Missouri Child Custody Form

PETITION FOR CHILD
CUSTODY FORMS
APPROVED BY
The Missouri Supreme Court
July, 2010
Do not file this page with the court.
PETITION FOR CHILD CUSTODY 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 Petition for Child
Custody, 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 Petitioner and the Respondent. The Parenting Plan
refers to the Mother and Father. It is assumed that you are the person that is
filing the case. Because of this, you must indicate whether you are the mother or
the father so that information from one form can be automatically transferred to
the other forms.
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 the other party signs the Answer so that service of process is not required,
then you only have to file one copy of the Petition for Child Custody, Income
and Expense Statement, Property and Debt Statement, and Parenting Plan.
If the other party does not sign an Answer, then you must file one additional
copy of all of these forms. 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.
NOTE - Only use these forms if paternity has already been established. If fathers
name does not appear on the birth certificate of the children, then paternity probably
has not been established.
TABLE OF CONTENTS
1. Petition for Child Custody (Form CAFC201)
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.
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 Petition for Child Custody (Form CAFC211)
The other party may sign this form if he or she does not want to be personally
served. By signing this form, the other party is allowing the court to decide your
case. The other party may also use this form to disagree with your statements on
your forms.
6. Child Custody and Support Judgment (Form CAFC270)
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.
7. Filing Information Sheet (Form CAFC067)
This form is required by most courts to enter the information about your case into
the Courts computer system.
8. Notice of Hearing (Form CAFC721)
You must use this form to give the other party notice of any hearings in this case.
The court will not consider any issues at any time in your case unless the other
party is property notified using this form.
Clear All Forms
Table of Contents
Print Motion
Form CAFC201 Petition for Child Custody

In what Missouri county will this case
be filed?
In the Circuit Court of
If this is an amended petition, what is

the case number of the pending case?
Case Number
MISSOURI
Division Number
Answer all questions on this form completely.
Your
Information
1. My full name is: (You are the Petitioner in this case.)

__________________
(First Name)
______________
(Middle Name)
_____________________________
(Last Name)
2.
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.
3.
I am the Mother
I am the Father
________
(Jr./Sr./III)
4. The last four numbers of my Social Security Number are: XXX-XX-_______________

5. My mailing address is:
___________________________________________________________________________________
(Street)
_____________________________________
(City)
_________________________
(Telephone Number)
Other Partys
Information
______________________
(State)
_______________
(Zip)
___________________________________________________
(E-Mail Address)
6. The full name of the other party is: (He or she is the Respondent in this case.)
__________________
(First Name)
______________
(Middle Name)
_____________________________
(Last Name)
________
(Jr./Sr./III)
7. The last four numbers of the other partys Social Security Number are:
XXX-XX-_______________
8. The other partys mailing address is:
___________________________________________________________________________________
(Street)
_____________________________________
(City)
_________________________
(Telephone Number)
______________________
(State)
___________________________________________________
(E-Mail Address)
Petition for Child Custody Page 1 of 5

Form CAFC201-7/1/2010
_______________
(Zip)
This form is available for free at www.selfrepresent.mo.gov
Service
Information
9.
The other party has signed a verified Answer to Petition for Determination of
Custody which is being filed with this motion. Therefore, do not issue a
summons.
The other party should be served at his or her residence.
___________________________________________________________________________________
(Street)
_____________________________________
(City)
______________________
(State)
_______________
(Zip)
The other party should be served at his or her place of employment.

______________________________________________________
(Employers Name - if applicable)
_______________________
(Hours of Employment)
___________________________________________________________________________________
(Street)
_____________________________________
(City)
______________________
(State)
_______________
(Zip)
Service by publication. I dont know where the other party is and I have no way
of locating him or her. Therefore, I am requesting that he or she be served by
publication. I have filed an Affidavit for Service by Publication and a Notice of
Publication.
Other method of service: ____________________________________________________
10.
The parent receiving support is not receiving Temporary Assistance for Needy
Families (TANF).
The parent receiving support is receiving TANF 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
Case
Information
11.I am entitled to ask for custody because:

Paternity was acknowledged by both parties and fathers name appears on the
birth certificate of each child listed in this petition. Copies of these birth
certificates are attached to this petition.
An administrative order was entered that determined paternity. A copy of this
administrative order is attached to this petition.
Father and Mother were married at the time of the birth of each child listed in
this petition and there are no existing custody judgments.
Other __________________________________________________________
(Explain)

Form CAFC201-7/1/2010
Military
Information
12.
The other party is NOT on active duty in the United States military.
The other party is on active duty in the United States military.
13.
I am self-employed
I am unemployed
I am employed at:
Employment
Information
___________________________________________________________________________________
(Name of Employer)
___________________________________________________________________________________
(Street)
_____________________________________
(City)
14.
______________________
(State)
_______________
(Zip)
The other party is self-employed

The other party is unemployed
I dont know the other partys employment status
The other party is employed at:
___________________________________________________________________________________
(Name of Employer)
___________________________________________________________________________________
(Street)
_____________________________________
(City)
Childrens
Information
______________________
(State)
15. There is/are ____________ child(ren) who is/are the subject of this proceeding as
listed below.
Childs Full Name

Form CAFC201-7/1/2010
_______________
(Zip)
Childs Age
Additional
Information
about the
Children
16. 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)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
17. 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.
18. Explanation: (If you checked any of the boxes in paragraph 17, please explain in
detail here.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Proposed
Parenting
Plan
Request for
Relief
19. 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. (You must attach a
completed copy of Parenting Plan Form CAFC501 to this petition.)
THEREFORE, I want the court to enter a judgment concerning custody as per Part A of
the attached parenting plan marked Exhibit 1.
I also request the following relief:
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 attorneys fees for this case.
Other (Please state the other requests)
_________________________________________________________________
Form CAFC201-7/1/2010
Petitioner, being of lawful age and duly sworn on his or her oath, states that he or she is the petitioner named
above and that the facts stated in this Petition to Determine Child Custody are true according to his or her best
knowledge and belief.
__________________________________
SIGN HERE
__________________________________
PRINT YOUR NAME HERE
Subscribed and sworn to this ___________ day of __________________, 20____.

________________________
Notary Public
My Commission Expires:
This should only be

completed if a lawyer
helped you with this
form
Sign this in front of a

Notary Public
_____________________
ATTORNEY INFORMATION (To be completed by your attorney)
______________________________________________
Attorney SIGN HERE
___________________
Missouri Bar Number
_____________________________________________________________________
Attorney for Movant PRINT YOUR NAME HERE
______________________________________________________________________________
(Street)
______________________________________
(City)
______________________
(State)
__________________
(Telephone Number)
_____________________________________
(Email Address)
_______________
(Fax Number)
__________
(Zip)

Form CAFC201-7/1/2010
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
Petitioner in the preparation
of these pleadings, but I am
not entering my appearance
on behalf of Petitioner.
Table of Contents
Print Parenting Plan Part A
Clear All Forms
EXHIBIT NO. __________
IN THE CIRCUIT COURT OF _____________________, MISSOURI

(County where court is located)
_________________
(First)
_____________
(Middle)
____________________
(Last)
If this parenting plan is filed after

the case has been filed, you
MUST enter the Case Number.
_________
(Jr./Sr./III)
Petitioner/Plaintiff,
Case No. ____________
-andDivision 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
Childs 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.
Parenting Plan Part A - Custody Page 1

Form CAFC501-08/29/2009
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.
RSMo. 452.375.1(2)
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.

Form CAFC501-08/29/2009
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
Email
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.

Form CAFC501-08/29/2009
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. RSMo. 452.375.1(3)
10. Physical Custody

You must check one and only one of the following nine boxes.
Joint Physical Custody Using Mothers 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 Fathers 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 childrens 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 childrens 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 childrens physical health or impair their emotional development. Father shall
not have access to records and information pertaining to the children pursuant to RSMo. 452.376.1.
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 childrens physical health or impair their emotional development. Mother shall not have
access to records and information pertaining to the children pursuant to RSMo. 452.376.1.
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.)

