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(C Z(Times New Roman TABLE A(hH  Z 6Times New Roman RegularLTABLE A d G.E.A.R.M.T.AiTABLE Bi)ZZZZ9Hairline!dxdx)Hairline d d !  _X MTR[A' LegalX3' LetterA' Legal3'TMNNX XXX1XX _@(StateofLouisiana*ParishofOuachita/_Morehouse_Ԁ*4thJudicialDistrictCourt  *"#ddd Xdd Xdd X%%,d ,dd +  # < ,<<##X X1#&6g%XX ff________________________________________________  (x Filed:____________________________________M  ԍ  ԍ  ԍ  ԍ  ԍMN  ԍN_  ԍ___  _ !(x << ,  !VS.NUMBER_______________(Division_________)  |    |  ______________________________________________   8 ByDyClerk:________________________________     ***************************************************************************************f #&6g%%&6g##X X%&6g#@ ( JOINTSTIPULATIONOFSUPPORT 2  @!(ANDCONSENTJUDGMENT  V   X XXX  ( BEFORE theundersignedNotaryPublic,personallycameandappearedPlaintiff,_____,and   Defendant,_____,who,afterfirstbeingdulysworn,statedasfollows: ( ThattheyaretheMotherandtheFatherofthefollowingminorchild(_ren_):#X XXX N#X XXX *xYZ(d dd dd "#%%x,dd ,dd",edd",dd"+  $ZZ| % $Name(s)oftheMinorChild(_ren_) /ZZZ|9ZZ| /DateofBirth /ZZ|9ZZZ| /CurrentAge /ZZ| ]ZZ| /SocialSecurityNumber +ZZ ]ZZ| + +ZZZ + -ZZZ - -ZZZZ -(  ZZ ( #X XXX #X XXX   X#aadd  f=   = ݌  Ќ X#ddaa       ThatthereareissuesbeforethecourtwhichthePlaintiffandDefendantdesiretosettleamicably,  [  withouttheneedforanyjudicialproceedingswhichinvolvethesaidissues;that,inordertodoso,andinconsiderationoftheirmutualagreementtoamicablyresolvesaidissues,theyherebyjointlystipulatetoallofthefollowing: A.  CHILDSUPPORT  % #X XXX  #X XXX   TheaveragegrossmonthlyincomeoftheFatheris$_____,andtheaveragegrossmonthlyincome  ' oftheMotheris$_____.Thecombinedaveragegrossmonthlyincomeofthepartiesis$_____,withtheFatherhaving_____%ofthecombinedincomeandtheMotherhaving_____%ofthecombinedincome.Thebaseamountofchildsupport,giventhecombinedincomeofthepartiesandthenumberof_child[ren_]atissue,is$_____.  Thecostof________________________insuranceforthe_child[ren_]is$_____.  Theactualcostofchildcare,onanaveragemonthlybasis,is$_____.TheFederalTaxCredittobeappliedtotheseexpensesis__%,basedontheannualincomeofthe_____.Thenetmonthlychildcareexpensestobeappliedtothechildsupportcalculationis$_____.  &6g%XX Theaveragemonthlycostofprivateschoolincludingtuition,registration,requiredbooks,andrequired +&3 supplyfeesbutnotincludingthecostofuniformsorschoollunches,is$_____.#X X%&6g##X XXX #X XXX  g,'4   BaseduponastraightforwardcalculationofchildsupportundertheLouisianaChildSupportGuidelines,the_____wouldbeorderedtopay$_____totheotherparentforthesupportandmaintenanceofthe_child[ren_].  ____________________shallpaychildsupportto_____________________intheamountof____________________________and___/00($________)dollarspermonth,retroactivetothe_____dayof_______________,20_____,andpayableinequalinstallmentsof$_____onthe_____and_____daysofeachcalendarmonth.  &6g%XX The________________shallpaythetuition,registration,requiredbooks,andrequiredsupplyfees#&6g%%&6g##X X%&6gm#&6g%XX Ԁofthe w61? minor_child[ren_]inatimelymanner.