Fill - Free fillable 4e9edded422de DISSOLUTION OF MARRIAGE FORMS PACKAGE PDF form

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FATHER’S PETITION FOR

DECLARATION OF

PATERNITY FORMS

Do not file this page with the court.

FATHER’S PETITION FOR DECLARATION OF PATERNITY,

CUSTODY AND/OR SUPPORT FORMS PACKAGE

Introduction

The Unauthorized Practice of Law

These forms are provided at no cost to you by the Missouri Supreme Court

Committee on Access to Family Courts so that you may have access to the

Missouri Courts. It is a crime for another person to charge you a fee for preparing

these forms for you unless that person is a licensed lawyer. If anyone other than

a lawyer attempts to charge you for preparing these forms, you should notify the

Office of Chief Disciplinary Counsel, 3335 American Avenue, Jefferson City,

Missouri, 65109.

General Information about All Forms

Information that you enter on these forms can be saved on your computer ONLY if

you are using Adobe Acrobat version 8.0 or higher. They can be completed using

the free Adobe Reader, but you will not be able to save the information you enter.

The forms listed below are interactive. You can enter the information on

these forms before you print them. If you fill the forms in on your computer, much

of the information you enter on one form is automatically transferred to other

forms. For example, if you type your first name on the “Father’s Petition for

Declaration of Paternity, Custody and/or Support,” your first name will also

appear on the other forms.

Some forms refer to the mother and father as the parties, while other forms

refer to the parties as the Plaintiff and the Defendant. The Parenting Plan refers

to the Mother and Father. It is assumed that you are the father of the children

and that you are the person that is filing the case.

This package also contains bookmarks. These bookmarks help you to

navigate throughout these forms. In addition, there are “links” embedded in the

forms. These links are usually green, and can take you to a related location in the

forms.

If all of the other parties sign an “Answer” so that service of process is not

required, then you only have to file one copy of the “Petition for Declaration of

Paternity, Custody and/or Support”, “Income and Expense Statement”, “Property

and Debt Statement”, and “Parenting Plan”. If all of the other parties do not sign

an “Answer”, then you must file one additional copy of all of these forms for each

of the defendants that has to be served. You should also keep a copy of these

forms for your records.

Some additional forms may be required by some Missouri Courts. You should

check with your local court.

Do not file this page with the court.

TABLE OF CONTENTS

1. Father’s Petition for Declaration of Paternity, Child Custody and/or

Support (Form CAFC301)

This is the first form you should complete. Information that you enter on this form

will be transferred to all the other forms in the package.

2. Parenting Plan (Form CAFC501)

There are two parts to this form, Part A and Part B. Part A deals with custody

issues of the children, and Part B deals with support issues of the children.

If you have different custody or support arrangements for some of the

children, you must complete a separate Parenting Plan for each set of children.

You do not have to file a parenting plan. You must file Part A of the Parenting

Plan if you want the court to enter child custody orders with respect to the

children. You must file Part B of the Parenting Plan if you want the court to enter

child support orders with respect to the children.

3. Income and Expense Statement (Form CAFC250)

This form requires that you list income and expenses for both you and the other

party. A lawyer can assist you in finding out this information.

4. Property and Debt Statement (Form CAFC240)

This form is required by most courts and helps the court reach a decision in your

case.

5. Answer to Father’s Petition for Declaration of Paternity, Child Custody

and/or Support (Form CAFC311) Copy for Mother

There are three separate copies of this form in this package. This first copy

should be used by the mother of the children. Mother may sign this form if she

does not want to be personally served. By signing this form, Mother is allowing

the court to decide your case. Mother may also use this form to disagree with

your statements on your forms.

6. Answer to Father’s Petition for Declaration of Paternity, Child Custody

and/or Support (Form CAFC311) Copy for First Presumed Father

There are three separate copies of this form in this package. This second copy

should be used by the person that you are alleging is a presumed father of the

children. The First Presumed Father may sign this form if he does not want to be

personally served. By signing this form, the First Presumed Father is allowing the

court to decide your case. The First Presumed Father may also use this form to

disagree with your statements on your forms.

Print All Forms

Do not file this page with the court.

7. Answer to Father’s Petition for Declaration of Paternity, Child Custody

and/or Support (Form CAFC311) Copy for Second Presumed Father

There are three separate copies of this form in this package. This third copy

should be used by the person that you are alleging is another presumed father of

the children. The Second Presumed Father may sign this form if he does not

want to be personally served. By signing this form, the Second Presumed Father

is allowing the court to decide your case. The Second Presumed Father may also

use this form to disagree with your statements on your forms.

8. Paternity Judgment (Form CAFC370)

This is a “proposed” judgment. Different courts handle the preparation of the

judgment in different ways. In some courts, the judge will direct you to prepare a

judgment, and in other courts, the judge will prepare the judgment.

9. Filing Information Sheet (Form CAFC067)

This form is required by most courts to enter the information about your case into

the Court’s computer system.

10. Notice of Hearing (Form CAFC721)

You must use this form to give all other parties notice of any hearings in this case.

The court will not consider any issues at any time in your case unless all other

parties are property notified using this form.

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 1 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Form CAFC301 – Father’s Petition for Declaration of

Paternity, Custody and/or Support

In what Missouri county will this case

be filed?

In the Circuit Court of

MISSOURI

If this is an amended petition, what is

the case number of the pending case?

Case Number

Division Number

Answer all questions on this form completely.

The Parties

1 I am filing this case and I am the PLAINTIFF. My name is:

__________________ ______________ _____________________________ ________

(Father’s First Name) (Middle Name) (Father’s Last Name) (Jr./Sr./III)

2 The mother of the child(ren) listed below in 4 is a DEFENDANT in this case and her

name is:

(She will be referred to as “Mother” on these forms)

__________________ ______________ _____________________________

(Mother’s First Name) (Middle Name) (Mother’s Last Name)

3 The following men are DEFENDANT(S) in this case. Either they -

• were married to the mother of the child(ren) listed below in 4 at the time of

each child’s birth, or

• were married to the mother of the child(ren) listed below in 4 within 300

days prior to each child’s birth, or

• are considered “presumed” fathers of the child(ren) listed below in 4

pursuant to §210.822, RSMo.

(They will be referred to as “First Presumed Father” and “Second Presumed Father” on these forms)

a. __________________ ______________ _____________________________ ________

( First Name) (Middle Name) (Last Name) (Jr./Sr./III)

b. __________________ ______________ _____________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

4 I am the father of the following children who are also DEFENDANT(S) in this case:

a. _________________________________________________ Birth Date: __________________

(Child’s full name as it appears on the birth certificate) (mm/dd/yyyy)

b. _________________________________________________ Birth Date: __________________

(Child’s full name as it appears on the birth certificate) (mm/dd/yyyy)

c. _________________________________________________ Birth Date: __________________

(Child’s full name as it appears on the birth certificate) (mm/dd/yyyy)

d. _________________________________________________ Birth Date: __________________

(Child’s full name as it appears on the birth certificate) (mm/dd/yyyy)

e. _________________________________________________ Birth Date: __________________

(Child’s full name as it appears on the birth certificate) (mm/dd/yyyy)

f. _________________________________________________ Birth Date: __________________

(Child’s full name as it appears on the birth certificate) (mm/dd/yyyy)

Clear All Forms

Print Petition

Table of Contents

How many children do Mother

and Father have together that

need a paternity judgment?

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 2 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

1 Your

Information

(Plaintiff)

5. My mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

6. This is the first petition I have filed in this case. (Original Petition)

This is the second petition I have filed in this case.

This is the third petition I have filed in this case.

7. The last four numbers of my Social Security Number are: XXX-XX-

_______________

8. I am __________ years old.

9. I reside in the Country of ________________.

10. I reside in the State of ___________________.

11. I reside in the County of ______________________-

Employment

Information

12. I am self-employed

I am unemployed

I am employed at:

___________________________________________________________________________________

(Name of Employer)

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

13. Mother is self-employed

Mother is unemployed

I don’t know Mother’s employment status

Mother is employed at:

___________________________________________________________________________________

(Name of Employer)

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

Your age is automatically calculated based upon your date of birth.

Choose one...

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 3 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

2 Mother’s

Information

(Defendant)

14. Mother’s mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

15. The last four numbers of Mother’s Social Security Number are:

XXX-XX-_______________.

16. Mother is __________ years old.

17. Mother resides in the Country of ______________________.

18. Mother resides in the State of ______________________.

19. Mother resides in the County of ______________________.

20. Mother is NOT on active duty in the United States military.

Mother is on active duty in the United States military.

21. Mother has signed a verified “Answer to Father’s Petition for Declaration of

Paternity, Custody and/or Support” which is being filed with this petition.

Therefore, do not issue a summons.

Mother should be served at her residence.

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

Mother should be served at her place of employment.

___________________________________________________________________________________

(Name of Employer)

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

Service by publication. I don’t know where Mother is and I have no way of

locating her. Therefore, I am requesting that she be served by publication.

Other method of service: ____________________________________________________

The information on this page is about the mother.

Choose one...

Mother's age is automatically calculated based upon her date of birth.

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 4 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Information

about the

First

Presumed

Father

(Defendant)

This is the person named on line 3a on the first page of this petition.

22. First Presumed Father’s mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

23. The last four numbers of First Presumed Father’s Social Security Number are:

XXX-XX-_______________

24. First Presumed Father is __________ years old.

25. First Presumed Father resides in the Country of ______________________.

26. First Presumed Father resides in the State of ______________________.

27. First Presumed Father resides in the County of ______________________.

28. First Presumed Father is NOT on active duty in the United States military.

First Presumed Father is on active duty in the United States military.

29. First Presumed Father has signed a verified “Answer to Father’s Petition for

Declaration of Paternity, Custody and/or Support” which is being filed with this

motion. Therefore, do not issue a summons.

First Presumed Father should be served at his residence.

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

First Presumed Father should be served at his place of employment.

______________________________________________________ _______________________

(Employer’s Name - if applicable) (Hours of Employment)

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

Service by publication. I don’t know where First Presumed Father is and I have

no way of locating him. Therefore, I am requesting that he be served by

publication. I have filed an Affidavit for Service by Publication and a Notice of

Publication.

Other method of service: ____________________________________________________

The information on this page is about the first presumed father.

First Presumed Father's age is automatically calculated based upon his date of birth.

Choose one...

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 5 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Information

about the

Second

Presumed

Father

(Defendant)

This is the person named on line 3b on the first page of this petition.

30. Second Presumed Father’s mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

31. The last four numbers of Second Presumed Father’s Social Security Number are:

XXX-XX-_______________

32. Second Presumed Father is __________ years old.

33. Second Presumed Father resides in the Country of ______________________.

34. Second Presumed Father resides in the State of ______________________.

35. Second Presumed Father resides in the County of ______________________-

36. Second Presumed Father is NOT on active duty in the United States military.

Second Presumed Father is on active duty in the United States military.

37. Second Presumed Father has signed a verified “Answer to Father’s Petition for

Declaration of Paternity, Custody and/or Support” which is being filed with this

motion. Therefore, do not issue a summons.

Second Presumed Father should be served at his residence.

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

Second Presumed Father should be served at his place of employment.

______________________________________________________ _______________________

(Employer’s Name - if applicable) (Hours of Employment)

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

Service by publication. I don’t know where Second Presumed Father is and I

have no way of locating him. Therefore, I am requesting that he be served by

publication. I have filed an Affidavit for Service by Publication and a Notice of

Publication.

Other method of service: ____________________________________________________

The information on this page is about the second presumed father.

Second Presumed Father's age is automatically calculated based upon his date of birth.

Choose one...