Form CAFC501-08/29/2009
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:
All exchanges shall occur at the childrens school or child care provider.
All exchanges shall occur at the Mothers Residence.
All exchanges shall occur at the Fathers 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 parents 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 childrens destination.
He or she must also provide a telephone number where the children can be reached.
16. Childrens 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 parents time with the
children, the parent scheduling the activity should obtain the affected parents 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:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Form CAFC501-08/29/2009
Other Provisions Concerning the Children

18. Relocation
RSMo. 452.377states:
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
____________________________
Attorney for Mother
____________________________
Attorney For Father
____________________________
Guardian ad Litem

Form CAFC501-08/29/2009
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 1

Form CAFC501-08/29/2009
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
Weekday/Weekend Schedules
Sunday
Monday
WEEK ONE
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
WEEK TWO
Tuesday
Wednesday
Thursday
Friday
Saturday

Form CAFC501-08/29/2009
Holiday Exchange Schedule

Holiday
Even
Numbered
Years
Odd
Numbered
Years
FATHER or
MOTHER
FATHER or
MOTHER
Physical Custody
From
To
Time
Time
New Years Eve

New Years Day
King Day
Presidents Day
Memorial Day
Independence Day
Labor Day
Thanksgiving
Christmas Eve
Christmas Day
Easter
Other Holidays
(specify)
FATHER is the "Parent Paying Support"
Special Occasions
(specify)
Halloween
Mothers Day
Fathers Day
Mothers Birthday
Fathers Birthday
Childs Birthday

Form CAFC501-08/29/2009
Holiday Schedules
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
1
1
1
1
7
4
2
1
1
8
5
3
2
2
2
9
8
5
3
2
2
9
6
4
3
3
3
10
9
6
4
3
10
10
7
5
4
4
4
11
10
7
5
4
11
11
8
6
5
12
12
12
11
8
6
5
12
12
9
7
6
13
13
13
12
9
7
13
13
13
10
8
7
14
14
14
13
10
8
14
14
14
11
9
15
15
15
15
21
18
16
15
15
22
19
17
16
16
16
23
22
19
17
16
16
23
20
18
17
17
17
24
23
20
18
17
24
24
21
19
18
18
18
25
24
21
19
18
25
25
22
20
19
26
26
26
25
22
20
19
26
26
23
21
20
27
27
27
26
23
21
27
27
27
24
22
21
28
28
28
27
24
22
28
28
28
25
23
29
29
29
29
30
31
30
31
30
29
29
31
30
30
31
31
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
8
5
5
2
1
1
1
6
3
1
1
1
9
6
6
3
2
2
9
7
4
2
2
2
10
7
7
4
3
3
10
8
5
3
3
10
11
8
8
5
4
11
11
9
6
4
4
11
12
9
9
6
5
12
12
10
7
5
12
12
13
10
10
7
6
13
13
11
8
6
13
13
14
11
11
8
14
14
14
12
9
7
14
14
22
19
19
16
15
15
15
20
17
15
15
15
23
20
20
17
16
16
23
21
18
16
16
16
24
21
21
18
17
17
24
22
19
17
17
24
25
22
22
19
18
25
25
23
20
18
18
25
26
23
23
20
19
26
26
24
21
19
26
26
27
24
24
21
20
27
27
25
22
20
27
27

Form CAFC501-08/29/2009
28
25
25
22
28
28
28
26
23
21
28
28
30
29
29
29
31
30
30
29
29
29
30
30
30
31
31
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
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.
EXCHANGES FOR DAY
Sunday
Monday
5:30 p.m. Dad receives children

8:30 p.m. Mom receives children at Moms house
WEEK ONE
Tuesday
This entry contains a

mistake. It is unclear
whether it refers to 5:30
a.m. or 5:30 p.m.
Wednesday
Thursday
Friday
5:30 Dad receives children at Daycare
Saturday
Sunday
6:00 p.m. Mom receives children at her house
This entry is also a mistake.

Mom already has the
children with her so she cant
receive the children. There
should always be an even
number of exchanges for
any two week period.
Monday
WEEK TWO
Tuesday
8:30 p.m. Mom receives children
Wednesday
Thursday
Friday
Saturday
5:30 p.m. Dad receives children at Moms house

8:30 p.m. Mom receives children at Moms house
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.

Form CAFC501-08/29/2009
Table of Contents
Print Parenting Plan Part B
Clear All Forms
EXHIBIT NO. __________
IN THE CIRCUIT COURT OF _____________________, MISSOURI

(County where court is located)
_________________
(First)
_____________
(Middle)
____________________
(Last)
If this parenting plan is filed after

the case has been filed, you
MUST enter the Case Number.
_________
(Jr./Sr./III)
Petitioner/Plaintiff,
Case No. ____________
-andDivision 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
Childs Age
Parenting Plan Part B - Support Page 1

Form CAFC501-08/29/2009
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 childrens 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. RSMo. 452.375.12 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.
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.

Form CAFC501-08/29/2009
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
parents 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 parents 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

Form 14
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 parents 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

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 parents 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 CAFC501-08/29/2009
Health Expenses Not Covered by Insurance

8. Medical, Dental, Vision, or Psychological Expenses not Covered by Insurance
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.
(RSMo. 454.633.3 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. RSMo. 454.603.5(2)
All reasonable and necessary medical or dental expenses of the children are covered by insurance. RSMo.
454.603.5(1)
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.
RSMo. 454.603.5(3)
9. Payment of Uninsured Extraordinary Medical Costs
Paid by Father
Form 14
Uncovered Extraordinary Medical Costs to be Paid by

Amount of Expense
Father INCLUDED on Form 14
$___________ 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
Amount of Expense
Mother INCLUDED on Form 14
$___________ 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 Mother
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.)

Form CAFC501-08/29/2009
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
Form 14
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
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
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 CAFC501-08/29/2009
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

RSMo. 452.340.5 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)

Form CAFC501-08/29/2009
14. Payment of Extraordinary Child-Rearing Costs of the Children
Extraordinary Child-Rearing Costs Paid by

Amount of Expense
Mother INCLUDED on Form 14
$___________ 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)
Paid by Mother

Amount of Expense
Father INCLUDED on Form 14
$___________ 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)

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 childrearing 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.
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 childrearing 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.

Form CAFC501-08/29/2009
Paid by Father
b. Extraordinary Child-Rearing Costs NOT INCLUDED on Form 14
Paid by Mother
Form 14
Paid by Father
a. Extraordinary Child-Rearing Costs INCLUDED on Form 14
Form 14 Child Support Calculation

CHILDREN
AGE
CHILDREN
Child One
Child Four
Child Two
Child Five
Child Three
AGE
Child Six
Parent Receiving Support
Parent Paying Support
Combined
1. MONTHLY GROSS INCOME
a. Court ordered maintenance being received.
2. ADJUSTMENTS (per month)

a. Other court or administratively ordered
child support being paid.
($
) ($
b. Court ordered maintenance being paid.
($
) ($
c. Support obligation for other children

primarily residing in parent's custody.
($
) ($
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).
Calculated Amount
0.0%
0.0%
Calculated Amount
Calculated Amount
Calculated Amount
5. BASIC CHILD SUPPORT AMOUNT

(From support chart using combined line 3 income).
$
Calculated Amount
6. ADDITIONAL CHILD-REARING COSTS

Paragraph 10
(per month)
a. Reasonable work-related child care costs of the parent receiving
support ($
)
less any child care tax credit ($
). Calculated Amount
b. Reasonable work-related child care costs
of the parent paying support.
Paragraph 10
c. Health insurance costs for the children who

are subjects of this proceeding.
Paragraph 7
d. Uninsured extraordinary medical costs.

