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Permanent Parenting Plan - Tennessee
| Permanent Parenting Plan Form. This is a Tennessee form and can be used in Circuit Court Shelby Local County . |
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IN THE CIRCUIT/CHANCERY COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS ) 7 No. vs. Plaintiff, ) ) DIVISION/PART - f ) Defendant. PERMANENT PARENTING PLAN This Permanent Parenting Plan regarding the parenting of their child(ren) is presented by: (hereinafter referred to as Mother) and (hereinafter referred to as "Father) OR This plan is proposed by: This plan has been reached by (Mark one) MAgreement ediation Other ADR by Court hearing on [Date] 1. PARENTING & SUPPORT 1.1 PARENTING. The parties will share parenting of their minor child(ren): Primary residence for purpose of Uniform Child Custody Jurisdiction and Enforcement Act, T.C.A. 36-6-201, et seq. and 36-6-41 0 is with: - - Mother Father [childs name] Social Security # [childs DOB] - -- Mother Father [childs name] Social Security # [childs DOB] - - Mother Father [childs name] Social Security # [childs DOB] - - Mother Father [childs name] Social Security # [childs DOB] - - Mother Father [childs name] Social Security # [childs DOB] The designation does not affect either parents rights and responsibilities under this Parenting Plan. Revised 01/18/01 Page 1 of 17<<<<<<<<<********>>>>>>>>>>>>> 21.2 FINANCIAL SUPPORT FOR CHILD(REN). 1.2.1 CHILD SUPPORT PER TENNESSEE CHILD SUPPORT GUIDELINES. * (Mark one) Mother Father shall pay child support, in accordance with the Tennessee Child Support Guidelines, in the amount of $ per(Mark one) week month twice per month (semi-monthly) or every two weeks (bi-weekly) beginning on the day of , 20 This amount is based on a gross monthly income of $ . ( * Attach a sworn statement of income if this is a Proposed Plan.) 1.2.2 Justification for any deviations: 1.2.3 This support shall be paid: (Mark one) Directly to the other parent. To the Central Child Support Receipting Unit and sent to the other parent at: By Direct Deposit to the other parent at Bank. By Wage Assignment Order issued to the employer of the obligor spouse. [Attach a copy of the Order] Employer shall deduct the amount of support noted above plus a five percent (5%) fee and remit the total withheld to: Central Child Support Receipting Unit P.O. Box 305200 Nashville, TN 37229 The parties affirmatively acknowledge that Court approval must be obtained before child support can be reduced or modified, unless such payments are automatically reduced or terminated under the terms of the Parenting Plan. Revised 01/18/01 Page 2 of 17 <<<<<<<<<********>>>>>>>>>>>>> 31.3 TAX EXEMPTION. (Mark one) Mother Father will receive the tax exemption for the child(ren). (Mark one) Mother Father will sign the appropriate Internal Revenue Service form to accomplish this designation. Other 1.4 ANNUAL AFFIDAVIT OF INCOME. Each parent shall provide to the other, on or before May 15th of every year, a signed affidavit disclosing their gross income for the previous calendar year. Gross income is defined by the Tennessee Child Support Guidelines. 1.5 HEALTH INSURANCE. 1.5.1 (Mark one or both) Mother Father will maintain medical/hospital, optical, and dental insurance on the minor child(ren), and proof of continuing coverage will be furnished to the other parent by May 15 of each year. 1.5.2 If both parents are providing insurance, the primary coverage will be provided by (Mark one) Mother Father 1.5.3 Uncovered medicals, including deductibles or co-payments, if any, and costs of eyeglasses, contact lenses, routine annual physicals will be paid by: (Mark one) Mother Father divided equally between the parties Other 1.5.4 After insurance has paid its portion, the parent receiving the bill indicating a remaining balance will send a copy of it and the Explanation of Benefits to the other parent within ten (10) days. The other parent will pay his/her share within thirty (30) days of receipt of the bill. Revised 01/18/01 Page 3 of 17<<<<<<<<<********>>>>>>>>>>>>> 41.6 ADDITIONAL HEALTH INSURANCE. (e.g., mental health) 1.7 LIFE INSURANCE . (Optional for parent not paying child support.) 1.7.1 (Mark one or both) Father shall insure his own life in the minimum amount of $ , whole or term, which may not decrease in face amount during the minority of any child except upon order of the Court. Mother shall insure her own life in the minimum amount of $ 7 whole or term, which may not decrease in face amount during the minority of any child except upon order of the Court. 1.7.2 The policy(ies) will name the minor child(ren) as primary beneficiaries and proof of continuing coverage will be furnished by May 15th of each year. The insured shall also designate (Mark one) Mother Father Other: as guardian over these funds for the benefit of the child(ren). The choice of secondary beneficiaries will be left to the owner of the policy, and if the type of policy chosen is whole life, the owner may retain control of the investment portion of the policy. 1.7.3 Other provisions regarding life insurance: 1.8 OTHER PROVISIONS FOR PARENTING AND SUPPORT. The following special provisions apply to parenting and support: Revised 01/18/01 Page 4 of 17 <<<<<<<<<********>>>>>>>>>>>>> 5 II. SCHEDULES 2.1 RESIDENTIAL SCHEDULE. This plan was reached by: (Mark one) Agreement Mediation other Alternative Dispute Resolution Court hearing on because the parties were unable to reach an agreement. 2.2 PRE-SCHOOL SCHEDULE. 2.2.1 (Mark one) There is one child there are (#) children of preschool age.2.2.2 Prior to enrollment in school, there are special education needs of [name(s) of child(ren)] which will be addressed as follows: 2.2.3 Prior to enrollment in school, the child(ren) will reside with: (Mark one) Mother Father, except for the following days and times when the child(ren) will reside or be with the other parent: From: [Day/Time] To: [Day/Time](Mark one) every week every other week the first and third weeks of the month the second and fourth weeks of the month other: Revised 01/18/01 Page 5 of 1 7<<<<<<<<<********>>>>>>>>>>>>> 6 and From: [Day/Time] To: [Day/Time](Mark one) every week every other week the first and third weeks of the month the second and fourth weeks of the month other: 2.3 SCHOOL SCHEDULE. Note: This schedule applies during the enrollment of the child(ren) in elementary, middle and high school. To the extent that the residential schedule is anticipated to change at any level of education, a separate school schedule should be prepared to reflect the change. 2.3.1 Upon enrollment in school, the child(ren) will reside with: (Mark one) Mother Father, except for the
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