NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA
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See § 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed documents. |
[Caption. See § 3 of the Introduction in volume 1 of this manual.]
Order in Suit to Modify Parent-Child Relationship
1.Date of Hearing
On [date] the Court heard this case.
2.Appearances
Appearances
2.A.Petitioner[s]
1.In Person and by Attorney
Petitioner, [name of petitioner], appeared in person and through attorney of record, [name], and announced ready for trial.
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Or |
2.Agreement
Petitioner, [name of petitioner], did not appear in person but has agreed to the terms of this order as evidenced by Petitioner’s signature below.
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Repeat for each additional petitioner. |
2.B.Respondent[s]
Respondent, [name of respondent],
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Select one of the following. |
1.In Person
appeared in person and announced ready for trial.
2.By Attorney
appeared through attorney of record, [name], and announced ready for trial.
3.In Person and by Attorney
appeared in person and through attorney of record, [name], and announced ready for trial.
4.Did Not Appear (Default with No Answer)
although duly and properly cited, did not appear and wholly made default.
5.Did Not Appear (Waiver)
waived issuance and service of citation by waiver duly filed and, after receiving proper notice, did not otherwise appear.
6.Agreement
has made a general appearance and has agreed to the terms of this order, to the extent permitted by law, as evidenced by Respondent’s signature below.
7.Did Not Appear (Default after Appearance)
has made a general appearance and was duly notified of trial but failed to appear and defaulted.
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Repeat for each additional respondent. |
2.C.Ad Litems/Amicus
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Select as applicable. |
2.C.1.Ad Litem for Child[ren]
Also appearing was [name], appointed by the Court as [guardian/attorney] ad litem of the child[ren] the subject of this suit. [Include if applicable: The [guardian/attorney] ad litem has agreed to the terms of this order, as evidenced by the signature of the [guardian/attorney] ad litem below.]
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Or |
2.C.2.Amicus
Also appearing was [name], appointed by the Court as amicus attorney to assist the Court in protecting the best interests of the child[ren] the subject of this suit. [Include if applicable: The amicus attorney has agreed to the terms of this order, as evidenced by the signature of the amicus attorney below.]
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And/Or |
2.C.3.Ad Litem for Parties Cited by Publication or Other Substituted Service
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Tex. R. Civ. P. 244 requires that a statement of evidence, approved and signed by the judge, be filed as a part of the record. See form 23-4. Tex. Fam. Code § 102.010 similarly requires a statement of the evidence of service. |
Also appearing was [name], appointed by the Court as attorney ad litem for [name of absent party], who received process by substituted service but did not otherwise answer or appear.
2.D.Other Parties
Other parties appearing were [name[s] and relationship[s] to child[ren]]. [Include if applicable: [Name[s]] [has/have] agreed to the terms of this order, as evidenced by the signature[s] below.]
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Include 3. if applicable. |
3.Consent by Person with Right to Designate Primary Residence
Consent by Person with Right to Designate Primary Residence
[Name], who has the exclusive right to designate the primary residence of the child[ren], has consented to the terms of this order as evidenced by [name]’s signature below.
Jurisdiction
The Court, after examining the record and the evidence and argument of counsel, finds that it has jurisdiction of this case and of all the parties and that no other court has continuing, exclusive jurisdiction of this case. All persons entitled to citation were properly cited.
5.Jury
Jury
5.A.Waived
A jury was waived, and all questions of fact and of law were submitted to the Court.
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Or |
5.B.Selected
A jury was duly selected, questions of fact were submitted to the jury, and a verdict was returned and duly filed.
6.Record
Record
6.A.Waived
§ 105.003(c)
The making of a record of testimony was waived by the parties with the consent of the Court.
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Or |
6.B.Reporter
The record of testimony was duly reported by [[name, address]/the court reporter for the [designation] Court].
Child[ren]
The Court finds that the following child[ren] [is/are] the subject of this suit:
Name:
Sex:
Birth date:
Home state:
Social Security number:
Driver’s license number and issuing state:
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Repeat above information for each additional child. |
8.Findings
Findings
8.A.Relief Denied
The Court finds that the petition to modify should be denied. IT IS ORDERED that all relief requested in the petition to modify is DENIED.
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Or |
8.B.Modification Granted
The Court finds that the material allegations in the petition to modify are true and that the requested modification is in the best interest of the child[ren]. IT IS ORDERED that the requested modification is GRANTED.
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If modification is granted, continue with the following as appropriate. If relief is denied, go to 23. |
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Include 9. unless the order only modifies child support. |
Parenting Plan
The Court finds that the provisions in these orders relating to the rights and duties of the parties with relation to the child[ren], possession of and access to the child[ren], child support, and optimizing the development of a close and continuing relationship between each party and the child[ren] constitute [the parties’ agreed parenting plan/the parenting plan established by the Court].
10.Conservatorship Orders
Conservatorship
The Court finds that the following orders are in the best interest of the child[ren].
10.A.Appointment
IT IS ORDERED that [name[s]] [is/are] removed as managing conservator[s] and that [name] and [name] are appointed Joint Managing Conservators of the following child[ren]: [name[s] of child[ren]].
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Or |
IT IS ORDERED that [name[s]] [is/are] removed as managing conservator[s] and that [name] is appointed Sole Managing Conservator and [name] is appointed Possessory Conservator of the following child[ren]: [name[s] of child[ren]].
10.B.Rights and Duties
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Select as applicable. The rights of conservators can be limited by court order. |
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Include 10.B.1. if the parents are appointed joint managing conservators. (If the parents are appointed sole managing and possessory conservators, use 10.B.2. and 10.B.3.) If one or more nonparents are appointed joint managing conservator, change title(s) as appropriate and modify the rights and duties of the nonparent(s) in accordance with Tex. Fam. Code §§ 153.371 and 153.376. |
10.B.1.Parents Joint Managing Conservators
a.Rights at All Times
§ 153.073
IT IS ORDERED that, at all times, [name of petitioner] and [name of respondent], as parent joint managing conservators, shall each have the following rights:
1.the right to receive information from any other conservator of the child[ren] concerning the health, education, and welfare of the child[ren];
2.the right to confer with the other parent to the extent possible before making a decision concerning the health, education, and welfare of the child[ren];
3.the right of access to medical, dental, psychological, and educational records of the child[ren];
4.the right to consult with a physician, dentist, or psychologist of the child[ren];
5.the right to consult with school officials concerning the child[ren]’s welfare and educational status, including school activities;
6.the right to attend school activities, including school lunches, performances, and field trips;
7.the right to be designated on the child[ren]’s records as a person to be notified in case of an emergency;
8.the right to consent to medical, dental, and surgical treatment during an emergency involving an immediate danger to the health and safety of the child[ren]; and
9.the right to manage the estate[s] of the child[ren] to the extent the estate[s] [has/have] been created by the parent’s family or by the parent, other than by the community or joint property of the parents.
b.Duties at All Times
§ 153.076
IT IS ORDERED that, at all times, [name of petitioner] and [name of respondent], as parent joint managing conservators, shall each have the following duties:
1.the duty to inform the other conservator[s] of the child[ren] in a timely manner of significant information concerning the health, education, and welfare of the child[ren];
2.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with for at least thirty days, marries, or intends to marry a person who the conservator knows is registered as a sex offender under chapter 62 of the Texas Code of Criminal Procedure or is currently charged with an offense for which on conviction the person would be required to register under that chapter. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the fortieth day after the date the conservator of the child[ren] begins to reside with the person or on the tenth day after the date the marriage occurs, as appropriate. IT IS ORDERED that the notice must include a description of the offense that is the basis of the person’s requirement to register as a sex offender or of the offense with which the person is charged. Warning: A conservator commits an offense punishable as a Class C Misdemeanor if the conservator fails to provide this notice;
3.the duty to inform the other conservator[s] of the child[ren] if the conservator establishes a residence with a person who the conservator knows is the subject of a final protective order sought by an individual other than the conservator that is in effect on the date the residence with the person is established. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the conservator establishes residence with the person who is the subject of the final protective order. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE;
4.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with, or allows unsupervised access to a child by, a person who is the subject of a final protective order sought by the conservator after the expiration of the sixty-day period following the date the final protective order is issued. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the ninetieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE; and
5.the duty to inform the other conservator[s] of the child[ren] if the conservator is the subject of a final protective order issued after the date of the order establishing conservatorship. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE.
c.Rights and Duties during Periods of Possession
§ 153.074
IT IS ORDERED that, during their respective periods of possession, [name of petitioner] and [name of respondent], as parent joint managing conservators, shall each have the following rights and duties:
1.the duty of care, control, protection, and reasonable discipline of the child[ren];
2.the duty to support the child[ren], including providing the child[ren] with clothing, food, shelter, and medical and dental care not involving an invasive procedure;
3.the right to consent for the child[ren] to medical and dental care not involving an invasive procedure; and
4.the right to direct the moral and religious training of the child[ren].
d.Other Rights and Duty of Petitioner
§§ 153.134(b), 153.132, 153.071, 151.001(a)(4), (5), 153.133(c)
IT IS ORDERED that [name of petitioner], as a parent joint managing conservator, shall have the following rights and duty:
1.the exclusive right to designate the primary residence of the child [within [specify geographic area]/without regard to geographic location];
2.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to consent to medical, dental, and surgical treatment involving invasive procedures;
3.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to consent to psychiatric and psychological treatment of the child[ren];
4.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to receive and give receipt for periodic payments for the support of the child[ren] and to hold or disburse these funds for the benefit of the child[ren];
5.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to represent the child[ren] in legal action and to make other decisions of substantial legal significance concerning the child[ren];
6.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to consent to marriage and to enlistment in the armed forces of the United States;
7.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to make decisions concerning the child[ren]’s education;
8.except as provided by section 264.0111 of the Texas Family Code, the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to the services and earnings of the child[ren];
9.except when a guardian of the child[ren]’s estate[s] or a guardian or attorney ad litem has been appointed for the child[ren], the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to act as an agent of the child[ren] in relation to the child[ren]’s estate[s] if the child[ren]’s action is required by a state, the United States, or a foreign government;
10.the [exclusive right/right, subject to the agreement of the other parent conservator,] to apply for [a] passport[s] for the child[ren], to renew the child[ren]’s passport[s], and to maintain possession of the child[ren]’s passport[s]; and
11.the [exclusive duty/duty, subject to the agreement of the other parent conservator,/independent duty] to manage the estate[s] of the child[ren] to the extent the estate[s] [has/have] been created by the community or joint property of the parents.