(Agreed by parents or ordered by court).
Paragraph 9
e. Other extraordinary child rearing costs.

(Agreed by parents or ordered by court)
Paragraph 14a
Calculated Amount
$
$
7. TOTAL ADDITIONAL CHILD-REARING COSTS (Sum of lines $

6a, 6b, 6c, 6d and 6e).
Calculated Amount
Calculated Amount
Calculated Amount
8. TOTAL COMBINED CHILD SUPPORT COSTS (Sum of line 5

and combined line 7).
9. EACH PARENT'S SUPPORT OBLIGATION (Multiply line 8 by
each parent's line 4)
$
$
Calculated Amount
10. CREDIT FOR ADDITIONAL CHILD-REARING COSTS (Line

7 of parent paying support).
($
11. ADJUSTMENT FOR A PORTION OF THE AMOUNTS

EXPENDED DURING PERIODS OF OVERNIGHT VISITATION
OR CUSTODY. (Multiply line 5 by ___________ %).
($
12. PRESUMED CHILD SUPPORT AMOUNT (Line 9 minus

lines 10 and 11).
PREPARED BY:
Calculated Amount
)
Calculated Amount
)
Calculated Amount
Calculated Amount
Income and Expense Statement

Form CAFC501-08/29/2009
Calculated Amount
Calculated Amount
Amount of Child Support

15. Presumed Monthly Amount of Child Support
The amounts in Paragraph 15 are

automatically calculated for you
as you complete Form 14.
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 RSMo. 452.340.8 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 courtordered 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.
Form 14
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.

Form CAFC501-08/29/2009
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 childs
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. RSMo.
452.370.4.
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

Form CAFC501-08/29/2009
In even numbered tax years,

this parent will claim this
child as a dependent
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, 651109001.
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
____________________________
Attorney for Mother
____________________________
Attorney For Father
____________________________
Guardian ad Litem