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 6 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Family

Support

Division

38. The parent receiving support is not receiving public assistance.

I don’t know if the parent receiving support is receiving public assistance.

The parent receiving support is receiving public assistance and therefore the

State of Missouri must be served. Summons to issue to be served on:

Director, Family Support Division

615 Howerton Court

Jefferson City, Missouri 65102

Additional

Information

about the

Children

39. The child(ren) have lived with the following persons at the following address(es)

during the past five years. (State the dates at each address)

_____________________________________________________________________________________

40. Check all boxes that apply to your case.

Someone other than me or the other parent has physical custody of one or more

of the child(ren) or claims to have custody or visitation rights with respect to one

or more of the child(ren).

There are other custody proceeding(s) concerning one or more of the child(ren)

pending in a court of this or another state.

I have participated in other litigation concerning the custody of one or more of

the child(ren) in this or another other state.

One or more of the child(ren) has been a victim of abuse or neglect.

41. Explanation: (If you checked any of the boxes in paragraph 40, please explain in

detail here.)

_____________________________________________________________________________________

Father’s Petition for Declaration of Paternity, Child Custody and/or Support – Page 7 of 7

Form CAFC301-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Request for

Relief

THEREFORE, I am requesting that I be declared the father of the children listed in

paragraph 4 of this petition and that the persons listed in paragraph 3 of this petition

be excluded as fathers of the children listed in paragraph 4 of this petition.

I also request the following relief:

Child custody should be as set forth in Part A of the attached Parenting plan

marked Exhibit 1. The custody arrangement that is in the best interests of the

minor children is set forth in Part A of the attached parenting plan marked

Exhibit 1.

Child support should be set as set forth in Part B of the attached parenting plan

marked Exhibit 1.

I am without sufficient funds to pay for my attorney and I request that the other

party pay my attorney’s fees for this case.

I want to change the child(ren)’s names as follows:

___________________________________________________________________________________

Other (Please state the other requests)

___________________________________________________________________________________

Plaintiff, being of lawful age and duly sworn on his oath, states that he is the plaintiff named above and that

the facts stated in this Petition for Declaration of Paternity, Child Custody and/or Support are true according to

his best knowledge and belief.

►__________________________________ __________________________________

SIGN HERE PRINT YOUR NAME HERE

Subscribed and sworn to this ___________ day of __________________, 20____.

________________________

Notary Public

My Commission Expires:

_____________________

ATTORNEY INFORMATION

(To be completed by your attorney)

______________________________________________ ___________________

Attorney – SIGN HERE Missouri Bar Number

_____________________________________________________________________

Attorney for Plaintiff – PRINT YOUR NAME HERE

______________________________________________________________________________

(Street)

______________________________________ ______________________ __________

(City) (State) (Zip)

__________________ _______________ _____________________________________

(Telephone Number) (Fax Number) (Email Address)

Do not enter any

information here if you are

filing this case without the

assistance of a lawyer.

This information should

be completed by your

attorney.

I have assisted Plaintiff

in the preparation of these

pleadings, but I am not

entering my appearance on

behalf of Plaintiff.

This should only be

completed if a lawyer

helped you with this

form

Sign this in front of a

Notary Public

Parenting Plan Part A - Custody – 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 A – Custody of the Children

1. Identification of the 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

4. Duration of Plan

The terms and conditions set forth in this parenting plan shall remain in full force and effect until the

children are emancipated or until this plan is modified by a court of competent jurisdiction.

If this parenting plan is filed after

the case has been filed, you

MUST enter the Case Number.

Clear All Forms

Print Parenting Plan Part A

Table of Contents

Parenting Plan Part A - Custody – Page 2

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Decisions Concerning the Children

“Joint legal custody” means that the parents share the decision-making rights, responsibilities, and authority

relating to the health, education and welfare of the child, and, unless allocated, apportioned, or decreed, the

parents shall confer with one another in the exercise of decision-making rights, responsibilities, and authority.

§452.375.1(2), RSMo.

5. Types of Decisions

The three types of decisions that parents must make concerning their children are major decisions, daily or

everyday decisions, and emergency decisions.

A. Major Decisions

Major decisions are the significant decisions about the children. Major decisions are made by the parent or

parents with legal custody. The following are examples of major decisions:

• The choice or change of schools, including college or special tutoring,

• The choice or change of physician, surgeon or dentist,

• Religious instruction, training or education,

• Selection of child care providers,

• Major medical care, surgery, or any medical procedure requiring hospitalization or out-patient surgery,

• Major dental work and orthodontia,

• Psychological or psychiatric treatment or counseling,

• The choice or change of camps or other special or extracurricular activities,

• The extent of any travel away from home,

• Part or full-time employment,

• Purchase or operation of a motor vehicle,

• Contraception and sex education,

• Actual or potential litigation on behalf of the children.

B. Daily or Everyday Decisions

Daily or everyday decisions are routine decisions like minor medical treatment, bedtimes, homework,

chores, selection of clothing and normal daily activities.

Daily decisions shall be made by the parent having actual physical custody at the time of the decision. The

parents shall cooperate in establishing mutually agreeable policies regarding such decisions in order that routine

decisions remain as consistent as possible.

C. Emergency Decisions

Emergency decisions are decisions of an urgent nature. They affect the health and safety of the children

and have to be made before it is possible to contact the other parent.

The parent who is with the minor child requiring emergency care may make the emergency decision. The

parent making the emergency decision shall advise the other parent of the nature and extent of the emergency as

soon as possible.

6. Access to Medical, Dental and Educational Records of the Children

Unless otherwise provided in this parenting plan, both parents are entitled to access to records and

information pertaining to the children, including, but not limited to, full and complete medical, dental, and

educational records subject to Part A, Paragraph 19.

Parenting Plan Part A - Custody – Page 3

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

7. Legal Custody

You must check one and only one of the following four boxes.

Mother and Father – Joint Legal Custody

It is in the best interests of the children that Mother and Father have joint legal custody of the children.

Major decisions shall be made by Mother and Father jointly. If Mother and Father disagree on a major decision

they shall resolve their disagreement through the dispute resolution procedure set forth herein.

Mother – Sole Legal Custody to Mother

It is in the best interests of the children that Mother has sole legal custody of the children. Major decisions

affecting the children shall be made by Mother. Mother and Father cannot share joint legal custody because:

(Missouri Law requires a statement of the reasons for a request for no shared decision-making. If you do not

enter a reason on this line, the court MUST grant joint legal custody.)

_________________________________________________________________________________________

Father – Sole Legal Custody to Father

It is in the best interests of the children that Father has sole legal custody of the children. Major decisions

affecting the children shall be made by Father. Mother and Father cannot share joint legal custody because:

(Missouri Law requires a statement of the reasons for a request for no shared decision-making. If you do not

enter a reason on this line, the court MUST grant joint legal custody.)

_________________________________________________________________________________________

Third Party – Sole Legal Custody to Third Party

It is in the best interest of the children that _____________________ (hereinafter referred to as “Third

Party”) has sole legal and sole physical custody of the children. Major decisions affecting the children shall be

made by Third Party. Both parents are unfit, unsuitable, or unable to be a custodian of the children or the

welfare of the children requires that neither parent have physical custody. (If this box is checked, the same box

MUST be checked under Part A, Paragraph 10.)

8. Communication between Parents

Communication between the parents concerning the children may be by any of the following methods:

Check each box that is appropriate in your case.

In person

Home telephone

Work telephone

Mobile telephone

Letter via U.S. Postal Service

Fax

Via a designated third person. This third person will be ________________________.

The children shall not be used as messengers.

9. Issues not to be Discussed in the Presence of the Children

Mother and Father shall each refrain from making negative, derogatory or degrading statements about the

other parent in front of the children. Both parents shall exercise their best efforts to foster the respect, love and

affection of the children toward the other parent. Mother and Father shall avoid discussing parenting issues,

financial issues, and other topics related to these proceedings when the children are present.

Mother and Father should prevent other persons from making negative, derogatory or degrading statements

about the other parent in the presence of the children.

Parenting Plan Part A - Custody – Page 4

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

When the Children Will Be with Each Parent

“Joint physical custody” means an order awarding each of the parents significant but not necessarily equal,

periods of time during which a child resides with or is under the care and supervision of each of the parents.

Joint physical custody shall be shared by the parents in such a way as to assure the child of frequent, continuing

and meaningful contact with both parents. §452.375.1(3), RSMo.

10. Physical Custody

You must check one and only one of the following nine boxes.

Joint Physical Custody Using Mother’s Address –It is in the best interest of the children that Mother

and Father have joint physical custody of the children. The address of the children for mailing and educational

purposes is the same as that of Mother.

Joint Physical Custody Using Father’s Address – It is in the best interest of the children that Mother

and Father have joint physical custody of the children. The address of the children for mailing and educational

purposes is the same as that of Father.

Sole Physical Custody to Mother and Visitation to Father – It is in the best interests of the children

that Mother has sole physical custody of the children and that Father have visitation as set forth herein.

Sole Physical Custody to Father and Visitation to Mother –It is in the best interests of the children

that Father has sole physical custody of the children and that Mother have visitation as set forth herein.

Sole Physical Custody to Mother and Supervised Visitation to Father – It is in the best interests of

the children that Mother have sole physical custody of the children and Father have supervised visitation as set

forth herein. Unsupervised visitation would endanger the children’s physical health or impair their emotional

development because: __________________________________________________________________

__________________________________________________________________.

Visitation will be supervised by __________________________________________________________.

Sole Physical Custody to Father and Supervised Visitation to Mother - It is in the best interests of the

children that Father have sole physical custody of the children and Mother have supervised visitation as set

forth herein. Unsupervised visitation would endanger the children’s physical health or impair their emotional

development because: __________________________________________________________________

__________________________________________________________________.

Visitation will be supervised by __________________________________________________________.

Sole Physical Custody to Mother and No Visitation to Father – It is in the best interests of the

children that Mother has sole physical custody of the children and Father has no visitation with the children.

Visitation would endanger the children’s physical health or impair their emotional development. Father shall

not have access to records and information pertaining to the children pursuant to §452.376.1, RSMo.

Sole Physical Custody to Father and No Visitation to Mother - It is in the best interests of the children

that Father has sole physical custody of the children and Mother has no visitation with the children. Visitation

would endanger the children’s physical health or impair their emotional development. Mother shall not have

access to records and information pertaining to the children pursuant to §452.376.1, RSMo.

Physical and Legal Custody to a Third Party – It is in the best interest of the children that

_____________________ (hereinafter referred to as “Third Party”) has sole legal and sole physical custody of

the children. Both parents are unfit, unsuitable, or unable to be a custodian of the children or the welfare of the

children requires that neither parent have physical custody. (If this box is checked, the same box MUST be

checked in Part A, Paragraph 7.)

Parenting Plan Part A - Custody – Page 5

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

11. Residential Schedules

Mother and Father shall have physical custody of the children as they agree. In the event they do not agree,

then Mother and Father shall exchange the children as set forth in the residential schedules.

Each parent shall consider reasonable changes when requested by the other parent or the children. If a

significant change is made, either parent may reduce their agreement to writing. All changes are unenforceable

unless in writing and signed by both parents.

12. Location of Exchanges

If a specific location for an exchange is not stated on the schedule, then the exchange shall occur at the

following location:

You must check one and only one of the following four boxes.

All exchanges shall occur at the children’s school or child care provider.

All exchanges shall occur at the Mother’s Residence.

All exchanges shall occur at the Father’s Residence.

All exchanges shall occur at _______________________________________________________________.

13. Transportation

The parent who has the children takes the children to the exchange location. Each party will pay the

expenses associated with his or her own transportation to and from the exchange location unless otherwise

indicated in this parenting plan.