e.Other Rights and Duty of Respondent
§§ 153.134(b), 153.132, 153.071, 151.001(a)(4), (5), 153.133(c)
IT IS ORDERED that [name of respondent], as a parent joint managing conservator, shall have the following rights and duty:
1.the exclusive right to designate the primary residence of the child [within [specify geographic area]/without regard to geographic location];
2.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to consent to medical, dental, and surgical treatment involving invasive procedures;
3.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to consent to psychiatric and psychological treatment of the child[ren];
4.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to receive and give receipt for periodic payments for the support of the child[ren] and to hold or disburse these funds for the benefit of the child[ren];
5.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to represent the child[ren] in legal action and to make other decisions of substantial legal significance concerning the child[ren];
6.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to consent to marriage and to enlistment in the armed forces of the United States;
7.the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to make decisions concerning the child[ren]’s education;
8.except as provided by section 264.0111 of the Texas Family Code, the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to the services and earnings of the child[ren];
9.except when a guardian of the child[ren]’s estate[s] or a guardian or attorney ad litem has been appointed for the child[ren], the [exclusive right/right, subject to the agreement of the other parent conservator,/independent right] to act as an agent of the child[ren] in relation to the child[ren]’s estate[s] if the child[ren]’s action is required by a state, the United States, or a foreign government;
10.the [exclusive right/right, subject to the agreement of the other parent conservator,] to apply for [a] passport[s] for the child[ren], to renew the child[ren]’s passport[s], and to maintain possession of the child[ren]’s passport[s]; and
11.the [exclusive duty/duty, subject to the agreement of the other parent conservator,/independent duty] to manage the estate[s] of the child[ren] to the extent the estate[s] [has/have] been created by the community or joint property of the parents.
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Use the following paragraph only if the primary residence of the child(ren) is restricted to a specific geographic area. |
f.Geographic Area for Primary Residence
§ 153.133(c)
The Court finds that, in accordance with section 153.001 of the Texas Family Code, it is the public policy of Texas to assure that children will have frequent and continuing contact with parents who have shown the ability to act in the best interest of the child, to provide a safe, stable, and nonviolent environment for the child, and to encourage parents to share in the rights and duties of raising their child after the parents have separated or dissolved their marriage. IT IS ORDERED that the primary residence of the child[ren] shall be within [specify geographic area], and the parties shall not remove the child[ren] from [specify geographic area] for the purpose of changing the primary residence of the child[ren] until this geographic restriction is modified by further order of the court of continuing jurisdiction or by a written agreement that is signed by the parties and filed with that court.
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Include the following if applicable. |
IT IS FURTHER ORDERED that [name] shall have the exclusive right to designate the child[ren]’s primary residence within [specify geographic area].
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Use the following paragraph only if one of the joint managing conservators is awarded the exclusive right to designate the primary residence of the child(ren). Caution: The following paragraph should be used only after careful consideration of the potential ramifications. See the practice notes at section 40.11. |
IT IS FURTHER ORDERED that this geographic restriction on the primary residence of the child[ren] shall be lifted if, at the time [name of joint managing conservator with right to designate] wishes to remove the child[ren] from [specify geographic area] for the purpose of changing the primary residence of the child[ren], [name of joint managing conservator without right to designate] does not reside in [specify geographic area].
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Continue with the following. |
g.Minimizing Disruption
§ 153.134(b)(3)
IT IS ORDERED that [include provisions to minimize disruption of the child[ren]’s education, daily routine, and association with friends].
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Include one of the following paragraphs if applicable, particularly if the right to make educational decisions is not allocated exclusively to one conservator. |
Notwithstanding any provision in this order to the contrary, IT IS ORDERED that [[name of petitioner]/[name of respondent]] shall have the exclusive right to enroll the child[ren] in school. Each conservator, during that conservator’s periods of possession, is ORDERED to ensure the child[ren]’s attendance in the schools in which [[name of petitioner]/[name of respondent]] has enrolled the child.
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Or |
Notwithstanding any provision in this order to the contrary, [name of petitioner] and [name of respondent] are each ORDERED to enroll the child[ren] [in the public school[s] for the attendance zone of [[name of petitioner]/[name of respondent]]’s residence/as follows: [name of child] in [name and address of school] as long as the child is eligible to attend that school [repeat for each child if more than one]]. Each conservator, during that conservator’s periods of possession, is ORDERED to ensure the child[ren]’s attendance in [this/these] school[s].
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Include 10.B.2. if a parent is appointed sole managing conservator or possessory conservator. |
10.B.2.Parent Sole Managing or Possessory Conservator
a.Rights at All Times
§ 153.073
IT IS ORDERED that, at all times, [name], as a parent [sole managing/possessory] conservator, [include if applicable: and [name], as a parent possessory conservator,] shall [each] have the following rights:
1.the right to receive information from any other conservator of the child[ren] concerning the health, education, and welfare of the child[ren];
2.the right to confer with the other parent to the extent possible before making a decision concerning the health, education, and welfare of the child[ren];
3.the right of access to medical, dental, psychological, and educational records of the child[ren];
4.the right to consult with a physician, dentist, or psychologist of the child[ren];
5.the right to consult with school officials concerning the child[ren]’s welfare and educational status, including school activities;
6.the right to attend school activities, including school lunches, performances, and field trips;
7.the right to be designated on the child[ren]’s records as a person to be notified in case of an emergency;
8.the right to consent to medical, dental, and surgical treatment during an emergency involving an immediate danger to the health and safety of the child[ren]; and
9.the right to manage the estate[s] of the child[ren] to the extent the estate[s] [has/have] been created by the parent’s family or by the parent, other than by the community or joint property of the parents.
b.Duties at All Times
§ 153.076
IT IS ORDERED that, at all times, [name], as a parent [sole managing/possessory] conservator, [include if applicable: and [name], as a parent possessory conservator,] shall [each] have the following duties:
1.the duty to inform the other conservator[s] of the child[ren] in a timely manner of significant information concerning the health, education, and welfare of the child[ren];
2.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with for at least thirty days, marries, or intends to marry a person who the conservator knows is registered as a sex offender under chapter 62 of the Texas Code of Criminal Procedure or is currently charged with an offense for which on conviction the person would be required to register under that chapter. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the fortieth day after the date the conservator of the child[ren] begins to reside with the person or on the tenth day after the date the marriage occurs, as appropriate. IT IS ORDERED that the notice must include a description of the offense that is the basis of the person’s requirement to register as a sex offender or of the offense with which the person is charged. Warning: A conservator commits an offense punishable as a Class C Misdemeanor if the conservator fails to provide this notice;
3.the duty to inform the other conservator[s] of the child[ren] if the conservator establishes a residence with a person who the conservator knows is the subject of a final protective order sought by an individual other than the conservator that is in effect on the date the residence with the person is established. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the conservator establishes residence with the person who is the subject of the final protective order. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE;
4.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with, or allows unsupervised access to a child by, a person who is the subject of a final protective order sought by the conservator after the expiration of the sixty-day period following the date the final protective order is issued. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the ninetieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE; and
5.the duty to inform the other conservator[s] of the child[ren] if the conservator is the subject of a final protective order issued after the date of the order establishing conservatorship. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE.
c.Rights and Duties during Periods of Possession
§ 153.074
IT IS ORDERED that, during [his/her/their respective] periods of possession, [name], as a parent [sole managing/possessory] conservator, [include if applicable: and [name], as a parent possessory conservator,] shall [each] have the following rights and duties:
1.the duty of care, control, protection, and reasonable discipline of the child[ren];
2.the duty to support the child[ren], including providing the child[ren] with clothing, food, shelter, and medical and dental care not involving an invasive procedure;
3.the right to consent for the child[ren] to medical and dental care not involving an invasive procedure; and
4.the right to direct the moral and religious training of the child[ren].
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Include 10.B.3. if a parent is appointed sole managing conservator. |
10.B.3.Exclusive Rights and Duty of Parent Sole Managing Conservator
§§ 153.132, 151.001(a)(4), (5)
IT IS ORDERED that [name], as parent sole managing conservator, shall have the following exclusive rights and duty:
1.the right to designate the primary residence of the child[ren];
2.the right to consent to medical, dental, and surgical treatment involving invasive procedures;
3.the right to consent to psychiatric and psychological treatment of the child[ren];
4.the right to receive and give receipt for periodic payments for the support of the child[ren] and to hold or disburse these funds for the benefit of the child[ren];
5.the right to represent the child[ren] in legal action and to make other decisions of substantial legal significance concerning the child[ren];
6.the right to consent to marriage and to enlistment in the armed forces of the United States;
7.the right to make decisions concerning the child[ren]’s education;
8.except as provided by section 264.0111 of the Texas Family Code, the right to the services and earnings of the child[ren];
9.except when a guardian of the child[ren]’s estate[s] or a guardian or attorney ad litem has been appointed for the child[ren], the right to act as an agent of the child[ren] in relation to the child[ren]’s estate[s] if the child[ren]’s action is required by a state, the United States, or a foreign government;
10.the right to apply for [a] passport[s] for the child[ren], to renew the child[ren]’s passport[s], and to maintain possession of the child[ren]’s passport[s]; and
11.the duty to manage the estate[s] of the child[ren] to the extent the estate[s] [has/have] been created by the community or joint property of the parents.