Form CAFC501-08/29/2009
2008 Schedule of Basic Child Support

Obligation
Gross
Income
One
Child
0-1000
1050
1100
1150
1200
1250
1300
1350
1400
1450
1500
1550
1600
1650
1700
1750
1800
1850
1900
1950
2000
2050
2100
2150
2200
2250
2300
2350
2400
2450
2500
2550
2600
2650
2700
2750
2800
2850
2900
2950
3000
3050
3100
3150
3200
3250
3300
3350
3400
3450
3500
3550
3600
3650
3700
3750
3800
3850
3900
3950
4000
4050
4100
4150
4200
4250
4300
4350
4400
4450
4500
4550
4600
4650
4700
4750
50
62
98
134
170
206
241
277
306
316
325
334
344
353
362
371
380
389
398
407
416
425
434
443
452
461
470
479
488
496
505
514
523
532
541
550
559
568
577
586
595
604
613
622
631
641
650
659
668
676
684
692
700
708
715
723
728
733
738
744
749
754
759
765
770
775
780
786
791
796
801
807
812
817
822
828
Two
Three
Four
Five
Six
Children Children Children Children Children
50
63
99
135
172
208
244
280
317
352
386
420
455
489
523
539
553
566
579
592
604
617
630
643
656
668
681
694
707
720
732
745
758
771
783
796
809
822
835
849
862
875
888
901
914
928
941
954
967
979
990
1002
1013
1025
1036
1047
1054
1061
1069
1076
1083
1091
1098
1105
1113
1120
1127
1135
1142
1149
1157
1164
1171
1179
1186
1193
50
64
100
137
173
210
247
282
320
356
391
425
459
494
528
563
597
632
666
699
713
728
743
758
773
788
803
818
833
848
863
878
893
908
922
937
952
968
984
999
1015
1030
1046
1062
1077
1093
1108
1124
1139
1154
1167
1181
1194
1208
1221
1234
1242
1250
1259
1267
1275
1283
1292
1300
1308
1317
1325
1333
1342
1350
1358
1367
1375
1383
1392
1400
50
64
101
138
175
212
249
286
324
360
395
430
464
499
534
569
604
638
673
708
743
778
812
847
864
880
897
914
930
947
964
980
997
1014
1030
1047
1064
1081
1099
1116
1134
1151
1168
1186
1203
1221
1238
1255
1273
1289
1304
1319
1334
1349
1364
1378
1387
1396
1406
1415
1424
1434
1443
1452
1461
1471
1480
1489
1499
1508
1517
1526
1536
1545
1554
1564
50
65
102
140
177
215
252
290
327
364
399
434
469
505
540
575
610
645
680
716
751
786
821
856
891
927
962
997
102
1042
1060
1078
1097
1115
1133
1152
1170
1189
1209
1228
1247
1266
1285
1304
1323
1343
1362
1381
1400
1417
1434
1451
1467
1484
1501
1516
1526
1536
1546
1557
1567
1577
1587
1597
1608
1618
1628
1638
1648
1659
1669
1679
1689
1700
1710
1720
50
66
103
141
179
217
255
293
330
368
403
439
474
510
546
581
617
652
688
723
759
794
830
865
901
936
972
1007
1043
1078
1114
1149
1185
1212
1232
1252
1272
1293
1314
1335
1355
1376
1397
1418
1439
1459
1480
1501
1522
1541
1559
1577
1595
1613
1631
1648
1659
1670
1681
1692
1703
1714
1725
1736
1747
1759
1770
1781
1792
1803
1814
1825
1836
1847
1859
1870
Gross
Income
One
Child
4800
4850
4900
4950
5000
5050
5100
5150
5200
5250
5300
5350
5400
5450
5500
5550
5600
5650
5700
5750
5800
5850
5900
5950
6000
6050
6100
6150
6200
6250
6300
6350
6400
6450
6500
6550
6600
6650
6700
6750
6800
6850
6900
6950
7000
7050
7100
7150
7200
7250
7300
7350
7400
7450
7500
7550
7600
7650
7700
7750
7800
7850
7900
7950
8000
8050
8100
8150
8200
8250
8300
8350
8400
8450
8500
8550
8600
8650
8700
8750
833
836
840
844
848
852
855
859
863
867
871
874
878
882
886
890
893
897
901
905
909
912
915
918
921
924
927
930
933
936
939
942
945
948
951
954
957
960
963
966
969
972
974
976
977
979
981
982
984
985
986
988
989
991
992
994
995
997
998
1000
1001
1002
1004
1005
1008
1013
1018
1023
1027
1032
1037
1042
1048
1053
1059
1064
1069
1075
1079
1083
Two
Three
Four
Five
Six
1200
1206
1211
1216
1222
1227
1233
1238
1243
1249
1254
1260
1265
1270
1276
1281
1286
1292
1297
1303
1308
1313
1317
1321
1325
1329
1333
1337
1341
1345
1348
1352
1356
1360
1364
1368
1372
1376
1380
1384
1388
1392
1395
1397
1399
1401
1403
1405
1407
1409
1410
1412
1414
1416
1418
1419
1421
1423
1425
1427
1428
1430
1432
1434
1437
1444
1451
1458
1465
1472
1479
1486
1494
1501
1509
1516
1524
1532
1538
1543
1408
1414
1420
1426
1433
1439
1445
1451
1458
1464
1470
1476
1482
1489
1495
1501
1507
1514
1520
1526
1532
1538
1542
1547
1551
1555
1559
1563
1567
1572
1576
1580
1584
1588
1592
1597
1601
1605
1609
1613
1617
1622
1626
1628
1629
1631
1633
1635
1637
1639
1641
1643
1644
1646
1648
1650
1652
1653
1655
1657
1659
1661
1663
1664
1668
1676
1684
1692
1700
1708
1716
1724
1733
1742
1750
1759
1768
1777
1784
1790
1573
1579
1586
1593
1600
1607
1614
1621
1628
1635
1642
1649
1656
1663
1670
1677
1684
1691
1698
1705
1712
1718
1723
1728
1732
1737
1741
1746
1751
1755
1760
1765
1769
1774
1779
1783
1788
1793
1797
1802
1807
1811
1816
1818
1820
1822
1824
1826
1829
1831
1833
1835
1837
1839
1841
1843
1845
1847
1849
1851
1852
1855
1857
1859
1863
1872
1881
1890
1899
1908
1916
1926
1936
1945
1955
1965
1975
1984
1993
1999
1730
1737
1745
1753
1760
1768
1776
1783
1791
1799
1806
1814
1822
1829
1837
1844
1852
1860
1867
1875
1883
1890
1895
1900
1905
1911
1916
1921
1926
1931
1936
1941
1946
1952
1957
1962
1967
1972
1977
1982
1987
1993
1997
2000
2002
2004
2007
2009
2011
2014
2016
2018
2020
2023
2025
2027
2029
2032
2034
2036
2038
2040
2043
2045
2050
2059
2069
2079
2089
2098
2108
2118
2129
2140
2151
2161
2172
2183
2192
2199
1880
1889
1897
1905
1914
1922
1930
1938
1947
1955
1963
1972
1980
1988
1997
2005
2013
2022
2030
2038
2046
2054
2060
2066
2071
2077
2082
2088
2093
2099
2105
2110
2116
2121
2127
2132
2138
2144
2149
2155
2160
2166
2171
2174
2176
2179
2181
2184
2186
2189
2191
2194
2196
2199
2201
2203
2206
2208
2211
2213
2216
2218
2220
2223
2228
2239
2249
2260
2270
2281
2291
2303
2314
2326
2338
2349
2361
2373
2383
2391
Gross
Income
One
Child
8800
8850
8900
8950
9000
9050
9100
9150
9200
9250
9300
9350
9400
9450
9500
9550
9600
9650
9700
9750
9800
9850
9900
9950
10000
10050
10100
10150
10200
10250
10300
10350
10400
10450
10500
10550
10600
10650
10700
10750
10800
10850
10900
10950
11000
11050
11100
11150
11200
11250
11300
11350
11400
11450
11500
11550
11600
11650
11700
11750
11800
11850
11900
11950
12000
12050
12100
12150
12200
12250
12300
12350
12400
12450
12500
12550
12600
12650
12700
12750
1086
1090
1093
1097
1100
1104
1107
1110
1114
1117
1121
1124
1128
1131
1135
1138
1141
1145
1148
1151
1153
1156
1159
1161
1164
1167
1169
1172
1175
1177
1180
1182
1185
1188
1190
1193
1196
1198
1201
1204
1206
1209
1212
1214
1217
1220
1223
1226
1229
1232
1235
1238
1240
1243
1246
1249
1252
1255
1258
1261
1264
1267
1270
1273
1276
1279
1282
1285
1288
1291
1294
1297
1300
1303
1306
1309
1312
1315
1318
1321
Two
Three
Four
Five
Six
1548
1553
1558
1563
1568
1573
1578
1582
1587
1592
1597
1602
1607
1612
1617
1622
1627
1632
1636
1640
1643
1647
1651
1654
1658
1662
1665
1669
1673
1676
1680
1684
1687
1691
1694
1698
1702
1705
1709
1713
1716
1720
1724
1727
1731
1735
1739
1743
1748
1752
1756
1760
1765
1769
1773
1777
1781
1786
1790
1794
1798
1803
1807
1811
1815
1819
1824
1828
1832
1836
1841
1845
1849
1853
1857
1862
1866
1870
1874
1879
1796
1801
1807
1813
1818
1824
1830
1836
1841
1847
1853
1858
1864
1870
1876
1881
1887
1893
1898
1902
1906
1910
1914
1918
1923
1927
1931
1935
1939
1943
1947
1951
1955
1960
1964
1968
1972
1976
1980
1984
1988
1992
1997
2001
2005
2009
2014
2019
2024
2029
2034
2039
2043
2048
2053
2058
2063
2068
2073
2078
2083
2087
2092
2097
2102
2107
2112
2117
2122
2127
2131
2136
2141
2146