14. Notification of Change from Residential Schedule

In the event either parent cannot exercise the scheduled time with the children, he or she should tell the

other parent as soon as possible, but not later than 24 hours before the start of the scheduled time with the

children. If a parent anticipates that he or she may have to cancel at the last minute, he or she should advise the

other parent of the possible last minute conflict. If a parent fails to notify the other as set forth above, he or she

shall be responsible for the reasonable costs incurred by the other parent.

15. Telephone Contact with Children

Each parent may contact the children in a reasonable manner when the children are with the other parent.

Neither parent shall contact the children at the other parent’s residence later than ____________. (If this line

is left blank, there are no restrictions as to time.)

Each parent shall provide the other parent with the telephone number at which the children may be

contacted. Neither parent shall configure their telephone system in such a manner as to “block” or prevent the

other parent from calling.

When a parent travels with the children, he or she must notify the other parent of the children’s destination.

He or she must also provide a telephone number where the children can be reached.

16. Children’s Activities

Both parents must attempt to accommodate the social and academic commitments of the children during

the time the children are with them. Each parent should attempt to refrain from scheduling activities that occur

primarily when the children are with the other parent. If an activity will affect the other parent’s time with the

children, the parent scheduling the activity should obtain the affected parent’s permission before committing the

children to the activity.

17. Dispute Resolution Procedure

This is the manner in which Mother and Father will resolve disagreements concerning the children. This

includes disagreements on the meaning or interpretation of any provision of this plan. Mother and Father shall

present their disagreements to a mediator chosen by them for non-binding mediation. In the event that the

parents cannot resolve the dispute by mediation, they may submit the issue to the Court through appropriate

proceedings.

Additional dispute resolution procedures are as follows:

_________________________________________________________________________________

Parenting Plan Part A - Custody – Page 6

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Other Provisions Concerning the Children

18. Relocation

§452.377, RSMo states:

“Absent exigent circumstances as determined by a court with jurisdiction, you as a party to this action are

ordered to notify, in writing by certified mail, return receipt requested, and at least sixty days prior to the

proposed relocation, each party to this action of any proposed relocation of the principal residence of the child,

including the following information:

(1) The intended new residence, including the specific address and mailing address, if known, and if

not known, the city;

(2) The home telephone number of the new residence, if known;

(3) The date of the intended move or proposed relocation;

(4) A brief statement of the specific reasons for the proposed relocation of the child; and

(5) A proposal for a revised schedule of custody or visitation with the child.

Your obligation to provide this information to each party continues as long as you or any other party

by virtue of this order is entitled to custody of a child covered by this order. Your failure to obey the order

of this court regarding the proposed relocation may result in further litigation to enforce such order,

including contempt of court. In addition, your failure to notify a party of a relocation of the child may be

considered in a proceeding to modify custody or visitation with the child. Reasonable costs and attorney

fees may be assessed against you if you fail to give the required notice.”

The residence of the child may be relocated sixty (60) days after providing notice unless a parent files

a motion seeking an order to prevent the relocation within thirty (30) days after receipt of notice. Such

motion shall be accompanied by an affidavit setting forth the specific factual bases supporting a prohibition

of the relocation.

19. Domestic Violence between the Parents

You must check one and only one of the following five boxes.

There has been no domestic violence between the parents.

There has been domestic violence by Mother against Father. Any educational records of the children shall

not include the address of Father or the children.

There has been domestic violence by Father against Mother. Any educational records of the children shall

not include the address of Mother or the children.

There has been domestic violence by Mother against Father; however, the educational records of the

children may include the address of Father or the children.

There has been domestic violence by Father against Mother; however, the educational records of the

children may include the address of Mother or the children.

20. Pattern of Domestic Violence between the Parents

You must check one and only one of the following three boxes.

There has been no pattern of domestic violence by either Mother or Father.

There has been a pattern of domestic violence by Mother against Father. This parenting plan best protects

the children and Father from any further violence.

There has been a pattern of domestic violence by Father against Mother. This parenting plan best protects

the children and Mother from any further violence.

21. Other Custody Provisions

_________________________________________________________________________________________

____________________________

Mother

Father

Guardian ad Litem

____________________________

Attorney for Mother

Attorney For Father

Parenting Plan Part A – Residential Schedules – Page 1

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Residential Schedules

1. Weekend and Weekday Schedule

Each exchange should be written on the Weekend and Weekday Exchange Schedule. A sample entry for

one of the exchanges may be as follows: “5:30 p.m. Father receives children”. This means that at 5:30 p.m.,

Father will begin a period of time during which the children will be with him.

The last person to receive custody on the Weekend and Weekday Schedule must be different than the first

person to receive custody on the schedule because after each two week period, the cycle repeats itself. There is

always an even number of exchanges for a two week period.

A sample two week exchange schedule is located on Page 5 of these Residential

Schedules.

_________________________________________________________________________________________

2. Vacation Schedule

You must select one and only one of the following two options.

No specific weeks will be set aside for our vacations.

Each parent may designate ______ week(s) each year during which they will have exclusive physical

custody of the children and the regular or special exchange schedules do not apply. Father shall have first

choice of weeks in odd-numbered years. Mother will have first choice of weeks in even-numbered years.

The parent with the first choice of weeks must designate the vacation weeks by March 31 of each year.

During this period, the holiday schedule still applies. Neither parent can select a week which would deny

the other parent of a holiday to which they are entitled.

_________________________________________________________________________________________

3. Holidays

A different schedule can apply on holidays. The times each parent will have with the children during the

holidays are set forth on the Holiday Exchange Schedule on page 3 of these Residential Schedules.

Include the name of the parent that will have the holiday and how the holiday will be structured. For

example, Memorial Day is always on a Monday. Should the Memorial Day holiday begin at 6:00 p.m. on

Sunday before Memorial Day? Alternatively, should it include the entire weekend? If the entire weekend is

included, then it is possible that one parent may not have a weekend with the children for several weeks.

Holidays and vacations do not alter the “Week One” or “Week Two” designation, but they do apply ahead

of the regular schedule. If the holiday schedule conflicts with any other schedule, the holiday schedule takes

precedence.

_________________________________________________________________________________________

Parenting Plan Part A – Residential Schedules – Page 2

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Weekday and Weekend Exchange Schedule

Enter the parent who is receiving custody and the specified time for each exchange.

See page 5 of these Residential Schedules for a sample schedule.

DAY OF WEEK EXCHANGES FOR DAY

WEEK ONE

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

WEEK TWO

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Weekday/Weekend Schedules

Parenting Plan Part A – Residential Schedules – Page 3

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Holiday Exchange Schedule

Holiday

Even

Numbered

Years

Odd

Numbered

Years

Physical Custody

From To

FATHER or

MOTHER

FATHER or

MOTHER

Time Time

New Year’s Eve

New Year’s Day

King Day

President’s Day

Memorial Day

Independence Day

Labor Day

Thanksgiving

Christmas Eve

Christmas Day

Easter

Other Holidays

(specify)

Special Occasions

(specify)

Halloween

Mother’s Day

Father’s Day

Mother’s Birthday

Father’s Birthday

Child’s Birthday

Holiday Schedules

FATHER is the "Parent Paying Support"

Parenting Plan Part A – Residential Schedules – Page 4

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

DETERMINATION OF WEEK ONE AND WEEK TWO

Determination of “Week One” or “Week Two” on the Weekday and Weekend Exchange Schedule

For purposes of this Parenting Plan, WEEK ONE is defined as a week that has Sunday on one of the

following dates:

January

February

March

April

May

June

July

August

September

October

November

December

For purposes of this Parenting Plan, WEEK TWO is defined as a week that has Sunday on one of the

following dates:

January

February

March

April

May

June

July

August

September

October

November

December

Parenting Plan Part A – Residential Schedules – Page 5

Form CAFC501-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Weekday and Weekend Exchange Schedule

Enter the parent who is receiving custody and the specified time for each exchange.

See page 5 of these Residential Schedules for a sample schedule.

DAY OF WEEK

EXCHANGES FOR DAY

WEEK ONE

Sunday

Monday

5:30 p.m. Dad receives children

8:30 p.m. Mom receives children at Mom’s house

Tuesday

Wednesday

Thursday

Friday

5:30 Dad receives children at Daycare

Saturday

WEEK TWO

Sunday

6:00 p.m. Mom receives children at her house

Monday

Tuesday

8:30 p.m. Mom receives children

Wednesday

Thursday

5:30 p.m. Dad receives children at Mom’s house

8:30 p.m. Mom receives children at Mom’s house

Friday

Saturday

Since the parties do not

specify an exchange location,

the exchange would occur at

the default location in

Paragraph 12 in Part A of the

Parenting Plan.

Since Dad is the first parent to

receive the children on this schedule,

Mom must be the last parent to

receive the children. Mom has the

children at the start of this schedule.

This entry is also a mistake.

Mom already has the

children with her so she can’t

receive the children. There

should always be an even

number of exchanges for

any two week period.

This entry contains a

mistake. It is unclear

whether it refers to 5:30

a.m. or 5:30 p.m.

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.

Clear All Forms

Print Parenting Plan Part B

Table of Contents

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.

Form 14

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

Form 14

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.

_________________________________________________________________________________________

Form 14

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

Form 14

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 WORKSHEET

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 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 children who are the 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 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)

Calculated Amount

0.0%

Paragraph 10

Paragraph 5

Paragraph 9

Paragraph 14a

Income and Expense Statement

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.

The amounts in Paragraph 15 are

automatically calculated for you

as you complete Form 14.