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Include 10.B.4. if a nonparent is appointed sole managing conservator. |
10.B.4.Nonparent Sole Managing Conservator
a.Rights and Duties
§§ 153.371, 153.076, 264.0111
IT IS ORDERED that [name of nonparent], as a nonparent sole managing conservator, shall have the following rights and duties:
1.the right to have physical possession and to direct the moral and religious training of the child[ren];
2.the duty of care, control, protection, and reasonable discipline of the child[ren];
3.the duty to provide the child[ren] with clothing, food, shelter, education, and medical, psychological, and dental care and to have access to the child[ren]’s medical records;
4.the right to consent for the child[ren] to medical, psychiatric, psychological, dental, and surgical treatment;
5.the right to receive and give receipt for payments for the support of the child[ren] and to hold or disburse funds for the benefit of the child[ren];
6.except as provided by section 264.0111 of the Texas Family Code, the right to the services and earnings of the child[ren];
7.the right to consent to marriage and to enlistment in the armed forces of the United States;
8.the right to represent the child[ren] in legal action and to make other decisions of substantial legal significance concerning the child[ren];
9.except when a guardian of the child[ren]’s estate[s] or a guardian or attorney ad litem has been appointed for the child[ren], the right to act as an agent of the child[ren] in relation to the child[ren]’s estate[s] if the child[ren]’s action is required by a state, the United States, or a foreign government;
10.the right to designate the primary residence of the child[ren] and to make decisions regarding the child[ren]’s education;
11.if the parent-child relationship has been terminated with respect to the parents, or only living parent, or if there is no living parent, the right to consent to the adoption of the child[ren] and to make any other decision concerning the child[ren] that a parent could make;
12.the right to apply for [a] passport[s] for the child[ren], to renew the child[ren]’s passport[s], and to maintain possession of the child[ren]’s passport[s];
13.the duty to inform the other conservator[s] of the child[ren] in a timely manner of significant information concerning the health, education, and welfare of the child[ren];
14.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with for at least thirty days, marries, or intends to marry a person who the conservator knows is registered as a sex offender under chapter 62 of the Texas Code of Criminal Procedure or is currently charged with an offense for which on conviction the person would be required to register under that chapter. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the fortieth day after the date the conservator of the child[ren] begins to reside with the person or on the tenth day after the date the marriage occurs, as appropriate. IT IS ORDERED that the notice must include a description of the offense that is the basis of the person’s requirement to register as a sex offender or of the offense with which the person is charged. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE;
15.the duty to inform the other conservator[s] of the child[ren] if the conservator establishes a residence with a person who the conservator knows is the subject of a final protective order sought by an individual other than the conservator that is in effect on the date the residence with the person is established. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the conservator establishes residence with the person who is the subject of the final protective order. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE;
16.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with, or allows unsupervised access to a child by, a person who is the subject of a final protective order sought by the conservator after the expiration of the sixty-day period following the date the final protective order is issued. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the ninetieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE; and
17.the duty to inform the other conservator[s] of the child[ren] if the conservator is the subject of a final protective order issued after the date of the order establishing conservatorship. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE.
b.Annual Reports
§ 153.375
IT IS ORDERED that [name of nonparent] shall, each twelve months after the date of this order, file with the Court a report of facts concerning the child[ren]’s welfare, including the child[ren]’s whereabouts and physical condition.
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Include 10.B.5. if a nonparent is appointed a possessory conservator. |
10.B.5.Nonparent Possessory Conservator
§§ 153.376, 153.377, 153.076
IT IS ORDERED that [name of nonparent], as a nonparent possessory conservator, shall have the following right and duties during periods of possession:
1.the duty of care, control, protection, and reasonable discipline of the child[ren];
2.the duty to provide the child[ren] with clothing, food, and shelter; and
3.the right to consent to medical, dental, and surgical treatment during an emergency involving an immediate danger to the health and safety of the child[ren].
IT IS FURTHER ORDERED that [name of nonparent], as a nonparent possessory conservator, shall have the following right and duties at all times:
1.the right of access to medical, dental, psychological, and educational records of the child[ren] to the same extent as the managing conservator[s];
2.the duty to inform the other conservator[s] of the child[ren] in a timely manner of significant information concerning the health, education, and welfare of the child[ren];
3.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with for at least thirty days, marries, or intends to marry a person who the conservator knows is registered as a sex offender under chapter 62 of the Texas Code of Criminal Procedure or is currently charged with an offense for which on conviction the person would be required to register under that chapter. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the fortieth day after the date the conservator of the child[ren] begins to reside with the person or on the tenth day after the date the marriage occurs, as appropriate. IT IS ORDERED that the notice must include a description of the offense that is the basis of the person’s requirement to register as a sex offender or of the offense with which the person is charged. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE;
4.the duty to inform the other conservator[s] of the child[ren] if the conservator establishes a residence with a person who the conservator knows is the subject of a final protective order sought by an individual other than the conservator that is in effect on the date the residence with the person is established. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the conservator establishes residence with the person who is the subject of the final protective order. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE;
5.the duty to inform the other conservator[s] of the child[ren] if the conservator resides with, or allows unsupervised access to a child by, a person who is the subject of a final protective order sought by the conservator after the expiration of the sixty-day period following the date the final protective order is issued. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the ninetieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE; and
6.the duty to inform the other conservator[s] of the child[ren] if the conservator is the subject of a final protective order issued after the date of the order establishing conservatorship. IT IS ORDERED that notice of this information shall be provided to the other conservator[s] of the child[ren] as soon as practicable, but not later than the thirtieth day after the date the final protective order was issued. WARNING: A CONSERVATOR COMMITS AN OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR IF THE CONSERVATOR FAILS TO PROVIDE THIS NOTICE.
10.B.6.Passport Application
22 CFR § 51.28
If a party applies for a passport for the child[ren], that party is ORDERED to notify the other [party/parties] of that fact no later than [number] days after the application.
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Include the following if applicable. |
IT IS ORDERED that if a parent’s consent is required for the issuance of a passport, that parent shall provide that consent in writing no later than [number] days after receipt of the consent documents, unless the parent has good cause for withholding that consent.
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See form 55-2 if international parental abduction is an issue. |
IT IS ORDERED that the following custodial account[s] now held by the parties for the parties’ child[ren] [is/are] placed under the sole and exclusive control of [name]: [list each financial institution account number and account name]. [Name] is ORDERED to appear in the law offices of [name of attorney] at [location], at [time] on [date], and to execute, have acknowledged, and deliver to [name] all documents necessary to effectuate [name]’s sole and exclusive control of the account[s].
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If applicable, repeat 10.B.7., describing other property, for other party. |
10.B.8.Tax Returns for Child[ren]
IT IS ORDERED that [name of party A] shall have the exclusive right and duty to prepare and file income tax returns for the child[ren]’s estate[s].
IT IS ORDERED that [name of party B] shall furnish such information to [name of party A] as is requested to prepare federal income tax returns for the child[ren]’s estates within thirty days of receipt of a written request for the information, and in no event shall the information be furnished later than March 1 of that year. As requested information becomes available after that date, it shall be provided within ten days of receipt.
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If appropriate, see form 45-5 or 45-6 for temporary orders regarding rights and duties to be effective for the duration of a party’s military duty. |
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Continue with the following. |
10.C.Possession and Access
IT IS ORDERED that the conservators shall have possession of the child[ren] at times mutually agreed to in advance by the parties and, in the absence of mutual agreement, as follows: [set out times and general terms and conditions for possession of or access to each child; if needed, adapt language from paragraph 10.F., form 23-1].
The periods of possession ordered above apply to [the/each] child the subject of this suit while that child is under the age of eighteen years and not otherwise emancipated.
10.C.1.Electronic Communication
For purposes of this order, the term “electronic communication” means any communication facilitated by the use of any wired or wireless technology via the Internet or any other electronic media. The term includes communication facilitated by the use of a telephone, electronic mail, instant messaging, videoconferencing, or webcam.
IT IS ORDERED that [[name[s]]/the conservators] shall have electronic communication with the child[ren] to supplement [his/her/their] periods of possession as follows: [set out times and general conditions of electronic communication between each child and each conservator granted electronic communication with that child].
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If there is a finding of family violence in the order, include the |
The Court finds that, even though it has [made a finding of family violence/imposed supervised visitation between the child[ren] and [name]/made a finding of family violence and imposed supervised visitation between the child[ren] and [name]], the parties have agreed to periods of electronic communication between [name] and the child[ren]. IT IS THEREFORE ORDERED that, pursuant to the parties’ agreement, [name] shall have electronic communication with the child[ren] as follows: [set out times and general conditions of electronic communication with each applicable child in bold-faced, capitalized type, including any specific restrictions relating to family violence or supervised visitation required by other law to be included in a possession or access order].
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Continue with the following. |
IT IS ORDERED that each conservator shall:
1.provide the other conservator[s] with the e-mail address[es] and other electronic communication access information of the child[ren] within [number] [hours/days] after the Court signs this order;
2.notify the other conservator[s] of any change in the e-mail
address[es] or other electronic communication access information not later than twenty-four hours after the date the change takes effect; and
3.if necessary equipment is reasonably available, accommodate electronic communication with the child with the same privacy, respect, and dignity accorded all other forms of access, at a reasonable time and for a reasonable duration subject to any limitation provided in this order.
10.C.2.Restricted Periods of Access—Family Violence/Sexual Offense Resulting in Pregnancy§ 153.004(d), (d–1)
10.C.2.a.Restricted Periods of Access—Family Violence
§ 153.004(d)(1), (d–1)
The Court finds that [name] has a history or pattern of committing family violence during the two-year period preceding the filing of this suit or during the pendency of this suit. The Court further finds that awarding [name] access to the child[ren] would not endanger the child[ren]’s physical health or emotional welfare and would be in the best interest of the child[ren]. IT IS THEREFORE ORDERED as follows:
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Select as applicable. |
1.Visitation shall be under the supervision of [name of person or supervising agency or program] [on the following days and times: [list days and times of access]/on the days and times prescribed by [name of person or supervising agency or program]].
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And/Or |
2.All exchanges of possession of the child[ren] shall occur at [specify place and address].
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And/Or |
3.[Name] shall abstain from the consumption of alcohol or any controlled substance within the twelve hours before and during the period of access to the child[ren].
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And/Or |
4.[Name] shall attend [describe details of battering intervention and prevention program or treatment by mental health professional] and shall provide proof of such attendance to the Court within [specify].
10.C.2.b.Restricted Periods of Access—Sexual Offense Resulting in Victim’s Pregnancy with Child
§ 153.004(d)(2), (d–1)
The Court finds that [name] has engaged in conduct that constitutes an offense under section [21.02/22.011/22.021/25.02] of the Texas Penal Code and, as a direct result of the conduct, the victim of the conduct became pregnant with [name]’s child, [name of child]. The Court further finds that awarding [name] access to the child would not endanger the child’s physical health or emotional welfare and would be in the best interest of the child. IT IS THEREFORE ORDERED as follows:
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Select as applicable. |
1.Visitation shall be under the supervision of [name of person or supervising agency or program] [on the following days and times: [list days and times of access]/on the days and times prescribed by [name of person or supervising agency or program]].