2151
2156
2161
2166
2170
2175
2006
2012
2018
2025
2031
2038
2044
2050
2057
2063
2069
2076
2082
2089
2095
2101
2108
2114
2120
2125
2129
2134
2138
2143
2147
2152
2157
2161
2166
2170
2175
2180
2184
2189
2193
2198
2203
2207
2212
2216
2221
2226
2230
2235
2239
2244
2250
2255
2261
2266
2272
2277
2283
2288
2293
2299
2304
2310
2315
2321
2326
2332
2337
2343
2348
2353
2359
2364
2370
2375
2381
2386
2392
2397
2403
2408
2114
2419
2424
2430
2206
2213
2220
2227
2234
2241
2248
2255
2262
2269
2276
2283
2290
2297
2304
2312
2319
2326
2332
2337
2342
2347
2352
2357
2362
2367
2372
2377
2382
2387
2393
2398
2403
2408
2413
2418
2423
2428
2433
2438
2443
2448
2453
2458
2463
2469
2475
2481
2487
2493
2499
2505
2511
2517
2523
2529
2535
2541
2547
2553
2559
2565
2571
2577
2583
2589
2595
2601
2607
2613
2619
2625
2631
2637
2643
2649
2655
2661
2667
2673
2398
2406
2413
2421
2429
2436
2444
2452
2459
2467
2474
2482
2490
2497
2505
2513
2520
2528
2535
2540
2546
2551
2557
2562
2568
2573
2579
2584
2590
2595
2601
2606
2612
2617
2623
2628
2634
2639
2645
2650
2656
2661
2667
2672
2678
2684
2690
2697
2703
2710
2716
2723
2729
2736
2742
2749
2755
2762
2768
2775
2781
2788
2794
2801
2808
2814
2821
2827
2834
2840
2847
2853
2860
2866
2873
2879
2886
2892
2899
2905
Gross
Income
One
Child
12800
12850
12900
12950
13000
13050
13100
13150
13200
13250
13300
13350
13400
13450
13500
13550
13600
13650
13700
13750
13800
13850
13900
13950
14000
14050
14100
14150
14200
14250
14300
14350
14400
14450
14500
14550
14600
14650
14700
14750
14800
14850
14900
14950
15000
15050
15100
15150
15200
15250
15300
15350
15400
15450
15500
15550
15600
15650
15700
15750
15800
15850
15900
15950
16000
16050
16100
16150
16200
16250
16300
16350
16400
16450
16500
16550
16600
16650
16700
16750
1324
1327
1329
1332
1335
1338
1341
1344
1347
1350
1353
1356
1359
1362
1365
1368
1371
1374
1377
1380
1383
1386
1389
1391
1394
1397
1400
1403
1406
1409
1412
1415
1418
1420
1423
1426
1429
1431
1434
1437
1439
1442
1445
1447
1450
1453
1455
1458
1461
1463
1466
1469
1472
1474
1477
1480
1483
1486
1489
1492
1495
1498
1501
1504
1507
1510
1513
1516
1519
1522
1525
1528
1531
1534
1537
1540
1543
1546
1549
1551
Two
Three
Four
Five
Six
1883
1887
1891
1895
1900
1904
1908
1912
1917
1921
1925
1929
1933
1938
1942
1946
1950
1955
1959
1963
1967
1971
1974
1978
1982
1986
1990
1994
1998
2002
2006
2010
2014
2018
2021
2025
2028
2032
2036
2039
2043
2047
2050
3054
2058
2061
2065
2068
2072
2076
2079
2083
2087
2090
2095
2099
2103
2107
2111
2116
2120
2124
2128
2133
2137
2141
2145
2149
2154
2158
2162
2166
2171
2175
2179
2183
2187
2192
2196
2200
2180
2185
2190
2195
2200
2205
2210
2214
2219
2224
2229
2234
2239
2244
2249
2253
2258
2263
2268
2272
2277
2281
2285
2290
2294
2299
2303
2307
2312
2316
2320
2325
2329
2333
2337
2341
2345
2350
2354
2358
2362
2366
2370
2374
2378
2382
2386
2390
2394
2398
2402
2406
2410
2414
2419
2424
2429
2434
2439
2443
2448
2453
2458
2463
2468
2473
2478
2483
2487
2492
2497
2502
2507
2512
2517
2522
2526
2531
2536
2541
2435
2441
2446
2452
2457
2463
2468
2474
2479
2484
2490
2495
2501
2506
2512
2517
2523
2528
2533
2538
2543
2548
2553
2558
2563
2567
2572
2577
2582
2587
2592
2597
2601
2606
2611
2615
2620
2624
2629
2633
2638
2642
2647
2651
2656
2660
2665
2669
2674
2678
2683
2687
2692
2697
2702
2708
2713
2718
2724
2729
2735
2740
2746
2751
2757
2762
2768
2773
2778
2784
2789
2795
2800
2806
2811
2817
2822
2828
2833
2838
2679
2685
2691
2697
2703
2709
2715
2721
2727
2733
2739
2745
2751
2757
2763
2769
2775
2781
2787
2792
2797
2803
2808
2814
2819
2824
2830
2835
2840
2846
2851
2856
2862
2867
2872
2877
2882
2887
2892
2897
2902
2907
2912
2917
2921
2926
2931
2936
2941
2946
2951
2956
2961
2966
2972
2978
2984
2990
2996
3002
3008
3014
3020
3026
3032
3038
3044
3050
3056
3062
3068
3074
3080
3086
3092
3098
3104
3110
3116
3122
2912
2918
2925
2931
2938
2945
2951
2958
2964
2971
2977
2984
2990
2997
3003
3010
3016
3023
3029
3035
3041
3047
3052
3058
3064
3070
3076
3082
3087
3093
3099
3105
3111
3116
3122
3127
3133
3138
3143
3149
3154
3160
3165
3170
3176
3181
3186
3192
3197
3203
3208
3213
3219
3224
3231
3237
3244
3250
3257
3263
3270
3277
3283
3290
3296
3303
3309
3316
3322
3329
3335
3342
3348
3355
3361
3368
3374
3381
3387
3394
Gross
Income
One
Child
16800
16850
16900
16950
17000
17050
17100
17150
17200
17250
17300
17350
17400
17450
17500
17550
17600
17650
17700
17750
17800
17850
17900
17950
18000
18050
18100
18150
18200
18250
18300
18350
18400
18450
18500
18550
18600
18650
18700
18750
18800
18850
18900
18950
19000
19050
19100
19150
19200
19250
19300
19350
19400
19450
19500
19550
19600
19650
19700
19750
19800
19850
19900
19950
20000
20050
20100
20150
20200
20250
20300
20350
20400
20450
20500
20550
20600
20650
20700
20750
1554
1557
1560
1563
1566
1569
1572
1575
1578
1581
1584
1587
1590
1593
1596
1599
1602
1605
1608
1611
1614
1617
1620
1623
1626
1629
1632
1635
1638
1641
1644
1646
1648
1651
1653
1655
1657
1659
1662
1664
1666
1668
1671
1673
1675
1677
1679
1682
1684
1686
1688
1691
1693
1695
1697
1699
1702
1704
1706
1708
1711
1713
1715
1717
1719
1722
1724
1726
1728
1731
1733
1735
1737
1739
1742
1744
1746
1748
1751
1753
Two
Three
Four
Five
Six
2204
2209
2213
2217
2221
2225
2230
2234
2238
2242
2247
2251
2255
2259
2264
2268
2272
2276
2280
2285
2289
2293
2297
2302
2306
2310
2314
2318
2323
2327
2331
2335
2338
2341
2344
2347
2350
2353
2356
2359
2362
2365
2368
2372
2375
2378
2381
2384
2387
2390
2393
2396
2399
2402
2405
2408
2411
2414
2418
2421
2424
2427
2430
2433
2436
2439
2442
2445
2448
2451
2454
2457
2460
2464
2467
2470
2473
2476
2479
2482
2546
2551
2556
2561
2566
2570
2575
2580
2585
2590
2595
2600
2605
2609
2614
2619
2624
2629
2634
2639
2644
2649
2653
2658
2663
2668
2673
2678
2683
2688
2692
2697
2700
2703
2707
2710
2714
2717
2721
2724
2728
2731
2735
2738
2741
2745
2748
2752
2755
2759
2762
2766
2769
2772
2776
2779
2783
2786
2790
2793
2797
2800
2803
2807
2810
2814
2817
2821
2824
2828
2831
2835
2838
2841
2845
2848
2852
2855
2859
2862
2844
2849
2855
2860
2866
2871
2877
2882
2887
2893
2898
2904
2909
2915
2920
2926
2931
2937
2942
2947
2953
2958
2964
2969
2975
2980
2986
2991
2997
3002
3007
3012
3016
3020
3024
3027
3031
3035
3039
3043
3047
3051
3054
3058
3062
3066
3070
3074
3078
3081
3085
3089
3093
3097
3101
3105
3108
3112
3116
3120
3124
3128
3131
3135
3139
3143
3147
3151
3155
3158
3162
3166
3170
3174
3178
3182
3185
3189
3193
3197
3128
3134
3140
3146
3152
3158
3164
3170
3176
3182
3188
3194
3200
3206
3212
3218
3224
3230
3236
3242
3248
3254
3260
3266
3272
3278
3284
3290
3296
3302
3308
3313
3318
3322
3326
3330
3334
3339
3343
3347
3351
3356
3360
3364
3368
3373
3377
3381
3385
3390
3394
3398
3402
3407
3411
3415
3419
3423
3428
3432
3436
3440
3445
3449
3453
3457
3462
3466
3470
3474
3479
3483
3487
3491
3495
3500
3504
3508
3512
3517
3400
3407
3413
3420
3426
3433
3440
3446
3453
3459
3466
3472
3479
3485
3492
3498
3505
3511
3518
3524
3531
3537
3544
3550
3557
3563
3570
3576
3583
3590
3596
3602
3606
3611
3615
3620
3615
3629
3634
3638
3643
3648
3652
3657
3661
3666
3671
3675
3680
3684
3689
3694
3698
3703
3707
3712
3717
3721
3726
3730
3735
3740
3744
3749
3754
3758
3763