Form 14

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

2008 Schedule of Basic Child Support

Obligation

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

0-1000 50 50 50 50 50 50

1050 62 63 64 64 65 66

1100 98 99 100 101 102 103

1150 134 135 137 138 140 141

1200 170 172 173 175 177 179

1250 206 208 210 212 215 217

1300 241 244 247 249 252 255

1350 277 280 282 286 290 293

1400 306 317 320 324 327 330

1450 316 352 356 360 364 368

1500 325 386 391 395 399 403

1550 334 420 425 430 434 439

1600 344 455 459 464 469 474

1650 353 489 494 499 505 510

1700 362 523 528 534 540 546

1750 371 539 563 569 575 581

1800 380 553 597 604 610 617

1850 389 566 632 638 645 652

1900 398 579 666 673 680 688

1950 407 592 699 708 716 723

2000 416 604 713 743 751 759

2050 425 617 728 778 786 794

2100 434 630 743 812 821 830

2150 443 643 758 847 856 865

2200 452 656 773 864 891 901

2250 461 668 788 880 927 936

2300 470 681 803 897 962 972

2350 479 694 818 914 997 1007

2400 488 707 833 930 102 1043

2450 496 720 848 947 1042 1078

2500 505 732 863 964 1060 1114

2550 514 745 878 980 1078 1149

2600 523 758 893 997 1097 1185

2650 532 771 908 1014 1115 1212

2700 541 783 922 1030 1133 1232

2750 550 796 937 1047 1152 1252

2800 559 809 952 1064 1170 1272

2850 568 822 968 1081 1189 1293

2900 577 835 984 1099 1209 1314

2950 586 849 999 1116 1228 1335

3000 595 862 1015 1134 1247 1355

3050 604 875 1030 1151 1266 1376

3100 613 888 1046 1168 1285 1397

3150 622 901 1062 1186 1304 1418

3200 631 914 1077 1203 1323 1439

3250 641 928 1093 1221 1343 1459

3300 650 941 1108 1238 1362 1480

3350 659 954 1124 1255 1381 1501

3400 668 967 1139 1273 1400 1522

3450 676 979 1154 1289 1417 1541

3500 684 990 1167 1304 1434 1559

3550 692 1002 1181 1319 1451 1577

3600 700 1013 1194 1334 1467 1595

3650 708 1025 1208 1349 1484 1613

3700 715 1036 1221 1364 1501 1631

3750 723 1047 1234 1378 1516 1648

3800 728 1054 1242 1387 1526 1659

3850 733 1061 1250 1396 1536 1670

3900 738 1069 1259 1406 1546 1681

3950 744 1076 1267 1415 1557 1692

4000 749 1083 1275 1424 1567 1703

4050 754 1091 1283 1434 1577 1714

4100 759 1098 1292 1443 1587 1725

4150 765 1105 1300 1452 1597 1736

4200 770 1113 1308 1461 1608 1747

4250 775 1120 1317 1471 1618 1759

4300 780 1127 1325 1480 1628 1770

4350 786 1135 1333 1489 1638 1781

4400 791 1142 1342 1499 1648 1792

4450 796 1149 1350 1508 1659 1803

4500 801 1157 1358 1517 1669 1814

4550 807 1164 1367 1526 1679 1825

4600 812 1171 1375 1536 1689 1836

4650 817 1179 1383 1545 1700 1847

4700 822 1186 1392 1554 1710 1859

4750 828 1193 1400 1564 1720 1870

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

4800 833 1200 1408 1573 1730 1880

4850 836 1206 1414 1579 1737 1889

4900 840 1211 1420 1586 1745 1897

4950 844 1216 1426 1593 1753 1905

5000 848 1222 1433 1600 1760 1914

5050 852 1227 1439 1607 1768 1922

5100 855 1233 1445 1614 1776 1930

5150 859 1238 1451 1621 1783 1938

5200 863 1243 1458 1628 1791 1947

5250 867 1249 1464 1635 1799 1955

5300 871 1254 1470 1642 1806 1963

5350 874 1260 1476 1649 1814 1972

5400 878 1265 1482 1656 1822 1980

5450 882 1270 1489 1663 1829 1988

5500 886 1276 1495 1670 1837 1997

5550 890 1281 1501 1677 1844 2005

5600 893 1286 1507 1684 1852 2013

5650 897 1292 1514 1691 1860 2022

5700 901 1297 1520 1698 1867 2030

5750 905 1303 1526 1705 1875 2038

5800 909 1308 1532 1712 1883 2046

5850 912 1313 1538 1718 1890 2054

5900 915 1317 1542 1723 1895 2060

5950 918 1321 1547 1728 1900 2066

6000 921 1325 1551 1732 1905 2071

6050 924 1329 1555 1737 1911 2077

6100 927 1333 1559 1741 1916 2082

6150 930 1337 1563 1746 1921 2088

6200 933 1341 1567 1751 1926 2093

6250 936 1345 1572 1755 1931 2099

6300 939 1348 1576 1760 1936 2105

6350 942 1352 1580 1765 1941 2110

6400 945 1356 1584 1769 1946 2116

6450 948 1360 1588 1774 1952 2121

6500 951 1364 1592 1779 1957 2127

6550 954 1368 1597 1783 1962 2132

6600 957 1372 1601 1788 1967 2138

6650 960 1376 1605 1793 1972 2144

6700 963 1380 1609 1797 1977 2149

6750 966 1384 1613 1802 1982 2155

6800 969 1388 1617 1807 1987 2160

6850 972 1392 1622 1811 1993 2166

6900 974 1395 1626 1816 1997 2171

6950 976 1397 1628 1818 2000 2174

7000 977 1399 1629 1820 2002 2176

7050 979 1401 1631 1822 2004 2179

7100 981 1403 1633 1824 2007 2181

7150 982 1405 1635 1826 2009 2184

7200 984 1407 1637 1829 2011 2186

7250 985 1409 1639 1831 2014 2189

7300 986 1410 1641 1833 2016 2191

7350 988 1412 1643 1835 2018 2194

7400 989 1414 1644 1837 2020 2196

7450 991 1416 1646 1839 2023 2199

7500 992 1418 1648 1841 2025 2201

7550 994 1419 1650 1843 2027 2203

7600 995 1421 1652 1845 2029 2206

7650 997 1423 1653 1847 2032 2208

7700 998 1425 1655 1849 2034 2211

7750 1000 1427 1657 1851 2036 2213

7800 1001 1428 1659 1852 2038 2216

7850 1002 1430 1661 1855 2040 2218

7900 1004 1432 1663 1857 2043 2220

7950 1005 1434 1664 1859 2045 2223

8000 1008 1437 1668 1863 2050 2228

8050 1013 1444 1676 1872 2059 2239

8100 1018 1451 1684 1881 2069 2249

8150 1023 1458 1692 1890 2079 2260

8200 1027 1465 1700 1899 2089 2270

8250 1032 1472 1708 1908 2098 2281

8300 1037 1479 1716 1916 2108 2291

8350 1042 1486 1724 1926 2118 2303

8400 1048 1494 1733 1936 2129 2314

8450 1053 1501 1742 1945 2140 2326

8500 1059 1509 1750 1955 2151 2338

8550 1064 1516 1759 1965 2161 2349

8600 1069 1524 1768 1975 2172 2361

8650 1075 1532 1777 1984 2183 2373

8700 1079 1538 1784 1993 2192 2383

8750 1083 1543 1790 1999 2199 2391

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

8800 1086 1548 1796 2006 2206 2398

8850 1090 1553 1801 2012 2213 2406

8900 1093 1558 1807 2018 2220 2413

8950 1097 1563 1813 2025 2227 2421

9000 1100 1568 1818 2031 2234 2429

9050 1104 1573 1824 2038 2241 2436

9100 1107 1578 1830 2044 2248 2444

9150 1110 1582 1836 2050 2255 2452

9200 1114 1587 1841 2057 2262 2459

9250 1117 1592 1847 2063 2269 2467

9300 1121 1597 1853 2069 2276 2474

9350 1124 1602 1858 2076 2283 2482

9400 1128 1607 1864 2082 2290 2490

9450 1131 1612 1870 2089 2297 2497

9500 1135 1617 1876 2095 2304 2505

9550 1138 1622 1881 2101 2312 2513

9600 1141 1627 1887 2108 2319 2520

9650 1145 1632 1893 2114 2326 2528

9700 1148 1636 1898 2120 2332 2535

9750 1151 1640 1902 2125 2337 2540

9800 1153 1643 1906 2129 2342 2546

9850 1156 1647 1910 2134 2347 2551

9900 1159 1651 1914 2138 2352 2557

9950 1161 1654 1918 2143 2357 2562

10000 1164 1658 1923 2147 2362 2568

10050 1167 1662 1927 2152 2367 2573

10100 1169 1665 1931 2157 2372 2579

10150 1172 1669 1935 2161 2377 2584

10200 1175 1673 1939 2166 2382 2590

10250 1177 1676 1943 2170 2387 2595

10300 1180 1680 1947 2175 2393 2601

10350 1182 1684 1951 2180 2398 2606

10400 1185 1687 1955 2184 2403 2612

10450 1188 1691 1960 2189 2408 2617

10500 1190 1694 1964 2193 2413 2623

10550 1193 1698 1968 2198 2418 2628

10600 1196 1702 1972 2203 2423 2634

10650 1198 1705 1976 2207 2428 2639

10700 1201 1709 1980 2212 2433 2645

10750 1204 1713 1984 2216 2438 2650

10800 1206 1716 1988 2221 2443 2656

10850 1209 1720 1992 2226 2448 2661

10900 1212 1724 1997 2230 2453 2667

10950 1214 1727 2001 2235 2458 2672

11000 1217 1731 2005 2239 2463 2678

11050 1220 1735 2009 2244 2469 2684

11100 1223 1739 2014 2250 2475 2690

11150 1226 1743 2019 2255 2481 2697

11200 1229 1748 2024 2261 2487 2703

11250 1232 1752 2029 2266 2493 2710

11300 1235 1756 2034 2272 2499 2716

11350 1238 1760 2039 2277 2505 2723

11400 1240 1765 2043 2283 2511 2729

11450 1243 1769 2048 2288 2517 2736

11500 1246 1773 2053 2293 2523 2742

11550 1249 1777 2058 2299 2529 2749

11600 1252 1781 2063 2304 2535 2755

11650 1255 1786 2068 2310 2541 2762

11700 1258 1790 2073 2315 2547 2768

11750 1261 1794 2078 2321 2553 2775

11800 1264 1798 2083 2326 2559 2781

11850 1267 1803 2087 2332 2565 2788

11900 1270 1807 2092 2337 2571 2794

11950 1273 1811 2097 2343 2577 2801

12000 1276 1815 2102 2348 2583 2808

12050 1279 1819 2107 2353 2589 2814

12100 1282 1824 2112 2359 2595 2821

12150 1285 1828 2117 2364 2601 2827

12200 1288 1832 2122 2370 2607 2834

12250 1291 1836 2127 2375 2613 2840

12300 1294 1841 2131 2381 2619 2847

12350 1297 1845 2136 2386 2625 2853

12400 1300 1849 2141 2392 2631 2860

12450 1303 1853 2146 2397 2637 2866

12500 1306 1857 2151 2403 2643 2873

12550 1309 1862 2156 2408 2649 2879

12600 1312 1866 2161 2114 2655 2886

12650 1315 1870 2166 2419 2661 2892

12700 1318 1874 2170 2424 2667 2899

12750 1321 1879 2175 2430 2673 2905

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

12800 1324 1883 2180 2435 2679 2912

12850 1327 1887 2185 2441 2685 2918

12900 1329 1891 2190 2446 2691 2925

12950 1332 1895 2195 2452 2697 2931

13000 1335 1900 2200 2457 2703 2938

13050 1338 1904 2205 2463 2709 2945

13100 1341 1908 2210 2468 2715 2951

13150 1344 1912 2214 2474 2721 2958

13200 1347 1917 2219 2479 2727 2964

13250 1350 1921 2224 2484 2733 2971

13300 1353 1925 2229 2490 2739 2977

13350 1356 1929 2234 2495 2745 2984

13400 1359 1933 2239 2501 2751 2990

13450 1362 1938 2244 2506 2757 2997

13500 1365 1942 2249 2512 2763 3003

13550 1368 1946 2253 2517 2769 3010

13600 1371 1950 2258 2523 2775 3016

13650 1374 1955 2263 2528 2781 3023

13700 1377 1959 2268 2533 2787 3029

13750 1380 1963 2272 2538 2792 3035

13800 1383 1967 2277 2543 2797 3041

13850 1386 1971 2281 2548 2803 3047

13900 1389 1974 2285 2553 2808 3052

13950 1391 1978 2290 2558 2814 3058

14000 1394 1982 2294 2563 2819 3064

14050 1397 1986 2299 2567 2824 3070

14100 1400 1990 2303 2572 2830 3076

14150 1403 1994 2307 2577 2835 3082

14200 1406 1998 2312 2582 2840 3087

14250 1409 2002 2316 2587 2846 3093

14300 1412 2006 2320 2592 2851 3099

14350 1415 2010 2325 2597 2856 3105

14400 1418 2014 2329 2601 2862 3111

14450 1420 2018 2333 2606 2867 3116

14500 1423 2021 2337 2611 2872 3122

14550 1426 2025 2341 2615 2877 3127

14600 1429 2028 2345 2620 2882 3133

14650 1431 2032 2350 2624 2887 3138

14700 1434 2036 2354 2629 2892 3143

14750 1437 2039 2358 2633 2897 3149

14800 1439 2043 2362 2638 2902 3154

14850 1442 2047 2366 2642 2907 3160

14900 1445 2050 2370 2647 2912 3165

14950 1447 3054 2374 2651 2917 3170

15000 1450 2058 2378 2656 2921 3176

15050 1453 2061 2382 2660 2926 3181

15100 1455 2065 2386 2665 2931 3186

15150 1458 2068 2390 2669 2936 3192