#X X%&6g4#X XXX  O72@   The_____shallmaintain________________________________insurancecoverageontheminor_child[ren_],andshallprovidetheotherparentwithacopyofthepolicy,healthcareproviders,andinsurancecard(s)necessarytoallowhim/hertosecuretreatmentand/ormedicationsfortheminor_child[ren_]pursuanttosaidcoverage,orshallprovidetheotherparentwiththemeanstosecuresaidinformation/documentation ;'7E ifthehealthinsuranceproviderdoesnotroutinelyprovidesametotheinsured.ThepartiesshallfurthershareallPuninsuredPOextraordinaryOmedicalQ,dental,visionandorthodonticQ_expensesR,asdefinedintheLouisianaChildSupportGuidelines_LSA_ԀRS9:315C.(3)incurredbyoronbehalfoftheminor_child[ren_]R_Ԁinthesamepercentagesastheirindividualincomesbeartotheircombinedincomes,asindicatedabove.  The______________shallbeentitledtoclaimthefollowingminor_child[ren_],asdependent(s)forallstateandfederalincometaxpurposes:  The__________________shallbepermittedtoclaimheadofhouseholdorearnedincomecreditforsaid_child[ren_],ifpermittedunderstateandfederalincometaxlaws.  &6g%XX Thepartiesshallexecuteallstateandfederalformsrequiredtoeffectuatetheaboveincometaxprovisions.  8  Failureorrefusaltocomplywiththisparagraphshallbepunishablebycontemptofcourt#X X%&6g##X XXX #X XXX #X XXX # X XXX    Thepartiesfurtheracknowledgethatthisconstitutesajointstipulationtothecontentsofthis   documentandaConsentJudgmentontheissuesbeforetheCourt,andthatneitherofthemmayobjectto p  orappealfromtheresultsofthisconsentagreement.#X XXX Z#       `     h     _______________________________________  \    `     h     Plaintiff  SWORNTOANDSUBSCRIBED beforeme,NotaryPublic,on[date],intheParishof   _______________,StateofLouisiana.@  _____________________________________  @'NOTARYPUBLIC  p    `     h     _______________________________________ 4     `     h     Defendant  SWORNTOANDSUBSCRIBED beforeme,NotaryPublic,on[date],intheParishof "H! _______________,StateofLouisiana.@  _____________________________________ '"& @'NOTARYPUBLIC  (#'   p)$( _X XXX 1XX @StateofLouisiana*ParishofOuachita/Morehouse*4thJudicialDistrictCourt  *dddd dd"edd"edd"YZ(%%, d ,dd +  # < ,<<##X X1r%#&6g%XX ff_____________________________________________N  ԍN___N  N  (x Filed:_______________________________N  ԍN__R  ԍR  ԍ______  !(x << ,  !VS.NUMBER___I___I___________(Division_______)  |    |  ____________________________________________J_____J   8 ByDyClerk:_____________________________K____K     **********************************************************************************L********Lfe'#&6g%%&6gS%##X X%&6g4'# @% CONSENTJUDGMENT  *     THECOURT, consideringthelawandthestipulationsofthepartiessetforthhereinabove:     ITISORDERED,ADJUDGED,ANDDECREED thatthesupportissue(s)beforetheCourtbe -} implementedpursuanttothepartiesJointStipulationofSupportandConsentJudgmentwhichismadea T parthereofasifcopiedinextenso. (    `     h      p       ITISFURTHERORDERED thatallcostsassociatedwiththeseproceedingsshallbeallocated  asfollows___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________  THUSORDERED this_____dayof________________,20____,in_______________,Louisiana.     `     h     ____________________________________ &v    `     h     DISTRICTJUDGE  J  @I I APPROVEDASTOFORMANDCONTENT:__________________________________________0 p ___________________________________"B%p%p% Plaintiff0 ` 0 ` %` %0 % %0h%%0h%h%  0p%%Defendant#&p%p% __________________________________________0 p ____________________________________B&!)p%p% CounselforPlaintiff0 0 % %0h%%0h%h%0%%0p%%CounselforDefendant 'f"*p%p% , ,XX Form.4.2JointStipulationandConsentJudgmentofSupport#X X ,,s2#