3767
3772
3777
3781
3786
3790
3795
3800
3804
3809
3813
3818
3823
Gross
Income
One
Child
20800
20850
20900
20950
21000
21050
21100
21150
21200
21250
21300
21350
21400
21450
21500
21550
21600
21650
21700
21750
21800
21850
21900
21950
22000
22050
22100
22150
22200
22250
22300
22350
22400
22450
22500
22550
22600
22650
22700
22750
22800
22850
22900
22950
23000
23050
23100
23150
23200
23250
23300
23350
23400
23450
23500
23550
23600
23650
23700
23750
23800
23850
23900
23950
24000
24050
24100
24150
24200
24250
24300
24350
24400
24450
24500
24550
24600
24650
24700
24750
1755
1757
1759
1762
1764
1766
1768
1771
1773
1775
1777
1779
1782
1784
1786
1788
1791
1793
1795
1797
1799
1802
1804
1806
1808
1811
1813
1815
1817
1819
1822
1824
1826
1828
1831
1833
1835
1837
1839
1842
1844
1846
1848
1850
1853
1855
1857
1859
1862
1864
1866
1868
1870
1873
1875
1877
1879
1882
1884
1886
1888
1890
1893
1895
1897
1899
1902
1904
1906
1908
1910
1913
1915
1917
1919
1922
1924
1926
1928
1930
Two
Three
Four
Five
Six
2485
2488
2491
2494
2497
2500
2503
2506
2510
2513
2516
2519
2522
2525
2528
2531
2534
2537
2540
2543
2546
2549
2553
2556
2559
2562
2565
2568
2571
2574
2577
2580
2583
2586
2589
2592
2595
2599
2602
2605
2608
2611
2614
2617
2620
2623
2626
2629
2632
2635
2638
2641
2645
2648
2651
2654
2657
2660
2663
2666
2669
2672
2675
2678
2681
2684
2687
2691
2694
2697
2700
2703
2706
2709
2712
2715
2718
2721
2724
2727
2866
2869
2872
2876
2879
2883
2886
2890
2893
2897
2900
2903
2907
2910
2914
2917
2921
2924
2928
2931
2934
2938
2941
2945
2948
2952
2955
2959
2962
2966
2969
2972
2976
2979
2983
2986
2990
2993
2997
3000
3003
3007
3010
3014
3017
3021
3024
3028
3031
3034
3038
3041
3045
3048
3052
3055
3059
3062
3066
3069
3072
3076
3079
3083
3086
3090
3093
3097
3100
3103
3107
3110
3114
3117
3121
3124
3128
3131
3134
3138
3201
3205
3209
3212
3216
3220
3224
3228
3232
3235
3239
3243
3247
3251
3255
3259
3262
3266
3270
3274
3278
3282
3286
3289
3293
3297
3301
3305
3309
3312
3316
3320
3324
3328
3332
3336
3339
3343
3347
3351
3355
3359
3363
3366
3370
3374
3378
3382
3386
3390
3393
3397
3401
3405
3409
3413
3416
3420
3424
3428
3432
3436
3440
3443
3447
3451
3455
3459
3463
3467
3470
3474
3478
3482
3486
3490
3493
3497
3501
3505
3521
3525
3529
3534
3538
3542
2546
3551
3555
3559
3563
3567
3572
3576
3580
3584
3589
3593
3597
3601
3606
3610
3614
3618
3623
3627
3631
3635
3639
3644
3648
3652
3656
3661
3665
3669
3673
3678
3682
3686
3690
3695
3699
3703
3707
3712
3716
3720
3724
3728
3733
3737
3741
3745
3750
3754
3758
3762
3767
3771
3775
3779
3784
3788
3792
3796
3800
3805
3809
3813
3817
3822
3826
3830
3834
3839
3843
3847
3851
3856
3827
3832
3836
3841
3846
3850
3855
3859
3864
3869
3873
3878
3882
3887
3892
3896
3901
3905
3910
3915
3919
3924
3929
3933
3938
3942
3947
3952
3956
3961
3965
3970
3975
3979
3984
3988
3993
3998
4002
4007
4011
4016
4021
4025
4030
4034
4039
4044
4048
4053
4057
4062
4067
4071
4076
4080
4085
4090
4094
4099
4103
4108
4113
4117
4122
4127
4131
4136
4140
4145
4150
4154
4159
4163
4168
4173
4177
4182
4186
4191
Gross
Income
One
Child
24800
24850
24900
24950
25000
25050
25100
25150
25200
25250
25300
25350
25400
25450
25500
25550
25600
25650
25700
25750
25800
25850
25900
25950
26000
26050
26100
26150
26200
26250
26300
26350
26400
26450
26500
26550
26600
26650
26700
26750
26800
26850
26900
26950
27000
27050
27100
27150
27200
27250
27300
27350
27400
27450
27500
27550
27600
27650
27700
27750
27800
27850
27900
27950
28000
28050
28100
28150
28200
28250
28300
28350
28400
28450
28500
28550
28600
28650
28700
28750
1933
1935
1937
1939
1942
1944
1946
1948
1950
1953
1955
1957
1959
1962
1964
1966
1968
1970
1973
1975
1977
1979
1982
1984
1986
1988
1990
1993
1995
1997
1999
2002
2004
2006
2008
2010
2013
2015
2017
2019
2022
2024
2026
2028
2030
2033
2035
2037
2039
2042
2044
2046
2048
3050
2053
2055
2057
2059
2062
2064
2066
2068
2070
2073
2075
2077
2079
2082
2084
2086
2088
2090
2093
2095
2097
2099
2102
2104
2106
2108
Two
Three
Four
Five
Six
2730
2733
2737
2740
2743
2746
2749
2752
2755
2758
2761
2764
2767
2770
2773
2776
2780
2783
2786
2789
2792
2795
2798
2801
2804
2807
2810
3813
2816
2819
2822
2826
2829
2832
2835
2838
2841
2844
2847
2850
2853
2856
2859
2862
2865
2868
2872
2875
2878
2881
2884
2887
2890
2893
2896
2899
2902
2905
2908
2911
2914
2918
2921
2924
2927
2930
2933
2936
2939
2942
2945
2948
2951
2954
2957
2960
2964
2967
2970
2973
3141
3145
3148
3152
3155
3159
3162
3165
3169
3172
3176
3179
3183
3186
3190
3193
3197
3200
3203
3207
3210
3214
3217
3221
3224
3228
3231
3234
3238
3241
3245
3248
3252
3255
3259
3262
3265
3269
3272
3276
3279
3283
3286
3290
3293
3297
3300
3303
3307
3310
3314
3317
3321
3324
3328
3331
3334
3338
3341
3345
3348
3352
3355
3359
3362
3365
3369
3372
3376
3379
3383
3386
3390
3393
3396
3400
3403
3407
3410
3414
3509
3513
3517
3520
3524
3528
3532
3536
3540
3544
3547
3551
3555
3559
3563
3567
3571
3574
3578
3582
3586
3590
3594
3597
3601
3605
3609
3613
3617
3621
3624
3628
3632
3636
3640
3644
3648
3651
3655
3659
3663
3667
3671
3674
3678
3682
3686
3690
3694
3698
3701
3705
3709
3713
3717
3721
3725
3728
3732
3736
3740
3744
3748
3752
3755
3759
3763
3767
3771
3775
3778
3782
3786
3790
3794
3798
3802
3805
3809
3813
3860
3864
3868
3872
3877
3881
3885
3889
3894
3898
3902
3906
3911
3915
3919
3923
3928
3932
3936
3940
3945
3949
3953
3957
3961
3966
3970
3974
3978
3983
3987
3991
3995
4000
4004
4008
4012
4017
4021
4025
4029
4033
4038
4042
4046
4050
4055
4059
4063
4067
4072
4076
4080
4084
4089
4093
4097
4101
4105
4110
4114
4118
4122
4127
4131
4135
4139
4144
4148
4152
4156
4161
4165
4169
4173
4178
4182
4186
4190
4194
4196
4200
4205
4209
4214
4219
4223
4228
4232
4237
4242
4246
4251
4255
4260
4265
4269
4274
4278
4283
4288
4292
4297
4302
4306
4311
4315
4320
4325
4329
4334
4338
4343
4348
4352
4357
4361
4366
4371
4375
4380
4384
4389
4394
4398
4403
4407
4412
4417
4421
4426
4430
4435
4440
4444
4449
4453
4458
4463
4467
4472
4476
4481
4486
4490
4495
4500
4504
4509
4513
4518
4523
4527
4532
4536
4541
4546
4550
4555
4559
Gross
Income
One
Child
28800
28850
28900
28950
29000
29050
29100
29150
29200
29250
29300
29350
29400
29450
29500
29550
29600
29650
29700
29750
29800
29850
29900
29950
30000
2110
2113
2115
2117
2119
2122
2124
2126
2128
2130
2133
2135
2137
2139
2142
2144
2146
2148
2150
2153
2155
2157
2159
2161
2164
Two
Three
Four
Five
Six
2976
2979
2982
2985
2988
2991
2994
2997
3000
3003
3006
3010
3013
3016
3019
3022
3025
3028
3031
3034
3037
3040
3043
3046
3049
3417
3421
3424
3428
3431
3434
3438
3441
3445
3448
3452
3455
3459
3462
3465
3469
3472
3476
3479
3483
3486
3490
3493
3496
3500
3817
3821
3825
3829
3832
3836
3840
3844
3848
3852
3856
3859
3863
3867
3871
3875
3879
3882
3886
3890
3894
3898
3902
3906
3909
4199
4203
4207
4211
4216
4220
4224
4228
4233
4237
4241
4245
4250
4254
4258
4262
4266
4271
4275
4279
4283
4288
4292
4296
4300
4564
4569
4573
4578
4582
4587
4592
4596
4601
4605
4610
4615
4619
4624
4628
4633
4638
4642
4647
4651
4656
4661
4665
4670
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
SelfSupport
Reserve
1350
Two
Three
Four
Five
Six
1700
1900
2100
2300
2600
Child Care Tax Credit Table