15200 1461 2072 2394 2674 2941 3197

15250 1463 2076 2398 2678 2946 3203

15300 1466 2079 2402 2683 2951 3208

15350 1469 2083 2406 2687 2956 3213

15400 1472 2087 2410 2692 2961 3219

15450 1474 2090 2414 2697 2966 3224

15500 1477 2095 2419 2702 2972 3231

15550 1480 2099 2424 2708 2978 3237

15600 1483 2103 2429 2713 2984 3244

15650 1486 2107 2434 2718 2990 3250

15700 1489 2111 2439 2724 2996 3257

15750 1492 2116 2443 2729 3002 3263

15800 1495 2120 2448 2735 3008 3270

15850 1498 2124 2453 2740 3014 3277

15900 1501 2128 2458 2746 3020 3283

15950 1504 2133 2463 2751 3026 3290

16000 1507 2137 2468 2757 3032 3296

16050 1510 2141 2473 2762 3038 3303

16100 1513 2145 2478 2768 3044 3309

16150 1516 2149 2483 2773 3050 3316

16200 1519 2154 2487 2778 3056 3322

16250 1522 2158 2492 2784 3062 3329

16300 1525 2162 2497 2789 3068 3335

16350 1528 2166 2502 2795 3074 3342

16400 1531 2171 2507 2800 3080 3348

16450 1534 2175 2512 2806 3086 3355

16500 1537 2179 2517 2811 3092 3361

16550 1540 2183 2522 2817 3098 3368

16600 1543 2187 2526 2822 3104 3374

16650 1546 2192 2531 2828 3110 3381

16700 1549 2196 2536 2833 3116 3387

16750 1551 2200 2541 2838 3122 3394

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

16800 1554 2204 2546 2844 3128 3400

16850 1557 2209 2551 2849 3134 3407

16900 1560 2213 2556 2855 3140 3413

16950 1563 2217 2561 2860 3146 3420

17000 1566 2221 2566 2866 3152 3426

17050 1569 2225 2570 2871 3158 3433

17100 1572 2230 2575 2877 3164 3440

17150 1575 2234 2580 2882 3170 3446

17200 1578 2238 2585 2887 3176 3453

17250 1581 2242 2590 2893 3182 3459

17300 1584 2247 2595 2898 3188 3466

17350 1587 2251 2600 2904 3194 3472

17400 1590 2255 2605 2909 3200 3479

17450 1593 2259 2609 2915 3206 3485

17500 1596 2264 2614 2920 3212 3492

17550 1599 2268 2619 2926 3218 3498

17600 1602 2272 2624 2931 3224 3505

17650 1605 2276 2629 2937 3230 3511

17700 1608 2280 2634 2942 3236 3518

17750 1611 2285 2639 2947 3242 3524

17800 1614 2289 2644 2953 3248 3531

17850 1617 2293 2649 2958 3254 3537

17900 1620 2297 2653 2964 3260 3544

17950 1623 2302 2658 2969 3266 3550

18000 1626 2306 2663 2975 3272 3557

18050 1629 2310 2668 2980 3278 3563

18100 1632 2314 2673 2986 3284 3570

18150 1635 2318 2678 2991 3290 3576

18200 1638 2323 2683 2997 3296 3583

18250 1641 2327 2688 3002 3302 3590

18300 1644 2331 2692 3007 3308 3596

18350 1646 2335 2697 3012 3313 3602

18400 1648 2338 2700 3016 3318 3606

18450 1651 2341 2703 3020 3322 3611

18500 1653 2344 2707 3024 3326 3615

18550 1655 2347 2710 3027 3330 3620

18600 1657 2350 2714 3031 3334 3615

18650 1659 2353 2717 3035 3339 3629

18700 1662 2356 2721 3039 3343 3634

18750 1664 2359 2724 3043 3347 3638

18800 1666 2362 2728 3047 3351 3643

18850 1668 2365 2731 3051 3356 3648

18900 1671 2368 2735 3054 3360 3652

18950 1673 2372 2738 3058 3364 3657

19000 1675 2375 2741 3062 3368 3661

19050 1677 2378 2745 3066 3373 3666

19100 1679 2381 2748 3070 3377 3671

19150 1682 2384 2752 3074 3381 3675

19200 1684 2387 2755 3078 3385 3680

19250 1686 2390 2759 3081 3390 3684

19300 1688 2393 2762 3085 3394 3689

19350 1691 2396 2766 3089 3398 3694

19400 1693 2399 2769 3093 3402 3698

19450 1695 2402 2772 3097 3407 3703

19500 1697 2405 2776 3101 3411 3707

19550 1699 2408 2779 3105 3415 3712

19600 1702 2411 2783 3108 3419 3717

19650 1704 2414 2786 3112 3423 3721

19700 1706 2418 2790 3116 3428 3726

19750 1708 2421 2793 3120 3432 3730

19800 1711 2424 2797 3124 3436 3735

19850 1713 2427 2800 3128 3440 3740

19900 1715 2430 2803 3131 3445 3744

19950 1717 2433 2807 3135 3449 3749

20000 1719 2436 2810 3139 3453 3754

20050 1722 2439 2814 3143 3457 3758

20100 1724 2442 2817 3147 3462 3763

20150 1726 2445 2821 3151 3466 3767

20200 1728 2448 2824 3155 3470 3772

20250 1731 2451 2828 3158 3474 3777

20300 1733 2454 2831 3162 3479 3781

20350 1735 2457 2835 3166 3483 3786

20400 1737 2460 2838 3170 3487 3790

20450 1739 2464 2841 3174 3491 3795

20500 1742 2467 2845 3178 3495 3800

20550 1744 2470 2848 3182 3500 3804

20600 1746 2473 2852 3185 3504 3809

20650 1748 2476 2855 3189 3508 3813

20700 1751 2479 2859 3193 3512 3818

20750 1753 2482 2862 3197 3517 3823

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

20800 1755 2485 2866 3201 3521 3827

20850 1757 2488 2869 3205 3525 3832

20900 1759 2491 2872 3209 3529 3836

20950 1762 2494 2876 3212 3534 3841

21000 1764 2497 2879 3216 3538 3846

21050 1766 2500 2883 3220 3542 3850

21100 1768 2503 2886 3224 2546 3855

21150 1771 2506 2890 3228 3551 3859

21200 1773 2510 2893 3232 3555 3864

21250 1775 2513 2897 3235 3559 3869

21300 1777 2516 2900 3239 3563 3873

21350 1779 2519 2903 3243 3567 3878

21400 1782 2522 2907 3247 3572 3882

21450 1784 2525 2910 3251 3576 3887

21500 1786 2528 2914 3255 3580 3892

21550 1788 2531 2917 3259 3584 3896

21600 1791 2534 2921 3262 3589 3901

21650 1793 2537 2924 3266 3593 3905

21700 1795 2540 2928 3270 3597 3910

21750 1797 2543 2931 3274 3601 3915

21800 1799 2546 2934 3278 3606 3919

21850 1802 2549 2938 3282 3610 3924

21900 1804 2553 2941 3286 3614 3929

21950 1806 2556 2945 3289 3618 3933

22000 1808 2559 2948 3293 3623 3938

22050 1811 2562 2952 3297 3627 3942

22100 1813 2565 2955 3301 3631 3947

22150 1815 2568 2959 3305 3635 3952

22200 1817 2571 2962 3309 3639 3956

22250 1819 2574 2966 3312 3644 3961

22300 1822 2577 2969 3316 3648 3965

22350 1824 2580 2972 3320 3652 3970

22400 1826 2583 2976 3324 3656 3975

22450 1828 2586 2979 3328 3661 3979

22500 1831 2589 2983 3332 3665 3984

22550 1833 2592 2986 3336 3669 3988

22600 1835 2595 2990 3339 3673 3993

22650 1837 2599 2993 3343 3678 3998

22700 1839 2602 2997 3347 3682 4002

22750 1842 2605 3000 3351 3686 4007

22800 1844 2608 3003 3355 3690 4011

22850 1846 2611 3007 3359 3695 4016

22900 1848 2614 3010 3363 3699 4021

22950 1850 2617 3014 3366 3703 4025

23000 1853 2620 3017 3370 3707 4030

23050 1855 2623 3021 3374 3712 4034

23100 1857 2626 3024 3378 3716 4039

23150 1859 2629 3028 3382 3720 4044

23200 1862 2632 3031 3386 3724 4048

23250 1864 2635 3034 3390 3728 4053

23300 1866 2638 3038 3393 3733 4057

23350 1868 2641 3041 3397 3737 4062

23400 1870 2645 3045 3401 3741 4067

23450 1873 2648 3048 3405 3745 4071

23500 1875 2651 3052 3409 3750 4076

23550 1877 2654 3055 3413 3754 4080

23600 1879 2657 3059 3416 3758 4085

23650 1882 2660 3062 3420 3762 4090

23700 1884 2663 3066 3424 3767 4094

23750 1886 2666 3069 3428 3771 4099

23800 1888 2669 3072 3432 3775 4103

23850 1890 2672 3076 3436 3779 4108

23900 1893 2675 3079 3440 3784 4113

23950 1895 2678 3083 3443 3788 4117

24000 1897 2681 3086 3447 3792 4122

24050 1899 2684 3090 3451 3796 4127

24100 1902 2687 3093 3455 3800 4131

24150 1904 2691 3097 3459 3805 4136

24200 1906 2694 3100 3463 3809 4140

24250 1908 2697 3103 3467 3813 4145

24300 1910 2700 3107 3470 3817 4150

24350 1913 2703 3110 3474 3822 4154

24400 1915 2706 3114 3478 3826 4159

24450 1917 2709 3117 3482 3830 4163

24500 1919 2712 3121 3486 3834 4168

24550 1922 2715 3124 3490 3839 4173

24600 1924 2718 3128 3493 3843 4177

24650 1926 2721 3131 3497 3847 4182

24700 1928 2724 3134 3501 3851 4186

24750 1930 2727 3138 3505 3856 4191

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

24800 1933 2730 3141 3509 3860 4196

24850 1935 2733 3145 3513 3864 4200

24900 1937 2737 3148 3517 3868 4205

24950 1939 2740 3152 3520 3872 4209

25000 1942 2743 3155 3524 3877 4214

25050 1944 2746 3159 3528 3881 4219

25100 1946 2749 3162 3532 3885 4223

25150 1948 2752 3165 3536 3889 4228

25200 1950 2755 3169 3540 3894 4232

25250 1953 2758 3172 3544 3898 4237

25300 1955 2761 3176 3547 3902 4242

25350 1957 2764 3179 3551 3906 4246

25400 1959 2767 3183 3555 3911 4251

25450 1962 2770 3186 3559 3915 4255

25500 1964 2773 3190 3563 3919 4260

25550 1966 2776 3193 3567 3923 4265

25600 1968 2780 3197 3571 3928 4269

25650 1970 2783 3200 3574 3932 4274

25700 1973 2786 3203 3578 3936 4278

25750 1975 2789 3207 3582 3940 4283

25800 1977 2792 3210 3586 3945 4288

25850 1979 2795 3214 3590 3949 4292

25900 1982 2798 3217 3594 3953 4297

25950 1984 2801 3221 3597 3957 4302

26000 1986 2804 3224 3601 3961 4306

26050 1988 2807 3228 3605 3966 4311

26100 1990 2810 3231 3609 3970 4315

26150 1993 3813 3234 3613 3974 4320

26200 1995 2816 3238 3617 3978 4325

26250 1997 2819 3241 3621 3983 4329

26300 1999 2822 3245 3624 3987 4334

26350 2002 2826 3248 3628 3991 4338

26400 2004 2829 3252 3632 3995 4343

26450 2006 2832 3255 3636 4000 4348

26500 2008 2835 3259 3640 4004 4352

26550 2010 2838 3262 3644 4008 4357

26600 2013 2841 3265 3648 4012 4361

26650 2015 2844 3269 3651 4017 4366

26700 2017 2847 3272 3655 4021 4371

26750 2019 2850 3276 3659 4025 4375

26800 2022 2853 3279 3663 4029 4380

26850 2024 2856 3283 3667 4033 4384

26900 2026 2859 3286 3671 4038 4389

26950 2028 2862 3290 3674 4042 4394

27000 2030 2865 3293 3678 4046 4398

27050 2033 2868 3297 3682 4050 4403

27100 2035 2872 3300 3686 4055 4407

27150 2037 2875 3303 3690 4059 4412

27200 2039 2878 3307 3694 4063 4417

27250 2042 2881 3310 3698 4067 4421

27300 2044 2884 3314 3701 4072 4426

27350 2046 2887 3317 3705 4076 4430

27400 2048 2890 3321 3709 4080 4435

27450 3050 2893 3324 3713 4084 4440

27500 2053 2896 3328 3717 4089 4444

27550 2055 2899 3331 3721 4093 4449

27600 2057 2902 3334 3725 4097 4453

27650 2059 2905 3338 3728 4101 4458

27700 2062 2908 3341 3732 4105 4463

27750 2064 2911 3345 3736 4110 4467

27800 2066 2914 3348 3740 4114 4472

27850 2068 2918 3352 3744 4118 4476

27900 2070 2921 3355 3748 4122 4481

27950 2073 2924 3359 3752 4127 4486

28000 2075 2927 3362 3755 4131 4490

28050 2077 2930 3365 3759 4135 4495

28100 2079 2933 3369 3763 4139 4500

28150 2082 2936 3372 3767 4144 4504

28200 2084 2939 3376 3771 4148 4509

28250 2086 2942 3379 3775 4152 4513

28300 2088 2945 3383 3778 4156 4518

28350 2090 2948 3386 3782 4161 4523

28400 2093 2951 3390 3786 4165 4527

28450 2095 2954 3393 3790 4169 4532

28500 2097 2957 3396 3794 4173 4536

28550 2099 2960 3400 3798 4178 4541

28600 2102 2964 3403 3802 4182 4546

28650 2104 2967 3407 3805 4186 4550

28700 2106 2970 3410 3809 4190 4555

28750 2108 2973 3414 3813 4194 4559

Gross

Income

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

28800 2110 2976 3417 3817 4199 4564

