly provided in the judgment,
provisions for the support of the child are terminated by emancipation of the child. The parent entitled to
receive child support shall have the duty to notify the parent obligated to pay support of the child’s
emancipation and failing to do so, the parent entitled to receive child support shall be liable to the parent
obligated to pay support for child support paid following emancipation of a minor child, plus interest.”
§452.370.4, RSMo.
Income Tax Considerations
19. Income Tax Dependents
The parties shall be entitled to claim the minor children as dependents for income tax purposes as follows:
(Person paying support must be current with all support obligations as of December 31 of the tax year in which
the child is to be claimed. Each parent will sign any appropriate documents to allow the other parent to make
such claims.)
NOTE: The Form 14 calculation assumes that the person receiving support will claim the children as
dependents. If the person paying support is entitled to claim one or more of the children, then the Form 14
guidelines are unjust and inappropriate and the second box in Paragraph 16 should be checked.
If the person claiming the children is not listed below, then the person receiving support shall be entitled to
claim the omitted children as dependents in all years.
Name of Child In odd numbered tax years, this parent will claim this child as a dependent
In even numbered tax years, this parent will claim this child as a dependent
Parenting Plan Part B – Support – Page 11 Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov
Payment of Child Support and Wage Assignments
Wage Assignment
A wage assignment means that the child support is taken directly out of the paycheck of the person paying
support. The amount withheld is sent to the Family Support Payment Center. The Family Support Payment
Center will then forward the support to the person receiving support. Child support withheld pursuant to a wage
assignment cannot be sent directly to the party receiving support. A record will be kept of all payments.
If a wage assignment is not ordered, then the child support may be paid directly to the person receiving
support. The person paying support may also voluntarily send payments to the Family Support Payment Center.
If the child support is not paid to the Family Support Payment Center, it is extremely important that each parent
keep accurate records of the amount of child support paid. This means that the party paying support may not
receive credit for his or her payments if he or she does not have receipts or cancelled checks. Because of this, it
is proper to request a receipt from the parent receiving support.
If the person paying support is currently unemployed or self-employed, the wage assignment may still be
ordered, but it will not take effect until the person paying support begins receiving regular wages.
20. Method of Payment of Child Support
You must check one and only one of the following five boxes if either party is paying child support in Part B,
Paragraph 17.
A wage assignment will not issue because a written agreement has been reached between the parties that
provides for an alternative arrangement. Child support shall be paid directly to the person receiving support.
A wage assignment will not issue because there is good cause not to require immediate income withholding
for the reason that implementation of an immediate wage withholding would not be in the best interest of the
child and the person paying support has made timely payments of all previously ordered support. Child support
shall be paid directly to the person receiving support.
A wage assignment will not issue because a written agreement has been reached between the parties that
provides for an alternative arrangement. Child support shall be paid directly to the Family Support Payment
Center, PO Box 109001, Jefferson City, Missouri, 65110-9001.
A wage assignment will not issue because there is good cause not to require immediate income withholding
for the reason that implementation of an immediate wage withholding would not be in the best interest of the
child and the person paying support has made timely payments of all previously ordered support. Child support
shall be paid directly to the Family Support Payment Center, PO Box 109001, Jefferson City, Missouri, 65110-
9001.
A wage assignment will be prepared by the person receiving support and issued by the Circuit Clerk upon
the effective date of this judgment. Child support is ordered to be paid to the Family Support Payment Center,
PO Box 109001, Jefferson City, Missouri, 65110-9001.
21. Additional Provisions Pertaining to Support of the Children:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
____________________________ ____________________________ ____________________________
Mother Father Guardian ad Litem
____________________________ ____________________________
Attorney for Mother Attorney For Father