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And/Or |
2.All exchanges of possession of the child shall occur at [specify place and address].
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And/Or |
3.[Name] shall abstain from the consumption of alcohol or any controlled substance within the twelve hours before and during the period of access to the child.
10.C.3.Supervised Visitation— Family Violence or Child Abuse or Neglect
§ 153.004(e)
The Court finds that credible evidence has been presented that there is a history or pattern of [child neglect/child abuse/family violence/child neglect and abuse/child neglect and family violence/child abuse and family violence/child abuse, child neglect, and family violence] committed by [Petitioner/Respondent/[name], who [resides in [Petitioner/Respondent]’s household/is permitted by [Petitioner/Respondent] to have unsupervised access to the child[ren] during [Petitioner/Respondent]’s periods of possession or access to the child[ren]]]. IT IS THEREFORE ORDERED that [Petitioner/Respondent]’s access shall be under the supervision of [name of person or supervising agency or program] [on the following days and times: [list days and times of access and general terms and conditions]/on the days and times prescribed by [name of person or supervising agency or program]].
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If appropriate, see form 45-5 or 45-6 for temporary orders regarding possession and access to be effective for the duration of a party’s military duty. |
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Continue with the following. |
10.D.Termination of Orders on [Marriage/Remarriage]
§ 154.006(b)
The provisions of this order relating to conservatorship, possession, or access terminate on the [marriage/remarriage] of [name of obligor] to [name of obligee] unless a nonparent or agency has been appointed conservator of the child[ren] under chapter 153 of the Texas Family Code.
10.E.Security for Possession and Access
IT IS ORDERED that [name of respondent], Respondent, [post a cash or surety bond of [number] dollars ($[amount]), payable to [name]/deposit with the Court [describe security]], conditioned on Respondent’s compliance with the order permitting possession of or access to the child[ren].
10.F.Means of Travel
Means of Travel—[See form 56-15 for provisions dealing with specific duties of the conservators to provide appropriate transportation to and from the relevant transportation facilities.]
Each conservator is ORDERED to provide [the/each] other conservator with the appropriate written authorization, within ten days after written request is received, as is necessary to allow the child[ren] to travel with the other conservator[s] beyond the territorial limits of the United States. The conservators are ORDERED to exchange passports as is necessary to allow such travel. [Include if applicable: The conservators agree and IT IS ORDERED that this order shall serve as written authorization for such travel.] [See form 56-12 for order regarding possession and transfer of child[ren]’s passport[s].]
11.Allocation of Increased Expenses
Allocation of Increased Expenses
The Court finds, taking into account the best interest of the child[ren] and the increased expenses of exercising possession of or access to the child[ren] resulting from [name]’s change of residence, that the following is a fair and equitable allocation of the increased costs. IT IS THEREFORE ORDERED that [specify allocation].
12.Child Support
Child Support
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With appropriate modification, the following paragraphs may be used to provide for monthly support for one child or for more than one child. If there is more than one child, modify the amount of support in each series of blanks to indicate the reduction in support as a child reaches eighteen, is otherwise emancipated, graduates, or begins active service. See 5.B. and 5.C. in form 41-9 if semimonthly or weekly payments are ordered. |
•All Orders Providing Child Support
12.A.Monthly Payments—One Child
IT IS ORDERED that [name of obligor] is obligated to pay and shall pay to [name of obligee] child support of [number] dollars ($[amount]) per month, with the first payment being due and payable on [date] and a like payment being due and payable on the [specify] day of each month thereafter until the first month following the date of the earliest occurrence of one of the events specified below:
1.the child reaches the age of eighteen years or graduates from high school, whichever occurs later, subject to the provisions for support beyond the age of eighteen years set out below;
2.the child marries;
3.the child dies;
4.the child enlists in the armed forces of the United States and begins active service as defined by section 101 of title 10 of the United States Code; or
5.the child’s disabilities are otherwise removed for general purposes.
If the child is eighteen years of age and has not graduated from high school and [name of obligor]’s obligation to support the child has not already terminated, IT IS ORDERED that [name of obligor]’s obligation to pay child support to [name of obligee] shall not terminate but shall continue for as long as the child is enrolled—
1.under chapter 25 of the Texas Education Code in an accredited secondary school in a program leading toward a high school diploma or under section 130.008 of the Education Code in courses for joint high school and junior college credit and is complying with the minimum attendance requirements of subchapter C of chapter 25 of the Education Code or
2.on a full-time basis in a private secondary school in a program leading toward a high school diploma and is complying with the minimum attendance requirements imposed by that school.
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Or |
12.B.Monthly Payments—More than One Child
IT IS ORDERED that [name of obligor] is obligated to pay and shall pay to [name of obligee] child support of [number] dollars ($[amount]) per month, with the first payment being due and payable on [date] and a like payment being due and payable on the [specify] day of each month thereafter until the first month following the date of the earliest occurrence of one of the events specified below:
1.any child reaches the age of eighteen years or graduates from high school, whichever occurs later, subject to the provisions for support beyond the age of eighteen years set out below;
2.any child marries;
3.any child dies;
4.any child enlists in the armed forces of the United States and begins active service as defined by section 101 of title 10 of the United States Code; or
5.any child’s disabilities are otherwise removed for general purposes.
Thereafter, [name of obligor] is ORDERED to pay to [name of obligee] child support of [number] dollars ($[amount]) per month, due and payable on the [specify] day of the first month immediately following the date of the earliest occurrence of one of the events specified above for that child and a like sum of [number] dollars ($[amount]) due and payable on the [specify] day of each month thereafter until the next occurrence of one of the events specified above for [the other/another] child for whom [name of obligor] remained obligated to pay support under this order. [Continue as required for additional reductions.]
If a child is eighteen years of age and has not graduated from high school and [name of obligor]’s obligation to support the child has not already terminated, IT IS ORDERED that [name of obligor]’s obligation to pay child support to [name of obligee] shall not terminate but shall continue for as long as the child is enrolled—
1.under chapter 25 of the Texas Education Code in an accredited secondary school in a program leading toward a high school diploma or under section 130.008 of the Education Code in courses for joint high school and junior college credit and is complying with the minimum attendance requirements of subchapter C of chapter 25 of the Education Code or
2.on a full-time basis in a private secondary school in a program leading toward a high school diploma and is complying with the minimum attendance requirements imposed by that school.
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Include the following if applicable. |
12.C.1.Minor Disabled Child
The Court finds that [name of child], a child the subject of this suit, requires substantial care and personal supervision because of a mental or physical disability and will not be capable of self-support, that payments for the support of this child should be continued after the child’s eighteenth birthday for an indefinite period, and that both parents have a duty to support the child.
IT IS ORDERED that [name of obligor] is obligated to pay and shall pay to [name of designated recipient] support for [name of child] of [number] dollars ($[amount]) per month, with the first installment being due and payable on [date] and a like installment being due and payable on the [specify] day of each month thereafter until the first month following the death of the child or further order modifying this child support.
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And/Or |
12.C.2.Adult Disabled Child
The Court finds that [name of child], an adult child the subject of this suit, requires substantial care and personal supervision because of a mental or physical disability and will not be capable of self-support, that the disability existed or its cause was known to exist before or on the child’s eighteenth birthday, that payments for the support of this child should be continued for an indefinite period, and that both parents have a duty to support the child.
IT IS ORDERED that [name of obligor] is obligated to pay and shall pay to [name of designated recipient] support for [name of child] of [number] dollars ($[amount]) per month, with the first installment being due and payable on [date] and a like installment being due and payable on the [specify] day of each month thereafter until the first month following the death of the child or further order modifying this child support.
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If properly requested by a party or if the support ordered varies from the statutory guidelines, include 12.D. (See form 26-10 for written request.) |
12.D.Statement on Guidelines
§ 154.130
In accordance with Texas Family Code section 154.130, the Court makes the following findings and conclusions regarding the child support order made in open court in this case on [date]:
1.[The amount of child support ordered by the Court is in accordance with the percentage guidelines./The application of the percentage guidelines in this case would be unjust or inappropriate.]
2.The net resources of [name of obligor] per month are $[amount].
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Include item 3. if applicable. |
3.The net resources of [name of obligee] per month are $[amount].
4.The percentage applied to the first $9,200 of [name of obligor]’s net resources for child support is [percent] percent.
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Include item 5. if applicable. |
5.The specific reasons that the amount of support per month ordered by the Court varies from the amount computed by applying the percentage guidelines of section [154.125/154.129] of the Texas Family Code are: [state reasons].
12.E.Withholding from Earnings
IT IS ORDERED that any employer of [name of obligor] shall be ordered to withhold the child support payments ordered in this order from the disposable earnings of [name of obligor] for the support of [name[s] of child[ren]].
12.F.Withholding as Credit against Support Obligation
IT IS FURTHER ORDERED that all amounts withheld from the disposable earnings of [name of obligor] by the employer and paid in accordance with the order to that employer shall constitute a credit against the child support obligation. Payment of the full amount of child support ordered paid by this order through the means of withholding from earnings shall discharge the child support obligation. If the amount withheld from earnings and credited against the child support obligation is less than 100 percent of the amount ordered to be paid by this order, the balance due remains an obligation of [name of obligor], and it is hereby ORDERED that [name of obligor] pay the balance due directly to the state disbursement unit as specified below.
12.G.Order to Employer
On this date the Court [signed/authorized the issuance of] an Income Withholding for Support. [See form 9-3.]
IT IS ORDERED that all payments shall be made through the state disbursement unit at Texas Child Support Disbursement Unit, P.O. Box 659791, San Antonio, Texas 78265-9791, and thereafter promptly remitted to [name of obligee] for the support of the child[ren]. IT IS ORDERED that all payments shall be made payable to the Office of the Attorney General and include the ten-digit Office of the Attorney General case number (if available), the cause number of this suit, [name of obligor]’s name as the name of the noncustodial parent (NCP), and [name of obligee]’s name as the name of the custodial parent (CP). Payment options are found on the Office of the Attorney General’s website at https://www.texasattorneygeneral.gov/cs/payment-options-and-types.
IT IS ORDERED that each party shall pay, when due, all fees charged to that party by the state disbursement unit and any other agency statutorily authorized to charge a fee.