28850 2113 2979 3421 3821 4203 4569

28900 2115 2982 3424 3825 4207 4573

28950 2117 2985 3428 3829 4211 4578

29000 2119 2988 3431 3832 4216 4582

29050 2122 2991 3434 3836 4220 4587

29100 2124 2994 3438 3840 4224 4592

29150 2126 2997 3441 3844 4228 4596

29200 2128 3000 3445 3848 4233 4601

29250 2130 3003 3448 3852 4237 4605

29300 2133 3006 3452 3856 4241 4610

29350 2135 3010 3455 3859 4245 4615

29400 2137 3013 3459 3863 4250 4619

29450 2139 3016 3462 3867 4254 4624

29500 2142 3019 3465 3871 4258 4628

29550 2144 3022 3469 3875 4262 4633

29600 2146 3025 3472 3879 4266 4638

29650 2148 3028 3476 3882 4271 4642

29700 2150 3031 3479 3886 4275 4647

29750 2153 3034 3483 3890 4279 4651

29800 2155 3037 3486 3894 4283 4656

29850 2157 3040 3490 3898 4288 4661

29900 2159 3043 3493 3902 4292 4665

29950 2161 3046 3496 3906 4296 4670

30000 2164 3049 3500 3909 4300 4674

Area above double line in the first column on the first

page is drawn below the income level which

represents the self-support reserve.

One

Child

Two

Children

Three

Children

Four

Children

Five

Children

Six

Children

Self-

Support

Reserve

1350 1700 1900 2100 2300 2600

Child Care Tax Credit Table

Gross Monthly

Income of

Parent

Receiving

Support

Tax Credit

(Percentage)

Maximum

Credit for

One Child

Maximum

Credit for

more than

One Child

$0 to $1250 35 $88 $175

1251 to 1416 34 $85 $170

1417 to 1583 33 $83 $165

1584 to 1750 32 $80 $160

1751 to 1916 31 $78 $155

1917 to 2083 30 $75 $150

2084 to 2250 29 $74 $145

2251 to 2416 28 $70 $140

2417 to 2583 27 $68 $135

2584 to 2750 26 $65 $130

2751 to 2916 25 $63 $125

2917 to 3083 24 $60 $120

3084 to 3250 23 $58 $115

3251 to 3416 22 $55 $110

3417 to 3583 21 $53 $105

3583 or

above

20 $50 $100

Line 11 Adjustment

Percentage of

Year

Number of

Overnight

Periods

Adjustment

Less than

10%

Less than 36 0%

10% to 20% 36 to 72 6%

20% to 25% 73 to 91 9%

25% to 30% 92 to 109 10%

More than

30%

More than 109 10% to 34%

Statement of Income and Expenses - Page 1 of 3

Form CAFC250-7/1/2010 This form is available for free at www.selfrepresent.mo.gov

Form CAFC250 - Income and Expense Statement

For use in Child Custody and Support Cases and Paternity Cases

In what Missouri County is this case to

be decided?

In the Circuit Court of

MISSOURI

What is the case number? (This number

is assigned at time of filing)

Case Number

Division Number

Answer all questions on this form completely.

Your

Information

My full name is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

I filed this case. (Petitioner/Plaintiff)

I did not file this case. (Respondent/Defendant)

I am the Mother

I am the Father

Other Party’s

Information

The full name of the other party is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

Monthly

Income

Information

Mother

Father

1. Monthly Gross Income from Salaries, Wages and

Commissions including Bonuses

________________ ________________

2. Monthly Self-Employment Income

________________ ________________

3. Imputed Monthly Income

________________ ________________

4. Monthly Social Security Benefits not including

Supplemental Security Income (SSI)

________________ ________________

5. Monthly Retirement Benefits

________________ ________________

6. Monthly Pension Income

________________ ________________

7. Monthly Interest Income

________________ ________________

8. Monthly Trust and Annuity Income

________________ ________________

9. Monthly Income from Dividends and Partnership

Distributions

________________ ________________

10. Monthly Unemployment Compensation Benefits

________________ ________________

11. Monthly Severance Pay

________________ ________________

12. Monthly Worker’s Compensation Benefits

________________ ________________

Clear All Forms

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Table of Contents

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shown in blue

on this form

does not print.

Form 14

Statement of Income and Expenses - Page 2 of 3

Form CAFC250-7/1/2010 This form is available for free at www.selfrepresent.mo.gov

Monthly

Income

Information

(Continued)

Mother

Father

13. Monthly Disability Insurance Benefits

________________ ________________

14. Monthly Veterans Disability Benefits

________________ ________________

15. Monthly Military Allowances for Subsistence and

Quarters

________________ ________________

16.

Total Monthly Gross Income from

Paragraphs 1 through 15 (Also enter on Form 14

– Line 1)

________________ ________________

17. Monthly Supplemental Security Income Benefits (SSI)

________________ ________________

18. Monthly Payments of Temporary Assistance for Needy

Families (TANF)

________________ ________________

19. Monthly Medicaid Benefits

________________ ________________

20. Food Stamps

________________ ________________

21. Number of unemancipated children who are NOT the

subject of this proceeding that primarily reside with

each parent (also enter on Form 14 – Line 2c(1))

Monthly amount of child support received pursuant to a

court or administrative order for unemancipated

children who are NOT the subject of this proceeding

that primarily reside with each parent (Also enter on

Form 14 – Line 2c(3))

_______

________________

_______

________________

22. Monthly Maintenance Received in THIS case

________________ ________________

23. Monthly Maintenance Received in OTHER cases

________________ ________________

24. Total Monthly court ordered maintenance being

received. Add lines 22 and 23. (Form 14 – Line 1a)

________________ ________________

Monthly

Expense

Information

Mother

Father

25. Monthly court or administratively ordered child support

being paid for children who are NOT the subject of this

Proceeding (Form 14 – Line 2a)

________________ ________________

26. Monthly Maintenance Paid in THIS case

________________ ________________

27. Monthly Maintenance Paid in OTHER cases

________________ ________________

28. Total Monthly Court Ordered Maintenance being Paid.

Add lines 26 and 27. (Form 14 – Line 2b)

________________ ________________

29. Reasonable work-related child care costs of each

parent for the children who are the subject of this

proceeding (Form 14 – Line 6a and Line 6b)

________________ ________________

30. Health insurance costs for the children who are the

subject of this proceeding (Form 14 – Line 6c)

________________ ________________

31. Uninsured extraordinary medical costs for the children

who are the subject of this proceeding (Form 14 – Line

6d)

________________ ________________

32. Other extraordinary child rearing costs for the children

who are the subject of this proceeding (Form 14- Line

6e)

________________ ________________

33. All Other Expenses of each Parent (Include housing

costs, utilities, transportation costs, food, clothing, loan

payments, charitable contributions, entertainment,

insurance other than listed on line 30, etc.)

________________ ________________

These numbers are automatically calculated for you as you fill in this form.

Form 14

These numbers are automatically calculated for you as you fill in this form.

Paragraph 10

Paragraph 5

Paragraph 9

Paragraph 14a

Statement of Income and Expenses - Page 3 of 3

Form CAFC250-7/1/2010 This form is available for free at www.selfrepresent.mo.gov

I certify under oath that I have given the other party a copy of this Income and Expense Statement pursuant to Missouri

Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the following four boxes)

Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

Handing a copy to the other party or his or her attorney on ____________________(Date).

Sending a copy to the other party or his or her attorney by fax to

_______________ (fax number) on ____________________ (Date) at ____________ (Time).

(To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other

party or his or her attorney at ________________________________________________________

(Email Address) on

____________________ (Date).

Instructions: The following information MUST be filled in before a notary public. This Income and Expense Statement is required to be verified before a notary

public. The “Affiant” is the person that is completing this document.

COUNTY OF ________________ )

) ss.

STATE OF _________________ )

Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant named herein and

that the facts stated in this Income and Expense Statement are true according to his or her best knowledge

and belief.

►__________________________________ _______________________________________

Affiant – SIGN HERE Affiant – PRINT YOUR NAME HERE

Subscribed and sworn to on ____________________.

__________________________________

Notary Public

My Commission Expires: _________________________

Sign here in front of

a Notary Public

Property and Debt Statement – Page 1 of 3

Form CAFC240-7/1/2010 This form is available for free at www.selfrepresent.mo.gov

Form CAFC240 - Property and Debt Statement

For use in Child Custody and Support Cases and Paternity Cases

In what Missouri county will this case

be decided?

In the Circuit Court of

MISSOURI

What is the case number? (This number

is assigned at time of filing)

Case Number

Division Number

Answer all questions on this form completely.

Your

Information

My full name is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

I filed this case. (Petitioner/Plaintiff)

I did not file this case. (Respondent/Defendant)

I am the Mother

I am the Father

Other Party’s

Information

The full name of the other party is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

Property

Owned by

You

Item of Property

Present Fair

Market Value

(Do not deduct amount

owed from this value)

Monthly

Income from

Property

Amount Owed on

Property?

(This debt should be listed

below)

Property is anything you own or you are in the process of buying. Anything you consider yours is property that

should be listed. This includes anything that you might own with another person.

Yes

Clear All Forms

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Table of Contents

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shown in blue

on this form

does not print.