Gross Monthly
Maximum
Income of
Maximum
Tax Credit Credit for Credit for
Parent
(Percentage)
more than
Receiving
One Child
One Child
Support
$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%
Print Income and Expenses
Clear All Forms
Table of Contents
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?
What is the case number? (This number
MISSOURI
Case Number
Information
shown in blue
on this form
does not print.
Division Number
is assigned at time of filing)
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 Partys
Information
Monthly
Income
Information
Form 14
The full name of the other party is:

___________________
(First Name)
______________
(Middle Name)
________________________________
(Last Name)
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 Workers Compensation Benefits
________________
________________
Statement of Income and Expenses - Page 1 of 3

Form CAFC250-7/1/2010
________
(Jr./Sr./III)
Monthly
Income
Information
(Continued)
Mother
Father
13. Monthly Disability Insurance Benefits
________________
________________
14. Monthly Veterans Disability Benefits
________________
________________
15. Monthly Military Allowances for Subsistence and

Quarters
________________
________________
________________
________________
17. Monthly Supplemental Security Income Benefits (SSI)
________________
________________
18. Monthly Payments of Temporary Assistance for Needy

Families (TANF)
________________
________________
19. Monthly Medicaid Benefits
________________
________________
20. Food Stamps
________________
________________
16.
Total Monthly Gross Income from

Paragraphs 1 through 15 (Also enter on Form 14
Line 1)
These numbers are automatically calculated for you as you fill in this form.
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
Form 14
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
Paragraph 10
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.)
________________
________________
Paragraph 7
________________
________________
Paragraph 9
________________
________________
Paragraph 14a
________________
________________

Form CAFC250-7/1/2010
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 ________________
STATE OF _________________
)
) ss.
)
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
Sign here in front of

a Notary Public
My Commission Expires: _________________________

Form CAFC250-7/1/2010
Print Property and Debt
Clear All Forms
Table of Contents
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?
Information
shown in blue
on this form
does not print.
MISSOURI
Case Number
Division Number
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 Partys
Information
Property
Owned by
You
The full name of the other party is:

___________________
(First Name)
______________
(Middle Name)
Item of Property
________________________________
(Last Name)
Present Fair
Market Value
(Do not deduct amount

owed from this value)
Monthly
Income from
Property
________
(Jr./Sr./III)
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
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Form CAFC240-7/1/2010
Property and Debt Statement Page 1 of 3

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)
Yes
No
(Continued from
Previous Page)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Debts Owed
by You
Creditor
Current
Balance
Monthly
Payment on
Loan
A debt is anything that you owe or that someone claims you owe.
Form CAFC240-7/1/2010

Security for Loan

(This property should be
listed above)
I certify under oath that I have given the other party a copy of this Property and Debt Statement pursuant to Missouri
______________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)

____________________ (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 ________________
STATE OF _________________
)
) ss.
)
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
_______________________________________
Subscribed and sworn to this _____ day of __________________, 20____.

________________________
Notary Public
My Commission Expires:
_____________________
Form CAFC240-7/1/2010

Table of Contents
Print Answer
Clear All Forms
Form CAFC211 - Answer to Petition for Child Custody

In what Missouri County is this case to
be decided?
MISSOURI
Case Number
Information
shown in blue
on this form
does not print.
Division Number
Your
Information
This "Answer to Petition
for Child Custody" should
be filled in by the the
other party if appropriate.
1. My full name is:

___________________
(First Name)
2.
______________
(Middle Name)
________________________________
(Last Name)
________
(Jr./Sr./III)
I am the Mother
I am the Father
3. The last four numbers of my Social Security Number are: XXX-XX-_______________

4. My mailing address is:
___________________________________________________________________________________
(Street)
_____________________________________
(City)
_________________________
(Telephone Number)
5. The full name of the other party is:
Military
Information
6.
Important
Information
______________
(Middle Name)
________________________________
(Last Name)
________
(Jr./Sr./III)
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.
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 attorneys fees.
Answer to Petition for Child Custody Page 1 of 2

Form CAFC211-7/1/2010
_______________
(Zip)
___________________________________________________
(E-Mail Address)
Other Partys
Information
___________________
(First Name)
______________________
(State)
Agree or
Disagree
with Petition
9. I admit as true EVERYTHING the other party stated in his or her Petition for Child
Custody and incorporate all of those allegations herein EXCEPT the following:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
I certify under oath that I have given the other party a copy of this Answer to Petition for Child Custody pursuant to Missouri
______________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)

____________________ (Date).
Respondent, of lawful age, being duly sworn on his or her oath, states that he or she is Respondent named
above and that the facts stated in this Answer to Petition for Child Custody are true according to his or her best
knowledge and belief.
__________________________________
SIGN HERE
__________________________________
Sign here in front of

a Notary Public
__________________________________
Notary Public
ATTORNEY INFORMATION (To be completed by your attorney)

______________________________________________
Attorney SIGN HERE
___________________
Missouri Bar Number
_____________________________________________________________________
PRINT YOUR ATTORNEYS NAME HERE
______________________________________________________________________________
(Street)
____________________________________
(City)
______________________
(State)
__________________
(Telephone Number)
_____________________________________
(Email Address)
_______________
(Fax Number)
__________
(Zip)
Answer to Petition for Child Custody Page 2 of 2

Form CAFC211-7/1/2010
This should only be

completed if a lawyer
helped you with this
form
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
Respondent in the
preparation of these
pleadings, but I am not
entering my appearance on
his or her behalf.
Table of Contents
Print Judgment
Clear All Forms
Approved for Use in Uncontested Cases Only
IN THE CIRCUIT COURT OF _________________________, MISSOURI

_________________
(First)
Petitioner,
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
-and_________________
(First)
Respondent.
Parties
1.
Case No. ____________

Division No. ____________
Child Custody and Support Judgment

As used herein, Mother refers to Petitioner and Father refers to Respondent.
As used herein, Father refers to Petitioner and Mother refers to Respondent.
2. Appearances (Check all that apply)

Petitioner appears in
person.
Respondent appears in
person.
Third Party _____________
appears in person.
Petitioner appears by
attorney.
Respondent appears by
attorney.
Third Party ___________
appears by attorney.
Guardian ad Litem
appears in person.
Cause submitted upon
affidavit of Petitioner.
Cause submitted upon
affidavit of Respondent.
3. The last four digits of Petitioners Social Security Number are ___________ and the last four
digits of Respondents Social Security Number are ___________.
Paternity
4.
Paternity was acknowledged by both parties and fathers name appears on the birth certificate
of each child listed in this judgment.
An administrative order was entered that determined paternity for each child listed in this
judgment.
Father and Mother were married at the time of the birth of each child listed in this judgment
and there are no other existing custody judgments.
Other __________________________________________________________
Children
(Explain)
This Judgment is applicable to how many children?
5. This judgment pertains to the following unemancipated child(ren) hereinafter referred to as

minor child(ren):
Name of Child
Form CAFC270-7/1/2010
Childs Age
Child Custody and Support Judgment Page 1 of 3