12.I.Change of Employment
IT IS FURTHER ORDERED that [name of obligor] shall notify this Court and [name of obligee] by U.S. certified mail, return receipt requested, of any change of address and of any termination of employment. This notice shall be given no later than seven days after the change of address or the termination of employment. This notice or a subsequent notice shall also provide the current address of [name of obligor] and the name and address of [his/her] current employer, whenever that information becomes available.
12.J.Clerk’s Duties
IT IS ORDERED that, on the request of a prosecuting attorney, the title IV-D agency, the friend of the Court, a domestic relations office, [name of obligee], [name of obligor], or an attorney representing [name of obligee] or [name of obligor], the clerk of this Court shall cause a certified copy of the Income Withholding for Support to be delivered to any employer.
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If the order to withhold is to be effective only if a delinquency or other violation of the order occurs, include 12.K. See Tex. Fam. Code §§ 154.007, 158.002. |
12.K.Suspension of Withholding from Earnings
The Court finds that [good cause exists/the parties have agreed] that no order to withhold from earnings for child support should be delivered to any employer of [name of obligor] as long as no delinquency or other violation of this child support order occurs and as long as the Office of the Attorney General Child Support Division is not providing services to [name of obligee]. For the purpose of this provision, a delinquency has occurred if [name of obligor] has been in arrears for an amount due for more than thirty days or the amount of the arrearages equals or is greater than the amount due for a one-month period. If a delinquency or other violation occurs or if the Office of the Attorney General Child Support Division begins providing services to [name of obligee], the clerk shall deliver the order to withhold earnings as provided above.
Accordingly, IT IS ORDERED that, as long as no delinquency or other violation of this child support order occurs and as long as the Office of the Attorney General Child Support Division is not providing services to [name of obligee], all payments shall be made through the state disbursement unit and thereafter promptly remitted to [name of obligee] for the support of the child[ren]. If a delinquency or other violation occurs or if the Office of the Attorney General Child Support Division begins providing services to [name of obligee], all payments shall be made in accordance with the order to withhold earnings as provided above.
12.L.Medical and Dental Support
§§ 154.008, 154.181–.192
IT IS ORDERED that [name of obligor] and [name of obligee] shall each provide additional child support for [the/each] child as set out in this order for as long as the Court may order [name of obligor] and [name of obligee] to provide support for the child under sections 154.001 and 154.002 of the Texas Family Code. Beginning on the day [name of obligor] and [name of obligee]’s actual or potential obligation to support [the/a] child under sections 154.001 and 154.002 of the Family Code terminates, IT IS ORDERED that [name of obligor] and [name of obligee] are discharged from these obligations [include if applicable: with respect to that child], except for any failure by a parent to fully comply with these obligations before that date. [Include if applicable: IT IS FURTHER ORDERED that the [cash medical support payments/additional child support payments for the cost of [health/dental/health and dental] insurance] ordered below are payable through the state disbursement unit and subject to the provisions for withholding from earnings provided above for other child support payments.]
12.L.1.Definitions
1.Definitions
§ 101.015
“Health insurance” means insurance coverage that provides basic health-care services, including usual physician services, office visits, hospitalization, and laboratory, X-ray, and emergency services, that may be provided through a health maintenance organization or other private or public organization, other than medical assistance under chapter 32 of the Texas Human Resources Code.
§ 154.181(e)
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Select one of the following. |
“Reasonable cost” of health insurance means the cost of health insurance coverage for a child that does not exceed 9 percent of [name of obligor]’s annual resources, as described by section 154.062(b) of the Texas Family Code.
|
Or |
“Reasonable cost” of health insurance means the total cost of health insurance coverage for all children for which [name of obligor] is responsible under a medical support order that does not exceed 9 percent of [name of obligor]’s annual resources, as described by section 154.062(b) of the Texas Family Code.
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Continue with the following. |
§ 101.0094
“Dental insurance” means insurance coverage that provides preventive dental care and other dental services, including usual dentist services, office visits, examinations, X-rays, and emergency services, that may be provided through a single service health maintenance organization or other private or public organization.
§ 154.1815(a)
|
Select one of the following. |
“Reasonable cost” of dental insurance means the cost of dental insurance coverage for a child that does not exceed 1.5 percent of [name of obligor]’s annual resources, as described by section 154.062(b) of the Texas Family Code.
|
Or |
“Reasonable cost” of dental insurance means the total cost of dental insurance coverage for all children for which [name of obligor] is responsible under a dental support order that does not exceed 1.5 percent of [name of obligor]’s annual resources, as described by section 154.062(b) of the Texas Family Code.
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Continue with the following. |
§ 154.183(c)
“Health-care expenses” include, without limitation, medical, surgical, prescription drug, mental health-care services, dental, eye care, ophthalmological, and orthodontic charges but do not include expenses for travel to and from the provider or for nonprescription medication.
“Health-care expenses that are not reimbursed by insurance” (“unreimbursed expenses”) include related copayments and deductibles.
“Furnish” means—
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Include as applicable. |
a.to hand deliver the document by a person eighteen years of age or older either to the recipient or to a person who is eighteen years of age or older and permanently resides with the recipient
b.to deliver the document to the recipient by first-class mail or by certified mail, return receipt requested, to the recipient’s last known mailing or residence address
c.to deliver the document to the recipient at the recipient’s last known mailing or residence address using any person or entity whose principal business is that of a courier or deliverer of papers or documents either within or outside the United States
d.to deliver the document to the recipient at the recipient’s electronic mail address as follows:
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[name of obligor]: |
[obligor’s e-mail address] |
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[name of obligee]: |
[obligee’s e-mail address] |
and in the event of any change in either recipient’s electronic mail address, that recipient is ORDERED to notify the other recipient of such change in writing within twenty-four hours after the change
e.to deliver the document to the recipient at the recipient’s mobile telephone number by text message as follows:
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[name of obligor]: |
[obligor’s mobile number] |
|
[name of obligee]: |
[obligee’s mobile number] |
and in the event of any change in either recipient’s mobile telephone number, that recipient is ORDERED to notify the other recipient of such change in writing within twenty-four hours after the change
f.to provide the document to the recipient by posting the document on the [name of coparenting website] Internet website program, in accordance with the provisions set forth below in this order
12.L.2.Findings on Availability of Health Insurance
§ 154.182(a), (b)
2.Findings on Availability of Health Insurance—Having considered the cost, accessibility, and quality of health insurance coverage available to the parties, the Court finds:
Health insurance is available or is in effect for the child[ren] through [name of obligor]’s employment or membership in a union, trade association, or other organization at a reasonable cost of $[amount] per month.
|
And/Or |
Health insurance is available or is in effect for the child[ren] through [name of obligee]’s employment or membership in a union, trade association, or other organization at a reasonable cost of $[amount] per month.
|
And/Or |
Health insurance is available to [name of obligor] at a reasonable cost of $[amount] per month from a source other than through [his/her] employment or membership in a union, trade association, or other organization, including the program under section 154.1826 of the Texas Family Code to provide health insurance in title IV-D cases.
|
And/Or |
Health insurance is available to [name of obligee] at a reasonable cost of $[amount] per month from a source other than through [his/her] employment or membership in a union, trade association, or other organization, including the program under section 154.1826 of the Texas Family Code to provide health insurance in title IV-D cases.
|
Or |
No parent has access to private health insurance at a reasonable cost.
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Include the following if applicable. |
Good cause exists to deviate from the statutory priorities in ordering health-care coverage for the following reason[s]: [specify good cause].
|
Continue with the following. |
IT IS FURTHER FOUND that the following orders regarding health-care coverage are in the best interest of the child[ren].
12.L.3.Provision of Health-Care Coverage
3.Provision of Health-Care Coverage
|
Select 12.L.3.a. (health insurance to be provided by obligor), 12.L.3.b. (health insurance to be provided by obligee), or 12.L.3.c. (no private insurance available). |
12.L.3.a.Health Insurance to Be Provided by Obligor
As additional child support, [name of obligor] is ORDERED to [maintain/obtain, within [number] days after entry of this order, and then maintain] health insurance for [the/each] child as long as child support is payable for that child. [Name of obligor] is ORDERED—
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Include the following paragraph a. if insurance is provided through obligor’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligor]’s Social Security number;
ii.the name and address of [name of obligor]’s employer;
iii.whether [name of obligor]’s employer is self-insured or has health insurance available;
iv.proof that health insurance has been provided for [the/each] child;
v.if [name of obligor]’s employer has health insurance available:
(a)the name of the health insurance carrier;
(b)the number of the policy;
(c)a copy of the policy;
(d)a schedule of benefits;
(e)a health insurance membership card;
(f) claim forms; and
(g) any other information necessary to submit a claim; and
vi.if [name of obligor]’s employer is self-insured:
(a) a copy of the schedule of benefits;
(b)a membership card;
(c)claim forms; and
(d)any other information necessary to submit a claim;
|
Or Include the following paragraph a. if insurance is provided through means other than obligor’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligor]’s Social Security number;
ii.proof that health insurance has been provided for [the/each] child; and
iii.the following information and documents:
(a) the name of the health insurance carrier;
(b) the number of the policy;
(c) a copy of the policy;
(d) a schedule of benefits;
(e) a health insurance membership card;
(f) claim forms; and
(g) any other information necessary to submit a claim;
|
Continue with the following. |
b.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] a copy of any renewals or changes to the health insurance policy covering [the/a] child and any additional information regarding health insurance coverage of the child[ren] not later than the fifteenth day after [name of obligor] receives or is provided with the renewal, change, or additional information;
c.to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of any termination or lapse of the health insurance coverage of [the/a] child not later than the fifteenth day after the date of the termination or lapse;
d.after a termination or lapse of health insurance coverage, to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of the availability to [name of obligor] of additional health insurance for the child[ren] not later than the fifteenth day after the date the additional health insurance becomes available; and
e.after a termination or lapse of health insurance coverage, to enroll the child[ren] in a health insurance plan that is available to [name of obligor] at reasonable cost at the next available enrollment period.
Pursuant to section 1504.051 of the Texas Insurance Code, IT IS ORDERED that if [name of obligor] is eligible for dependent health coverage but fails to apply to obtain coverage for the child[ren], the insurer shall enroll the child[ren] on application of [name of obligee] or others as authorized by law.