Property and Debt Statement – Page 2 of 3

Form CAFC240-7/1/2010 This form is available for free at www.selfrepresent.mo.gov

Property

Owned by

You

(Continued from

Previous Page)

Item of Property

Present Fair

Market Value

(Do not deduct amount

owed from this value)

Monthly

Income from

Property

Amount Owed on

Property?

(This debt should be listed

below)

Yes

Debts Owed

by You

Creditor

Current

Balance

Monthly

Payment on

Loan

Security for Loan

(This property should be

listed above)

A debt is anything that you owe or that someone claims you owe.

Property and Debt Statement – Page 3 of 3

Form CAFC240-7/1/2010 This form is available for free at www.selfrepresent.mo.gov

I certify under oath that I have given the other party a copy of this Property and Debt Statement pursuant to Missouri

Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the following four boxes)

Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

Handing a copy to the other party or his or her attorney on ____________________(Date).

Sending a copy to the other party or his or her attorney by fax to

_______________ (fax number) on ____________________ (Date) at ____________ (Time).

(To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other

party or his or her attorney at ________________________________________________________

(Email Address) on

____________________ (Date).

Instructions: The following information MUST be filled in before a notary public. This Property and Debt Statement is required to be verified before a notary

public. The “Affiant” is the person that is completing this document.

COUNTY OF ________________ )

) ss.

STATE OF _________________ )

Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant named herein and

that the facts stated in this Property and Debt Statement are true according to his or her best knowledge and

belief.

►__________________________________ _______________________________________

Affiant – SIGN HERE Affiant – PRINT YOUR NAME HERE

Subscribed and sworn to this _____ day of __________________, 20____.

________________________

Notary Public

My Commission Expires:

_____________________

Answer to Father’s Petition for Declaration of Paternity, Custody and/or Support – Page 1 of 2

Form CAFC311-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Form CAFC311 - Answer to Father’s Petition for Declaration of

Paternity, Custody and/or Support

In what Missouri County is this case to

be decided?

In the Circuit Court of

MISSOURI

What is the case number? (This number

is assigned at time of filing)

Case Number

Division Number

Answer all questions on this form completely.

Your

Information

1. I am a DEFENDANT and my full name is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

2. I am the Mother

I am a presumed Father

3. The last four numbers of my Social Security Number are: XXX-XX-

_______________

4. My mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

Other Party’s

Information

5. The full name of Plaintiff is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

Military

Information

6. I am NOT on active duty in the United States military.

I am on active duty in the United States military, but waive my rights pursuant to

the Servicemembers Civil Relief Act of 2003.

Important

Information

7. I understand that by voluntarily entering my appearance and filing this pleading, I

am subjecting myself to the jurisdiction of this court, and the court may enter such

orders and judgments as are authorized by law, including orders awarding child

support, child custody, parenting time/visitation, and attorney’s fees.

Clear All Forms

Print Answer

Table of Contents

Information

shown in blue

on this form

does not print.

The information on this page is about the mother.

This "Answer to Father's

Petition for Declaration of

Paternity" should be filled

in by Mother if

appropriate. There is

another form for the First

Presumed Father and

another for a Second

Presumed Father.

Answer to Father’s Petition for Declaration of Paternity, Custody and/or Support – Page 2 of 2

Form CAFC311-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Agree or

Disagree

with Petition

8. I admit as true EVERYTHING Plaintiff stated in his Petition for Declaration of

Paternity, Custody and/or Support and incorporate all of those allegations herein

EXCEPT the following:

______________________________________________________________________________________

I certify under oath that I have given the other parties a copy of this Answer to Father’s Petition for Declaration of Paternity,

Custody and/or Support pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the

following four boxes)

Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

Handing a copy to the other party or his or her attorney on ____________________(Date).

Sending a copy to the other party or his or her attorney by fax to

_______________ (fax number) on ____________________ (Date) at ____________ (Time).

(To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other

party or his or her attorney at ________________________________________________________

(Email Address) on

____________________ (Date).

Defendant, of lawful age, being duly sworn on his or her oath, states that he or she is the party named above

and that the facts stated in this Answer to Father’s Petition for Declaration of Paternity, Custody and/or

Support are true according to his or her best knowledge and belief.

► __________________________________ __________________________________

SIGN HERE PRINT YOUR NAME HERE

Subscribed and sworn to on ____________________.

__________________________________

Notary Public

My Commission Expires: _________________________

ATTORNEY INFORMATION

(To be completed by your attorney)

______________________________________________ ___________________

Attorney – SIGN HERE Missouri Bar Number

_____________________________________________________________________

PRINT YOUR ATTORNEY’S NAME HERE

______________________________________________________________________________

(Street)

____________________________________ ______________________ __________

(City) (State) (Zip)

__________________ _______________ _____________________________________

(Telephone Number) (Fax Number) (Email Address)

Do not enter any

information here if you are

filing this pleading without

the assistance of a lawyer.

This information should

be completed by your

attorney.

I have assisted the

above named party in the

preparation of these

pleadings, but I am not

entering my appearance on

his or her behalf.

Sign here in front of

a Notary Public

This should only be

completed if a lawyer

helped you with this

form

Answer to Father’s Petition for Declaration of Paternity, Custody and/or Support – Page 1 of 2

Form CAFC311-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Form CAFC311 - Answer to Father’s Petition for Declaration of

Paternity, Custody and/or Support

In what Missouri County is this case to

be decided?

In the Circuit Court of

MISSOURI

What is the case number? (This number

is assigned at time of filing)

Case Number

Division Number

Answer all questions on this form completely.

Your

Information

1. I am a DEFENDANT and my full name is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

2. I am the Mother

I am a presumed Father

3. The last four numbers of my Social Security Number are: XXX-XX-

_______________

4. My mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

Other Party’s

Information

5. The full name of Plaintiff is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

Military

Information

6. I am NOT on active duty in the United States military.

I am on active duty in the United States military, but waive my rights pursuant to

the Servicemembers Civil Relief Act of 2003.

Important

Information

7. I understand that by voluntarily entering my appearance and filing this pleading, I

am subjecting myself to the jurisdiction of this court, and the court may enter such

orders and judgments as are authorized by law, including orders awarding child

support, child custody, parenting time/visitation, and attorney’s fees.

The information on this page is about the first presumed father.

Answer to Father’s Petition for Declaration of Paternity, Custody and/or Support – Page 2 of 2

Form CAFC311-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Agree or

Disagree

with Petition

8. I admit as true EVERYTHING Plaintiff stated in his Petition for Declaration of

Paternity, Custody and/or Support and incorporate all of those allegations herein

EXCEPT the following:

______________________________________________________________________________________

I certify under oath that I have given the other parties a copy of this Answer to Father’s Petition for Declaration of Paternity,

Custody and/or Support pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the

following four boxes)

Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

Handing a copy to the other party or his or her attorney on ____________________(Date).

Sending a copy to the other party or his or her attorney by fax to

_______________ (fax number) on ____________________ (Date) at ____________ (Time).

(To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other

party or his or her attorney at ________________________________________________________

(Email Address) on

____________________ (Date).

Defendant, of lawful age, being duly sworn on his or her oath, states that he or she is the party named above

and that the facts stated in this Answer to Father’s Petition for Declaration of Paternity, Custody and/or

Support are true according to his or her best knowledge and belief.

► __________________________________ __________________________________

SIGN HERE PRINT YOUR NAME HERE

Subscribed and sworn to on ____________________.

__________________________________

Notary Public

My Commission Expires: _________________________

ATTORNEY INFORMATION

(To be completed by your attorney)

______________________________________________ ___________________

Attorney – SIGN HERE Missouri Bar Number

_____________________________________________________________________

PRINT YOUR ATTORNEY’S NAME HERE

______________________________________________________________________________

(Street)

____________________________________ ______________________ __________

(City) (State) (Zip)

__________________ _______________ _____________________________________

(Telephone Number) (Fax Number) (Email Address)

Do not enter any

information here if you are

filing this pleading without

the assistance of a lawyer.

This information should

be completed by your

attorney.

I have assisted the

above named party in the

preparation of these

pleadings, but I am not

entering my appearance on

his or her behalf.

Sign here in front of

a Notary Public

This should only be

completed if a lawyer

helped you with this

form

Answer to Father’s Petition for Declaration of Paternity, Custody and/or Support – Page 1 of 2

Form CAFC311-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Form CAFC311 - Answer to Father’s Petition for Declaration of

Paternity, Custody and/or Support

In what Missouri County is this case to

be decided?

In the Circuit Court of

MISSOURI

What is the case number? (This number

is assigned at time of filing)

Case Number

Division Number

Answer all questions on this form completely.

Your

Information

1. I am a DEFENDANT and my full name is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

2. I am the Mother

I am a presumed Father

3. The last four numbers of my Social Security Number are: XXX-XX-

_______________

4. My mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________ ______________________ _______________

(City) (State) (Zip)

_________________________ ___________________________________________________

(Telephone Number) (E-Mail Address)

Other Party’s

Information

5. The full name of Plaintiff is:

___________________ ______________ ________________________________ ________

(First Name) (Middle Name) (Last Name) (Jr./Sr./III)

Military

Information

6. I am NOT on active duty in the United States military.

I am on active duty in the United States military, but waive my rights pursuant to

the Servicemembers Civil Relief Act of 2003.

Important

Information

7. I understand that by voluntarily entering my appearance and filing this pleading, I

am subjecting myself to the jurisdiction of this court, and the court may enter such

orders and judgments as are authorized by law, including orders awarding child

support, child custody, parenting time/visitation, and attorney’s fees.

The information on this page is about the second presumed father.

Answer to Father’s Petition for Declaration of Paternity, Custody and/or Support – Page 2 of 2

Form CAFC311-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Agree or

Disagree

with Petition

8. I admit as true EVERYTHING Plaintiff stated in his Petition for Declaration of

Paternity, Custody and/or Support and incorporate all of those allegations herein

EXCEPT the following:

______________________________________________________________________________________

I certify under oath that I have given the other parties a copy of this Answer to Father’s Petition for Declaration of Paternity,

Custody and/or Support pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the

following four boxes)

Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

Handing a copy to the other party or his or her attorney on ____________________(Date).

Sending a copy to the other party or his or her attorney by fax to

_______________ (fax number) on ____________________ (Date) at ____________ (Time).

(To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other

party or his or her attorney at ________________________________________________________

(Email Address) on

____________________ (Date).

Defendant, of lawful age, being duly sworn on his or her oath, states that he or she is the party named above

and that the facts stated in this Answer to Father’s Petition for Declaration of Paternity, Custody and/or

Support are true according to his or her best knowledge and belief.

► __________________________________ __________________________________

SIGN HERE PRINT YOUR NAME HERE

Subscribed and sworn to on ____________________.

__________________________________

Notary Public

My Commission Expires: _________________________

ATTORNEY INFORMATION

(To be completed by your attorney)

______________________________________________ ___________________

Attorney – SIGN HERE Missouri Bar Number

_____________________________________________________________________

PRINT YOUR ATTORNEY’S NAME HERE

______________________________________________________________________________

(Street)

____________________________________ ______________________ __________

(City) (State) (Zip)

__________________ _______________ _____________________________________

(Telephone Number) (Fax Number) (Email Address)

Do not enter any

information here if you are

filing this pleading without

the assistance of a lawyer.

This information should

be completed by your

attorney.

I have assisted the

above named party in the

preparation of these

pleadings, but I am not

entering my appearance on

his or her behalf.

Sign here in front of

a Notary Public

This should only be

completed if a lawyer

helped you with this

form

Approved for Use in Uncontested Cases Only

Paternity Judgment – Page 1 of 3

Form CAFC370-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

IN THE CIRCUIT COURT OF _________________________, MISSOURI

______________________________________________________

Plaintiff(s),

-v.- Case No. ____________

______________________________________________________

______________________________________________________ Division No. _________

______________________________________________________

Defendant(s).