Child Custody
6.
The court does NOT have jurisdiction over the custody arrangements of the minor child(ren)
pursuant to the Uniform Child Custody Jurisdiction and Enforcement Act, RSMo. 452.700 et
seq. and therefore enters no further orders with respect to the custodial arrangements of the
minor child(ren).
The court has jurisdiction over the custody arrangements of the minor child(ren) pursuant to
the Uniform Child Custody Jurisdiction and Enforcement Act, RSMo. 452.700 et seq.
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 RSMo. 452.425.
Child Support
7.
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.
Attorneys Fees
8.
Petitioner shall pay to _____________________ the sum of _____________ as and for

Respondents attorneys fees herein.
Respondent shall pay to _____________________ the sum of _____________ as and for
Petitioners attorneys fees herein.
9.
Petitioner shall pay to _____________________ the sum of _____________ as and for
Guardian ad Litem fees in addition to the sum of _____________ previously ordered.
Respondent shall pay to _____________________ the sum of _____________ as and for
Guardian ad Litem fees in addition to the sum of _____________ previously ordered.
Other Orders
10.
Other orders are as per the attached Exhibit Number___________, which is incorporated by
reference as if fully set forth herein.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Court Costs
11.
Court costs are to be paid from the court cost deposit(s) previously posted.
Court costs are waived.
Form CAFC270-7/1/2010

Waiver of Right to Rehearing (If case is heard by a Commissioner pursuant to RSMo. 487.010 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)
(If heard by a Family Court Commissioner)
Findings and Recommendations of Commissioner:
__________________________
Judge
___________
Date
__________________________
Commissioner
___________
Date
Approved and Adopted as 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)
Petitioners Attorney
Respondents Attorney
Guardian ad Litem
____________________________
____________________________
____________________________
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
(Signature of Attorney)
Petitioner
(Signature of Guardian ad Litem)
Respondent
____________________________
(Signature of Petitioner)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
Form CAFC270-7/1/2010
(Signature of Attorney)
____________________________
(Signature of Respondent)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
Third Party
____________________________
(Signature of Third Party)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)

Print Information Sheet
Clear All Forms
Table of Contents
Case Number (For Court Use Only) ___________________________
CONFIDENTIAL CASE FILING INFORMATION SHEET DOMESTIC RELATIONS CASES

Required at Case Initiation and with Responsive Filings
INSTRUCTIONS:
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)
DENNIS
(Middle)
Address:
City:
DOB:
State:
Gender:
Male
Female
Zip:
SSN:
Attorney Name (if represented by counsel):
Bar ID:
Party Type Code:
Respondent/Defendant Information:
Party Type Code:
Name: (Last)
(First)
(Middle)
Address:
City:
DOB:
State:
Gender:
Male
Female
Party Type Code:
Zip:
SSN:
Bar ID:
Party Type Code:
Name (if person): (Last)
(First)
(Middle)
Organization (if non-person):

Address:
City:
DOB:
State:
Gender:
Male
Female
SSN:
Party Type Code:
Zip:
Bar ID:
Party Type Code:
Name (if person): (Last)
(First)
(Middle)
Organization (if non-person):

Address:
City:
DOB:
State:
Gender:

OSCA (10-09) FI-10
Male
Female
Zip:
SSN:
Bar ID:
Party Type Code:
Case Number (For Court Use Only) ___________________________
Employer Information
Petitioner/Plaintiff Employer Name:
Employer Address:
City:
State:
Zip:
State:
Zip:
Respondent/Defendant Employer Name:

Employer Address:
City:
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
This Filing Information Sheet is applicable to how many children?
Children:
Name:
Gender:
SSN:
Male
Female
Optional: MACSS Member Number (to be completed by the court):
Name:
Gender:
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
SSN:
Male
Female
DOB:
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:
Phone:
State:
Zip:
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.
OSCA (10-09) FI-10
Print Notice of Hearing
Clear All Forms
Table of Contents
Form CAFC721 Notice of Hearing

Notice must be sent to every party in this case
In what Missouri county is this case
pending?
What is the case number in the

pending case?
Case Number
Parties
1. Petitioner or Plaintiff is:
Information
shown in blue
on this form
does not print.
MISSOURI
Division Number
____________________________________________.
(Full Name of Petitioner/Plaintiff)
2. Respondent or Defendant is: ____________________________________________.

(Full Name of Respondent/Defendant)
Information
about the
Hearing
4. Date and Time of Hearing: _______________________ at _____________ a.m./p.m.
(What, When, Where)
The hearing will be held promptly at the Courthouse in the above County and Division.
Party Giving
Notice
_________________________________
Hearing on Petition for Custody

3. Type of matter to be heard: _____________________________________________
(Date of Hearing)
SIGN HERE
__________________
(Telephone Number)
You must send the

other party notice of
the court date.
Please make sure
you indicate how you
sent notice and where
you sent the notice.
If you are not

represented by a
lawyer, then this form
must be signed in
front of a notary
public.
___________________________
__________________
(State)
_______________
(Fax Number)
______________
(Zip)
_____________________________________
(Email Address)
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)

(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.
DENNIS
__________________________________
__________________________________
Affiant SIGN HERE
________________________
Notary Public
Notice of Hearing - Page 1 of 1

Form CAFC721-05/17/2009
__________
BAR NUMBER
______________________________________________________________________
(Street)
_________________________
(City)
Proof of
Service
(Time of Hearing)

Missouri Child Custody Form

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Missouri Child Custody Form

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PETITION FOR CHILD

Do not file this page with the court.

PETITION FOR CHILD CUSTODY FORMS PACKAGE

General Information about All Forms

Do not file this page with the court.

2. Parenting Plan (Form CAFC501)

3. Income and Expense Statement (Form CAFC250)

4. Property and Debt Statement (Form CAFC240)

5. Answer to Petition for Child Custody (Form CAFC211)

6. Child Custody and Support Judgment (Form CAFC270)

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

7. Filing Information Sheet (Form CAFC067)

8. Notice of Hearing (Form CAFC721)

Do not file this page with the court.

Clear All Forms

Form CAFC201 Petition for Child Custody

In the Circuit Court of

If this is an amended petition, what is

Answer all questions on this form completely.

1. My full name is: (You are the Petitioner in this case.)

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

Petition for Child Custody Page 1 of 5

This form is available for free at www.selfrepresent.mo.gov

The other party should be served at his or her place of employment.

11.I am entitled to ask for custody because:

Petition for Child Custody Page 2 of 5

This form is available for free at www.selfrepresent.mo.gov

The other party is self-employed

Petition for Child Custody Page 3 of 5

This form is available for free at www.selfrepresent.mo.gov

17. Check all boxes that apply to your case.

This form is available for free at www.selfrepresent.mo.gov

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

This should only be

Sign this in front of a

Petition for Child Custody Page 5 of 5

This form is available for free at www.selfrepresent.mo.gov

Do not enter any

Print Parenting Plan Part A

Clear All Forms

EXHIBIT NO. __________

IN THE CIRCUIT COURT OF _____________________, MISSOURI

If this parenting plan is filed after

Case No. ____________

-andDivision No. ____________

3. Names and Ages of Children

Parenting Plan Part A - Custody Page 1

This form is available for free at www.selfrepresent.mo.gov

Decisions Concerning the Children

B. Daily or Everyday Decisions

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

Parenting Plan Part A - Custody Page 2

This form is available for free at www.selfrepresent.mo.gov

Mother and Father Joint Legal Custody

Mother Sole Legal Custody to Mother

Father Sole Legal Custody to Father

Third Party Sole Legal Custody to Third Party

8. Communication between Parents

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

Parenting Plan Part A - Custody Page 3

This form is available for free at www.selfrepresent.mo.gov

When the Children Will Be with Each Parent

10. Physical Custody

Parenting Plan Part A - Custody Page 4

Subscribed and sworn to this _ day of ____, 20.