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Or |
12.L.3.b.Health Insurance to Be Provided by Obligee
As additional child support, [name of obligee] is ORDERED to [maintain/obtain, within [number] days after entry of this order, and then maintain] health insurance for [the/each] child as long as child support is payable for that child. [Name of obligee] is ORDERED—
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Include the following paragraph a. if insurance is provided through obligee’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligee]’s Social Security number;
ii.the name and address of [name of obligee]’s employer;
iii.whether [name of obligee]’s employer is self-insured or has health insurance available;
iv.proof that health insurance has been provided for [the/each] child;
v.if [name of obligee]’s employer has health insurance available:
(a)the name of the health insurance carrier;
(b)the number of the policy;
(c)a copy of the policy;
(d)a schedule of benefits;
(e)a health insurance membership card;
(f)claim forms; and
(g)any other information necessary to submit a claim; and
vi.if [name of obligee]’s employer is self-insured:
(a)a copy of the schedule of benefits;
(b)a membership card;
(c)claim forms; and
(d)any other information necessary to submit a claim;
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Or Include the following paragraph a. if insurance is provided through means other than obligee’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligee]’s Social Security number;
ii.proof that health insurance has been provided for [the/each] child; and
iii.the following information and documents:
(a) the name of the health insurance carrier;
(b) the number of the policy;
(c) a copy of the policy;
(d) a schedule of benefits;
(e) a health insurance membership card;
(f) claim forms; and
(g) any other information necessary to submit a claim;
|
Continue with the following. |
b.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] a copy of any renewals or changes to the health insurance policy covering [the/a] child and any additional information regarding health insurance coverage of the child[ren] not later than the fifteenth day after [name of obligee] receives or is provided with the renewal, change, or additional information;
c.to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of any termination or lapse of the health insurance coverage of [the/a] child not later than the fifteenth day after the date of the termination or lapse;
d.after a termination or lapse of health insurance coverage, to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of the availability to [name of obligee] of additional health insurance for the child[ren] not later than the fifteenth day after the date the additional health insurance becomes available; and
e.after a termination or lapse of health insurance coverage, to enroll the child[ren] in a health insurance plan that is available to [name of obligee] at reasonable cost at the next available enrollment period.
Pursuant to section 1504.051 of the Texas Insurance Code, IT IS ORDERED that if [name of obligee] is eligible for dependent health coverage but fails to apply to obtain coverage for the child[ren], the insurer shall enroll the child[ren] on application of [name of obligor] or others as authorized by law.
Pursuant to section 154.182(b–1) of the Texas Family Code, [name of obligor] is ORDERED to pay [name of obligee], as additional child support, the amount of [number] dollars ($[amount]) per month for the cost of health insurance, with the first installment being due and payable on [date] and a like installment being due and payable on or before the [specify] day of each month thereafter until the termination of current child support for [the child/all children] under this order.
IT IS FURTHER ORDERED that the Income Withholding Order for Support authorized above in this order shall include the payments for the cost of health insurance ordered herein.
IT IS FURTHER ORDERED that all payments for the cost of health insurance shall be made through the state disbursement unit at Texas Child Support Disbursement Unit, P.O. Box 659791, San Antonio, Texas 78265-9791. IT IS ORDERED that all payments shall be made payable to the Office of the Attorney General and include the ten-digit Office of the Attorney General case number (if available), the cause number of this suit, [name of obligor]’s name as the name of the noncustodial parent (NCP), and [name of obligee]’s name as the name of the custodial parent (CP). Payment options are found on the Office of the Attorney General’s website at https://www.texas attorneygeneral.gov/cs/payment-options-and-types.
IT IS ORDERED that the provisions of this order for payments for the cost of health insurance shall be an obligation of the estate of [name of obligor] and shall not terminate on [his/her] death.
|
Or |
12.L.3.c.No Private Health Insurance Available
[Name of obligee] is ORDERED to [maintain/apply for, within [number] days after entry of this order, and then maintain] coverage under a governmental medical assistance program or health plan for [the/each] child as long as child support is payable for that child, by paying all applicable fees required for the coverage, including but not limited to enrollment fees and premiums. [Name of obligee] is ORDERED—
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligee]’s Social Security number;
ii.proof that coverage under a governmental medical assistance program or health plan has been provided for [the/each] child; and
iii.the following documents, to the extent they are applicable for the coverage provided for [the/each] child:
(a) the name of the health insurance carrier;
(b) the number of the policy;
(c) a copy of the policy;
(d) a schedule of benefits;
(e) a health insurance membership card or Children’s Medicaid card;
(f) claim forms; and
(g) any other information necessary to submit a claim;
b.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] a copy of any renewals or changes to the coverage provided for [the/a] child and any additional information regarding that coverage of the child not later than the fifteenth day after [name of obligee] receives or is provided with the renewal, change, or additional information;
c.to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of any termination or lapse of the coverage provided for [the/a] child not later than the fifteenth day after the date of the termination or lapse;
d.after a termination or lapse of the coverage provided for [the/a] child, to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of the availability to [name of obligee] of additional health insurance for the child[ren] or coverage under a governmental medical assistance program or health plan not later than the fifteenth day after the date the additional health insurance or coverage becomes available; and
e.after a termination or lapse of the coverage provided for [the/a] child, to enroll the child[ren] in a medical assistance program under chapter 32 of the Texas Human Resources Code or a state child health plan under chapter 62 of the Texas Health and Safety Code if the child[ren] [is/are] eligible for enrollment in the program.
Pursuant to section 154.182(b)(3) of the Texas Family Code, [name of obligor] is ORDERED to pay [name of obligee] cash medical support, as additional child support, of [number] dollars ($[amount]) per month, with the first installment being due and payable on [date] and a like installment being due and payable on or before the [specify] day of each month thereafter until the termination of current child support for [the child/all children] under this order.
IT IS FURTHER ORDERED that the Income Withholding Order for Support authorized above in this order shall include the payments for the cash medical support ordered herein.
IT IS FURTHER ORDERED that all payments of cash medical support shall be made through the state disbursement unit at Texas Child Support Disbursement Unit, P.O. Box 659791, San Antonio, Texas 78265-9791. IT IS ORDERED that all payments shall be made payable to the Office of the Attorney General and include the ten-digit Office of the Attorney General case number (if available), the cause number of this suit, [name of obligor]’s name as the name of the noncustodial parent (NCP), and [name of obligee]’s name as the name of the custodial parent (CP). Payment options are found on the Office of the Attorney General’s website at https://www.texasattorneygeneral.gov/cs/payment-options-and-types.
IT IS ORDERED that the cash medical support provisions of this order shall be an obligation of the estate of [name of obligor] and shall not terminate on [his/her] death.
[Name of obligor] is allowed to discontinue payment of cash medical support, for the time [name of obligor] is providing coverage, if—
a.health insurance for the child[ren] becomes available to [name of obligor] at a reasonable cost;
b.[name of obligor] enrolls the child[ren] in the insurance plan; and
c.[name of obligor] provides [name of obligee] [include if applicable: and the title IV-D agency] the information required under section 154.185 of the Texas Family Code.
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Continue with the following. |
12.L.4.Findings on Availability of Dental Insurance
§ 154.1825(b), (c)
4.Findings on Availability of Dental Insurance—Having considered the cost, accessibility, and quality of dental insurance coverage available to the parties, the Court finds:
Dental insurance is available or is in effect for the child[ren] through [name of obligor]’s employment or membership in a union, trade association, or other organization at a reasonable cost of $[amount] per month.
|
And/Or |
Dental insurance is available or is in effect for the child[ren] through [name of obligee]’s employment or membership in a union, trade association, or other organization at a reasonable cost of $[amount] per month.
|
And/Or |
Dental insurance is available to [name of obligor] at a reasonable cost of $[amount] per month from a source other than through [his/her] employment or membership in a union, trade association, or other organization.
|
And/Or |
Dental insurance is available to [name of obligee] at a reasonable cost of $[amount] per month from a source other than through [his/her] employment or membership in a union, trade association, or other organization.
|
Or |
No parent has access to dental insurance at a reasonable cost.
|
Continue with the following if the court found that dental insurance is available to a parent at a reasonable cost. Otherwise, skip to 12.L.6. |
|
Include the following if applicable. |
Good cause exists to deviate from the statutory priorities in ordering dental coverage for the following reason[s]: [specify good cause].
|
Continue with the following. |
IT IS FURTHER FOUND that the following orders regarding dental coverage are in the best interest of the child[ren].
12.L.5.Provision of Dental Coverage
5.Provision of Dental Coverage
|
Select 12.L.5.a. (dental insurance to be provided by obligor) or 12.L.5.b. (dental insurance to be provided by obligee). |
12.L.5.a.Dental Insurance to Be Provided by Obligor
As additional child support, [name of obligor] is ORDERED to [maintain/obtain, within [number] days after entry of this order, and then maintain] dental insurance for [the/each] child as long as child support is payable for that child. [Name of obligor] is ORDERED—
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Include the following paragraph a. if insurance is provided through obligor’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligor]’s Social Security number;
ii.the name and address of [name of obligor]’s employer;
iii.whether [name of obligor]’s employer is self-insured or has dental insurance available;
iv. proof that dental insurance has been provided for [the/each] child;
v.if [name of obligor]’s employer has dental insurance available:
(a) the name of the dental insurance carrier;
(b) the number of the policy;
(c) a copy of the policy;
(d)a schedule of benefits;
(e)a dental insurance membership card;
(f)claim forms; and
(g)any other information necessary to submit a claim; and
vi.if [name of obligor]’s employer is self-insured:
(a)a copy of the schedule of benefits;
(b) a membership card;
(c) claim forms; and
(d) any other information necessary to submit a claim;
|
Or Include the following paragraph a. if insurance is provided through means other than obligor’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligor]’s Social Security number;
ii. proof that dental insurance has been provided for [the/each] child; and
iii. the following information and documents:
(a) the name of the dental insurance carrier;
(b) the number of the policy;
(c) a copy of the policy;
(d) a schedule of benefits;
(e) a dental insurance membership card;
(f) claim forms; and
(g) any other information necessary to submit a claim;
|
Continue with the following. |
b.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] a copy of any renewals or changes to the dental insurance policy covering [the/a] child and any additional information regarding dental insurance coverage of the child[ren] not later than the fifteenth day after [name of obligor] receives or is provided with the renewal, change, or additional information;
c.to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of any termination or lapse of the dental insurance coverage of [the/a] child not later than the fifteenth day after the date of the termination or lapse;
d.after a termination or lapse of dental insurance coverage, to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of the availability to [name of obligor] of additional dental insurance for the child[ren] not later than the fifteenth day after the date the additional dental insurance becomes available; and
e.after a termination or lapse of dental insurance coverage, to enroll the child[ren] in a dental insurance plan that is available to [name of obligor] at reasonable cost at the next available enrollment period.
