A printout of a computer calculation and finding is attached.
Non-Guideline Child Support: The parties agree that: (1) they are fully informed of their rights concerning guideline child
support; (2) they have agreed to the child support provisions of this Stipulation without coercion or duress; (3) this Stipulatio
in the best interests of the children involved; (4) the needs of the children will be adequately met by this agreed-upon child
support; and (5) they have not assigned the right to support to the county and no public assistance application is pending.
Child Support Arrears
Petitioner Respondent owes to the other parent child support arrears in the principal amount of $ for the
from to Arrears shall at $ Per month due of each
month commencing until paid in full.
Additional Child Support Orders:
An Income Withholding Order for the above child support shall issue.
Respondent shall pay to the other parent for child care costs related to employment:
(1) The sum of $ per month commencing .
(2) A sum equal to ½ of the verifiable daycare expenses.
Respondent shall obtain and/or maintain for the minor children medical, dental and visual insurance,
Lf available at reasonable cost through employment, self-employment, or union affiliation. The cost is presumed
reasonable if it does not exceed 5% of the responsible parent’s gross income.
(2) Any health expenses not paid by insurance shall be shared Petitioner 50% and Respondent 50%.
If the person who receives child support enters into a contract with a private child support collector, the party ordered to pay support
must pay the fee charged by the private support collector. The fee must not exceed 33⅓ % of the total amount of arrears nor may it
exceed 50% of any fee charged by the private child support collector. The money judgment created by this provision is in favor of
the private child support collector and the party receiving support, jointly.
Petitioner Respondent shall pay spousal/partner support of $ per month, due ½ on the 1
, and ½ on the
day of each month commencing and continuing until the death of either party, remarriage or
Uegistration of a new domestic partnership by the party receiving support, further order of the court or termination date of
Spousal/Partner Support Arrears
Petitioner Respondent owes to the other party spousal/partner support arrears in the principal amount of $
period from to Arrears shall be paid at $ per month due
of each month commencing until paid in full.
Page 2 of 3
Approved for Optional Use
Riverside Superior Court
RI-FL03 [Rev. 05/27/14]
STIPULATION AND ORDER ON REQUEST FOR ORDER