Paternity Judgment

Parties

1. As used herein, “Mother” refers to ____________________________________ and “Father” refers to

____________________________________.

2. Appearances

(Check all that apply)

Defendant(s) remains in default as to the pleadings.

Mother appears in person.

Mother appears by

attorney.

Guardian ad Litem

appears in person.

Cause submitted upon

affidavit of Mother.

Cause submitted upon

affidavit of Father.

Father appears in person.

Father appears by

attorney.

Third Party _____________

appears in person.

Third Party ___________

appears by attorney.

Additional Appearances:

__________________________________________________________________________.

3. The last four digits of Mother’s Social Security Number are ___________ and the last four digits

of Father’s Social Security Number are ___________.

4. Defendant(s) is/are not on active duty in the armed services of the United States now or any

time since the filing of the petition herein.

Defendant ____________________________________ is on active duty in the armed services of

the United States, but has waived his or her rights pursuant to the Servicemembers Civil Relief

Act of 2003.

Children

5. This judgment pertains to the following child(ren) hereinafter referred to as “minor child(ren):”

Name of Child Birth Date

Clear All Forms

Print Judgment

Table of Contents

How many children do Mother and Father have together that need a paternity judgment?

Paternity Judgment – Page 2 of 3

Form CAFC370-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

Paternity

6. The court finds that ____________________________________ is the father of the minor

child(ren).

The court finds that ____________________________________ is/are NOT the father of the minor

child(ren) and all his child support arrears are extinguished.

______________________________________________________________________________

Child Custody

7. The court does NOT have “jurisdiction” (as defined in the Uniform Child Custody Jurisdiction

and Enforcement Act, §452.700, RSMo et seq.) over the custody arrangements of the minor

child(ren) and therefore enters no further orders with respect to the custodial arrangements of

the minor child(ren).

The court has “jurisdiction” (as defined in the Uniform Child Custody Jurisdiction and

Enforcement Act, §452.700, RSMo et seq.) over the custody arrangements of the minor

child(ren).

The court approves the provisions of Part A of the parenting plan marked exhibit _________

pertaining to the custodial arrangements of the minor child(ren) and finds that the custodial

arrangements contained in said parenting plan are in the best interests of the minor child(ren).

Therefore, the court orders the provisions of Part A of the said parenting plan pertaining to

the custodial arrangements of the minor child(ren) and incorporates by reference all of the terms

and conditions pertaining to the custodial arrangements of the minor child(ren) set forth in Part A

of said parenting plan as if fully set forth herein.

The sheriff or other law enforcement officers shall enforce the rights of any person to custody

or visitation pursuant to §452.425, RSMo.

Child Support

8. The court does not have jurisdiction to enter any orders with respect to the support of the

minor child(ren).

The court orders the provisions of Part B of the parenting plan marked exhibit _________ ,

pertaining to the support of the minor child(ren) and incorporates by reference all of the terms

and conditions set forth in Part B of said parenting plan as if fully set forth herein.

9. ____________________________________ is to pay to ____________________________________ the

sum of _________________ as and for reimbursement of necessary child support.

10. The State of Missouri has provided public assistance under the TANF program for the minor

child(ren) herein. The total amount due as authorized by law and the guidelines is

_____________ and judgment is entered against _____________________ and in favor of the

State of Missouri for said amount.

Attorney’s Fees

11. _____________________ shall pay to _____________________ the sum of _____________

as and for attorney’s fees herein.

12. Mother shall pay to _____________________ the sum of _____________ as and for Guardian

ad Litem fees in addition to the sum of _____________ previously ordered.

Father shall pay to _____________________ the sum of _____________ as and for Guardian

ad Litem fees in addition to the sum of _____________ previously ordered.

Other Orders

13. The child(ren) named above was/were born in the State of Missouri and the Missouri Bureau

of Vital Records shall amend the birth record of the minor child(ren) pursuant to §210.481 and

§210.849, RSMo to reflect that Father is the biological father of the minor child(ren) as stated

above and to remove any biographical information of any father currently listed on the birth

record(s). A certified copy of this judgment shall be sent to the Missouri Bureau of Vital Records.

Paternity Judgment – Page 3 of 3

Form CAFC370-01/01/2011 This form is available for free at www.selfrepresent.mo.gov

14. The Bureau of Vital Records shall change the name on the birth record(s) of the minor

child(ren) as follows:

_________________________________________________________________________________________

15. Other orders are as per the attached Exhibit Number___________, which is incorporated by

reference as if fully set forth herein.

_________________________________________________________________________________________

Court Costs

16. Court costs are to be paid from the court cost deposit(s) previously posted.

Court costs are waived.

Waiver of Right to Rehearing (If case is heard by a Commissioner pursuant to §487.010, RSMo et. seq.)

We, the undersigned parties, do hereby acknowledge receipt of the findings and recommendations of

the commissioner, and waive the right to file a motion for rehearing in this case.

(If heard by a Family Court Judge)

__________________________ ___________

Judge Date

(If heard by a Family Court Commissioner)

Findings and Recommendations of Commissioner:

__________________________ ___________

Commissioner Date

All orders and these findings and recommendations

of the Commissioner are confirmed and adopted as

the judgment of the court.

__________________________ ___________

Judge Date

A certified copy of this judgment is to be mailed to the following person(s):

(Check all applicable boxes)

Plaintiff’s Attorney

____________________________

(Signature of Attorney)

____________________________

(Street)

____________ ______ ______

(City) (State) (Zip)

_________________________

(Telephone Number)

Defendant’s Attorney

____________________________

(Signature of Attorney)

____________________________

(Street)

____________ ______ ______

(City) (State) (Zip)

_________________________

(Telephone Number)

Guardian ad Litem

____________________________

(Signature of Guardian ad Litem)

____________________________

(Street)

____________ ______ ______

(City) (State) (Zip)

_________________________

(Telephone Number)

Plaintiff

____________________________

(Signature of Plaintiff)

____________________________

(Street)

____________ ______ ______

(City) (State) (Zip)

_________________________

(Telephone Number)

Defendant

____________________________

(Signature of Defendant)

____________________________

(Street)

____________ ______ ______

(City) (State) (Zip)

_________________________

(Telephone Number)

Third Party/Defendant

____________________________

(Signature of Third Party)

____________________________

(Street)

____________ ______ ______

(City) (State) (Zip)

_________________________

(Telephone Number)

Case Number (For Court Use Only) ___________________________

OSCA (10-09) FI-10

CONFIDENTIAL CASE FILING INFORMATION SHEET – DOMESTIC RELATIONS CASES

Required at Case Initiation and with Responsive Filings

NSTRUCTIONS:

9 Complete this form for all parties known at the time of filing. Provide the most appropriate Case Type and Party

Type codes and descriptions. (Found on the Case Types List and Party Types List at www.courts.mo.gov

on the

Court Forms/Filing Information page.)

9 If additional space is needed, complete additional Confidential Case Filing Information Sheets.

NOTE: The full Social Security Number (SSN) is required pursuant to Section 509.520 RSMo if the party is a

person.

Filing Date: County/City of St. Louis:

Style of Case:

(i.e. Petitioner v. Respondent)

Case Type Code: Case Type Description:

Petitioner/Plaintiff Information:

Party Type Code: Party Type Description:

Name: (Last) (First) (Middle)

Address:

City: State: Zip:

DOB: Gender: Male Female SSN:

Attorney Name (if represented by counsel): Bar ID: Party Type Code:

Respondent/Defendant Information:

Party Type Code: Party Type Description:

Name: (Last) (First) (Middle)

Address:

City: State: Zip:

DOB: Gender: Male Female SSN:

Attorney Name (if represented by counsel): Bar ID: Party Type Code:

Party Type Code: Party Type Description:

Name (if person): (Last) (First) (Middle)

Organization (if non-person):

Address:

City: State: Zip:

DOB: Gender: Male Female SSN:

Attorney Name (if represented by counsel): Bar ID: Party Type Code:

Party Type Code: Party Type Description:

Name (if person): (Last) (First) (Middle)

Organization (if non-person):

Address:

City: State: Zip:

DOB: Gender: Male Female SSN:

Attorney Name (if represented by counsel): Bar ID: Party Type Code:

Clear All Forms

Print Information Sheet

Table of Contents

Case Number (For Court Use Only) ___________________________

OSCA (10-09) FI-10

Employer Information

Petitioner/Plaintiff Employer Name:

Employer Address:

City:

State: Zip:

Respondent/Defendant Employer Name:

Employer Address:

City:

State: Zip:

The following information regarding children is required. Complete this section for any child subject to the action of

this case.

*MACSS – Missouri Automated Child Support System

Children:

Name:

SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Name: SSN: DOB:

Gender: Male Female Optional: MACSS Member Number (to be completed by the court):

Check if more than ten children and attach additional sheet

Submitted by: Bar ID (required if attorney):

Address (if not shown on previous page):

City:

State: Zip:

Phone:

Email Address:

*IMPORTANT: It is the parties’ responsibility to keep the court informed of any change of address or employment.*

Instructions to Clerk

Maintain the closed portion(s) of the record in a sealed manila envelope within the file. The file can be

maintained with other open records. If a request is made to review the open portion of the file, the

envelope can be removed from the file. Access to the record must be restricted to avoid access to the

closed portion of the record.

This Filing Information Sheet is applicable to how many children?

Notice of Hearing - Page 1 of 1

Form CAFC721-05/17/2009 This form is available for free at www.selfrepresent.mo.gov

Form CAFC721 – Notice of Hearing

Notice must be sent to every party in this case

In what Missouri county is this case

pending?

In the Circuit Court of

MISSOURI

What is the case number in the

pending case?

Case Number

Division Number

Parties

1. Petitioner or Plaintiff is: ____________________________________________.

(Full Name of Petitioner/Plaintiff)

2. Respondent or Defendant is: ____________________________________________.

(Full Name of Respondent/Defendant)

Information

about the

Hearing

(What, When, Where)

3. Type of matter to be heard: _____________________________________________

4. Date and Time of Hearing: _______________________ at _____________ a.m./p.m.

(Date of Hearing) (Time of Hearing)

The hearing will be held promptly at the Courthouse in the above County and Division.

Party Giving

Notice

► _________________________________ ___________________________ __________

SIGN HERE PRINT YOUR NAME HERE BAR NUMBER

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

__________________ _______________ _____________________________________

(Telephone Number) (Fax Number) (Email Address)

Proof of

Service

I certify under oath that I have given _____________________ a copy of this Notice of Hearing

pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the

following four boxes)

Mailing a copy to the other party or his or her attorney on ____________________ (Date)

at the following address:

______________________________________________________________________

(Street)

_________________________ __________________ ______________

(City) (State) (Zip)

Handing a copy to the other party or his or her attorney on ____________________(Date).

Sending a copy to the other party or his or her attorney by fax to

_______________ (fax number) on ____________________ (Date) at ____________ (Time).

(To be used only by written consent of the party filed with the court) Sending a copy via

electronic mail to the other party or his or her attorney at

________________________________

(Email Address) on ____________________ (Date).

Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant

named herein and that the facts stated in this Notice of Hearing are true according to his or her

best knowledge and belief.

►__________________________________ __________________________________

Affiant – SIGN HERE Affiant – PRINT YOUR NAME HERE

Subscribed and sworn to on

____________________.

________________________ My Commission Expires: _________________________

Notary Public

Clear All Forms

Print Notice of Hearing

Table of Contents

Information

shown in blue

on this form

does not print.

Hearing on Paternity Petition

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