Pursuant to section 1504.051 of the Texas Insurance Code, IT IS ORDERED that if [name of obligor] is eligible for dependent dental coverage but fails to apply to obtain coverage for the child[ren], the insurer shall enroll the child[ren] on application of [name of obligee] or others as authorized by law.
|
Or |
12.L.5.b.Dental Insurance to Be Provided by Obligee
As additional child support, [name of obligee] is ORDERED to [maintain/obtain, within [number] days after entry of this order, and then maintain] dental insurance for [the/each] child as long as child support is payable for that child. [Name of obligee] is ORDERED—
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Include the following paragraph a. if insurance is provided through obligee’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligee]’s Social Security number;
ii.the name and address of [name of obligee]’s employer;
iii.whether [name of obligee]’s employer is self-insured or has dental insurance available;
iv.proof that dental insurance has been provided for [the/each] child;
v.if [name of obligee]’s employer has dental insurance available:
(a)the name of the dental insurance carrier;
(b)the number of the policy;
(c)a copy of the policy;
(d)a schedule of benefits;
(e)a dental insurance membership card;
(f)claim forms; and
(g)any other information necessary to submit a claim; and
vi.if [name of obligee]’s employer is self-insured:
(a)a copy of the schedule of benefits;
(b)a membership card;
(c)claim forms; and
(d)any other information necessary to submit a claim;
|
Or Include the following paragraph a. if insurance is provided through means other than obligee’s employment. |
a.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] the following information no later than the thirtieth day after the date the notice of the rendition of this order is received:
i.[name of obligee]’s Social Security number;
ii.proof that dental insurance has been provided for [the/each] child; and
iii.the following information and documents:
(a) the name of the dental insurance carrier;
(b) the number of the policy;
(c) a copy of the policy;
(d) a schedule of benefits;
(e) a dental insurance membership card;
(f) claim forms; and
(g) any other information necessary to submit a claim;
|
Continue with the following. |
b.to furnish to each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] a copy of any renewals or changes to the dental insurance policy covering [the/a] child and any additional information regarding dental insurance coverage of the child[ren] not later than the fifteenth day after [name of obligee] receives or is provided with the renewal, change, or additional information;
c.to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of any termination or lapse of the dental insurance coverage of [the/a] child not later than the fifteenth day after the date of the termination or lapse;
d.after a termination or lapse of dental insurance coverage, to notify each conservator of the child[ren] [include if applicable: and the Office of the Attorney General Child Support Division] of the availability to [name of obligee] of additional dental insurance for the child[ren] not later than the fifteenth day after the date the additional dental insurance becomes available; and
e.after a termination or lapse of dental insurance coverage, to enroll the child[ren] in a dental insurance plan that is available to [name of obligee] at reasonable cost at the next available enrollment period.
Pursuant to section 1504.051 of the Texas Insurance Code, IT IS ORDERED that if [name of obligee] is eligible for dependent dental coverage but fails to apply to obtain coverage for the child[ren], the insurer shall enroll the child[ren] on application of [name of obligor] or others as authorized by law.
Pursuant to section 154.1825(d) of the Texas Family Code, [name of obligor] is ORDERED to pay [name of obligee], as additional child support, the amount of [number] dollars ($[amount]) per month for the cost of dental insurance, with the first installment being due and payable on [date] and a like installment being due and payable on or before the [specify] day of each month thereafter until the termination of current child support for [the child/all children] under this order.
IT IS FURTHER ORDERED that the Income Withholding Order for Support authorized above in this order shall include the payments ordered herein for the cost of dental insurance.
IT IS FURTHER ORDERED that all payments for the cost of dental insurance shall be made through the state disbursement unit at Texas Child Support Disbursement Unit, P.O. Box 659791, San Antonio, Texas 78265-9791. IT IS ORDERED that all payments shall be made payable to the Office of the Attorney General and include the ten-digit Office of the Attorney General case number (if available), the cause number of this suit, [name of obligor]’s name as the name of the noncustodial parent (NCP), and [name of obligee]’s name as the name of the custodial parent (CP). Payment options are found on the Office of the Attorney General’s website at https://www.texas attorneygeneral.gov/cs/payment-options-and-types.
IT IS ORDERED that the provisions of this order for payments for the cost of dental insurance shall be an obligation of the estate of [name of obligor] and shall not terminate on [his/her] death.
|
Continue with the following in all orders. |
12.L.6.Allocation of Unreimbursed Expenses
§ 154.183(c)
|
Select 12.L.6.a. if 12.L.3.a. (health insurance to be provided by obligor) or 12.L.3.b. (health insurance to be provided by obligee) is used. Select 12.L.6.b. if 12.L.3.c. (no private health insurance available) is used. |
12.L.6.a.Allocation If Private Health Insurance Ordered
6.Allocation of Unreimbursed Expenses—Pursuant to section 154.183(c) of the Texas Family Code, the reasonable and necessary health-care expenses of the child[ren] that are not reimbursed by health insurance [include if applicable: or dental insurance] are allocated as follows: [name of obligee] is ORDERED to pay [percent] percent and [name of obligor] is ORDERED to pay [percent] percent of the unreimbursed health-care expenses if, at the time the expenses are incurred, [[name of obligor] is providing health insurance/[name of obligee] is providing health insurance and [name of obligor] is paying additional child support for the cost of health insurance] [include if applicable: and [[name of obligor] is providing dental insurance/[name of obligee] is providing dental insurance and [name of obligor] is paying additional child support for the cost of dental insurance]] as ordered.
|
Or |
12.L.6.b.Allocation If No Private Insurance Available
6.Allocation of Unreimbursed Expenses—Pursuant to section 154.183(c) of the Texas Family Code, the reasonable and necessary health-care expenses of the child[ren] that are not reimbursed by health insurance [include if applicable: or dental insurance] or are not otherwise covered by the amount of cash medical support ordered above are allocated as follows: [name of obligee] is ORDERED to pay [percent] percent and [name of obligor] is ORDERED to pay [percent] percent of the unreimbursed health-care expenses that exceed the amount of cash medical support paid by [name of obligor].
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Continue with the following. |
12.L.6.c.Payment of Allocated Expenses
The conservator who incurs a health-care expense on behalf of [the/a] child is ORDERED to furnish to the other conservator all forms, receipts, bills, statements, and explanations of benefits reflecting the unreimbursed portion of the health-care expenses within thirty days after the incurring conservator receives them. If the incurring conservator furnishes to the nonincurring conservator the forms, receipts, bills, statements, and explanations of benefits reflecting the unreimbursed portion of the health-care expenses within thirty days after the incurring conservator receives them, the nonincurring conservator is ORDERED to pay the nonincurring conservator’s percentage of the unreimbursed portion of the health-care expenses either by paying the health-care provider directly or by reimbursing the incurring conservator for any advance payment exceeding the incurring conservator’s percentage of the unreimbursed portion of the health-care expenses within thirty days after the nonincurring conservator receives the forms, receipts, bills, statements, and/or explanations of benefits. If the incurring conservator fails to furnish to the nonincurring conservator the forms, receipts, bills, statements, and explanations of benefits reflecting the unreimbursed portion of the health-care expenses within thirty days after the incurring conservator receives them, the nonincurring conservator is ORDERED to pay the nonincurring conservator’s percentage of the unreimbursed portion of the health-care expenses either by paying the health-care provider directly or by reimbursing the incurring conservator for any advance payment exceeding the incurring conservator’s percentage of the unreimbursed portion of the health-care expenses within 120 days after the nonincurring conservator receives the forms, receipts, bills, statements, and/or explanations of benefits.
12.L.7.Secondary Coverage
7.Secondary Coverage—IT IS ORDERED that if a conservator provides secondary health insurance coverage [include if applicable: or dental insurance coverage] for the child[ren], the conservators shall cooperate fully with regard to the handling and filing of claims with the insurance carrier providing the coverage in order to maximize the benefits available to the child[ren] and to ensure that the conservator who pays for health-care expenses for the child[ren] is reimbursed for the payment from both carriers to the fullest extent possible.
12.L.8.Compliance with Insurance Company Requirements
8.Compliance with Insurance Company Requirements—Each conservator is ORDERED to conform to all requirements imposed by the terms and conditions of any policy of health [include if applicable: or dental] insurance covering the child[ren] in order to assure the maximum reimbursement or direct payment by any insurance company of the incurred health-care expense, including but not limited to requirements for advance notice to any carrier, second opinions, and the like. Each conservator is ORDERED to use “preferred providers” or services within the health maintenance organization or preferred provider network, if applicable. Disallowance of the bill by an insurance company shall not excuse the obligation of a conservator to make payment. Excepting emergency health-care expenses incurred on behalf of the child[ren], if a conservator incurs health-care expenses for the child[ren] using “out-of-network” providers or services or fails to follow the insurance company procedures or requirements, that conservator shall pay all such health-care expenses incurred absent (1) written agreement of the conservators allocating such health-care expenses or (2) further order of the Court.
12.L.9.Claims
9.Claims—Except as provided in this paragraph, a conservator who is not carrying the health [include if applicable: or dental] insurance policy covering the child[ren] is ORDERED to furnish to the conservator carrying the policy, within fifteen days of receiving them, all forms, receipts, bills, and statements reflecting the health-care expenses the conservator not carrying the policy incurs on behalf of the child[ren]. In accordance with sections 1204.251 and 1504.055(a) of the Texas Insurance Code, IT IS ORDERED that the conservator who is not carrying the health [include if applicable: or dental] insurance policy covering the child[ren], at that conservator’s option, or others as authorized by law, may file any claims for health-care expenses directly with the insurance carrier with and from whom coverage is provided for the benefit of the child[ren] and receive payments directly from the insurance company. Further, for the sole purpose of section 1204.251 of the Texas Insurance Code, [name of conservator not carrying policy] is designated the managing conservator or possessory conservator of the child[ren].
The conservator who is carrying the health [include if applicable: or dental] insurance policy covering the child[ren] is ORDERED to submit all forms required by the insurance company for payment or reimbursement of health-care expenses incurred by either conservator on behalf of [the/a] child to the insurance carrier within fifteen days of that conservator’s receiving any form, receipt, bill, or statement reflecting the expenses.
12.L.10.Constructive Trust
10.Constructive Trust for Payments Received—IT IS ORDERED that any insurance payments received by a conservator from the health [include if applicable: or dental] insurance carrier as reimbursement for health-care expenses incurred by or on behalf of [the/a] child shall belong to the conservator who paid those expenses. IT IS FURTHER ORDERED that the conservator receiving the insurance payments is designated a constructive trustee to receive any insurance checks or payments for health-care expenses paid by the other conservator, and the conservator carrying the policy shall endorse and forward the checks or payments, along with any explanation of benefits received, to the other conservator within three days of receiving them.
12.L.11.Warning
§ 154.188
11.Warning—A parent ordered to provide health insurance [include if applicable: or dental insurance] or to pay the other parent additional child support for the cost of health insurance [include if applicable: or dental insurance] who fails to do so is liable for necessary medical expenses [include if applicable: or dental expenses] of the child[ren], without regard to whether the expenses would have been paid if health insurance [include if applicable: or dental insurance] had been provided, and for the cost of health insurance premiums [include if applicable: , dental insurance premiums,] or contributions, if any, paid on behalf of the child[ren].
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Include 12.L.12. if insurance through a conservator’s employment is ordered. |
12.Notice to Employer—On this date a Medical Support Notice [see form 9-1] was [signed/authorized to be issued] by the Court. For the purpose of section 1169 of title 29 of the United States Code, the conservator not carrying the health [include if applicable: or dental] insurance policy is designated the custodial parent and alternate recipient’s representative.
12.M.Military Health Care and Commissary Privileges
The Court finds that [name] is a member of the United States Armed Forces and that the child[ren] the subject of this suit [is/are] eligible to receive health care and other benefits as [a] dependent[s] of a United States Armed Forces member. Therefore, [name] is ORDERED to keep and maintain in current status and deliver to [name] the identification card[s] and any other forms necessary for the child[ren] the subject of this suit to be provided health care through all facilities available to the child[ren] as [a] dependent[s] of a United States Armed Forces member. [Name] is FURTHER ORDERED to provide to [name] all additional verified applications for renewal of dependent identification cards at least thirty days before the expiration date of the identification card[s], until the child[ren] [is/are] no longer eligible for these benefits.
12.N.No Credit for Informal Payments
IT IS ORDERED that the child support as prescribed in this order shall be exclusively discharged in the manner ordered and that any direct payments made by [name] to [name] or any expenditures incurred by [name] during [name]’s periods of possession of or access to the child[ren], as prescribed in this order, for food, clothing, gifts, travel, shelter, or entertainment are deemed in addition to and not in lieu of the support ordered in this order.
As additional child support, IT IS ORDERED that [name of obligor] shall [include if applicable: purchase and], as long as child support is payable under the terms of this order, maintain in full force and effect at [name of obligor]’s sole cost and expense a life insurance policy, which may be a decreasing term life insurance policy, insuring the life of [name of obligor], with an initial death benefit not less than the amount of the “Unpaid Child Support,” that will establish an insurance-funded [trust/annuity] payable to [name of obligee] for the benefit of the child[ren] that will satisfy the support obligation under the child support order in the event of the obligor’s death, pursuant to sections 154.015 and 154.016 of the Texas Family Code.
“Unpaid Child Support” is defined as the sum of the following:
1.an amount equal to the total amount of monthly periodic child support payments under the terms of this order, as modified by future court orders, that would be due between the date of this order until the end of the month of [the/each] child’s eighteenth birthday [, which the Court finds to be [number] dollars ($[amount])];
2.an amount equal to the total amount of health insurance and dental insurance premiums payable for the benefit of the child[ren] under the terms of this order, as modified by future court orders, that would be due between the date of this order until the end of the month of [the/each] child’s eighteenth birthday [, which the Court finds to be [number] dollars ($[amount])]; and
3.an amount equal to the balance owing on all cumulative judgments awarded against [name of obligor] for retroactive child support, child support arrearages, medical support arrearages, and dental support arrearages, as well as postjudgment interest on each judgment as of the date of this order [, which the Court finds to be [number] dollars ($[amount])].
The Court finds that as of the date of this order the amount of Unpaid Child Support is [number] dollars ($[amount]).
[Name of obligor] is ORDERED to provide [name of obligee] written proof from the life insurance company confirming the coverage required under this portion of the order no later than thirty days after the date this order is signed by the Court [through the parties’ attorneys/by mailing to [name of obligee] at [address]/by e-mailing to [name of obligee] at [e-mail address]].
IT IS ORDERED that on [date] of each calendar year [name of obligor] and [name of obligee] shall recalculate the amount of Unpaid Child Support, replacing the date of the order or, if applicable, the date of the most recent recalculation with the date of the newest recalculation until the balance of the Unpaid Child Support is zero. After each recalculation, [name of obligor] may decrease the amount of the death benefit of the insurance policy to an amount equal to or greater than the most recently recalculated Unpaid Child Support. If after any recalculation the death benefit of the life insurance policy is less than the recalculated Unpaid Child Support, within thirty days of that recalculation [name of obligor] is ORDERED to increase and maintain the death benefit to an amount equal to or greater than the most recently recalculated Unpaid Child Support.
Within thirty days of any change of the death benefit or of any beneficiary of the life insurance policy or of any written request by [name of obligee] [mailed to [name of obligor]’s last known mailing address/e-mailed to [name of obligor]’s last known e-mail address/sent by text message to [name of obligor]’s last known mobile telephone number/[other method of communication]], [name of obligor] is ORDERED to provide [name of obligee] at [name of obligee]’s last known [mailing/e-mail] address the documentation from the life insurance company showing the policy’s current death benefit and the policy’s current beneficiary designation(s). With [his/her] signature to this order, [name of obligor] authorizes [name of obligee] to obtain directly from the insurance company issuing the life insurance policy the current death benefit of the policy and the policy’s beneficiary designation(s). Not later than thirty days after receipt of a form required by the insurance company to authorize [name of obligee] to directly obtain this information, [name of obligor] is ORDERED to execute and deliver each such form to [name of obligee] at [name of obligee]’s last known mailing address.
On the date of this order, [name of obligor] is ORDERED to create an insurance-funded [trust/annuity], the complete terms and documents of which [name of obligor] shall provide to [name of obligee] [through the parties’ attorneys/by mailing to [name of obligee] at [address]/by e-mailing to [name of obligee] at [e-mail address]]. Within fifteen days of any written request by [name of obligee] [mailed to [name of obligor]’s last known mailing address/e-mailed to [name of obligor]’s last known e-mail address/sent by text message to [name of obligor]’s last known mobile telephone number/[other method of communication]], [name of obligor] is ORDERED to provide [name of obligee] at [name of obligee]’s last known [mailing/e-mail] address the complete, current terms and documents of the [trust/annuity].
If [name of obligor]’s death occurs before the termination of [his/her] child support obligation, the proceeds of the life insurance policy shall fund the [trust/annuity] and shall be distributed as ordered by the Court in accordance with the Texas Family Code. If the proceeds of the life insurance policy are insufficient to satisfy [name of obligor]’s child support obligation as determined by the Court, any unpaid child support obligation shall be an obligation of [name of obligor]’s estate. If the proceeds of the life insurance policy exceed [name of obligor]’s child support obligation as determined by the Court, [name of obligor], through the terms of the [trust/annuity], shall determine the disposition of those excess funds after [name of obligee] is paid a sum equal to the child support obligation.
IT IS ORDERED if any person or entity other than the insurance-funded [trust/annuity] described above receives proceeds of the life insurance policy [name of obligor] is ordered to maintain under the terms of this portion of the order before both the Court orders the distribution of those proceeds and those proceeds are distributed in accordance with that order, that person or entity shall be designated a constructive trustee of those funds for the benefit of [name of obligee] to the extent the Court orders those funds to be paid to [name of obligee] to satisfy [name of obligor]’s child support obligation.
12.P.Other Items
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Several child-related items that are frequently covered by an agreement incident to divorce may be inserted in the final order in a suit affecting the parent-child relationship. These provisions commonly cover such subjects as private schools, automobiles, summer camp, and extracurricular activities. See form 23-6 for drafting suggestions. |
12.Q.Security for Child Support
§ 157.109
IT IS ORDERED that [name] shall post a cash or security bond in the amount of [number] dollars ($[amount]) and payable through the registry of the Court to [name], conditioned on [name]’s payment of past-due temporary support and future child support as ordered in this order.
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Continue with the following. |
12.R.Support as Obligation of Estate
IT IS ORDERED that the provisions for child support in this order shall be an obligation of the estate of [name of obligor] and shall not terminate on the death of [name of obligor]. IT IS ORDERED that payments received by [name of obligee] for the benefit of the child[ren] due to the death of [name of obligor], including payments from the Social Security Administration, Department of Veterans Affairs, or other governmental agency or life insurance proceeds, annuity payments, trust distributions, or retirement survivor benefits, shall be a credit against this obligation. Any remaining balance of the child support is an obligation of [name of obligor]’s estate.
12.S.Termination of Orders on [Re]marriage of Parties but Not on Death of Obligee
§§ 154.006(b), 154.013(a)
The provisions of this order relating to current child support terminate on the [marriage/remarriage] of [name of obligor] to [name of obligee] unless a nonparent or agency has been appointed conservator of the child[ren] under chapter 153 of the Texas Family Code. An obligation to pay child support under this order does not terminate on the death of [name of obligee] but continues as an obligation to [name[s] of child[ren]].
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If appropriate, see form 45-5 or 45-6 for temporary orders regarding support to be effective for the duration of a party’s military duty. |
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Include 12.T. if modification is under Tex. Fam. Code § 156.409. |
12.T.Change in Physical Possession
§ 156.409(a–1), (a–3)
IT IS ORDERED that [name of obligor] pay to [Petitioner/[name of person with physical possession]] any unpaid child support that is not subject to offset or reimbursement under section 157.008 of the Texas Family Code accrued after [date of relinquishment or incarceration].
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Include the following if applicable. |
On [name]’s release from incarceration, [name] may file an affidavit with the Court stating that [name] has been released from incarceration, that there has not been a modification of the conservatorship of the child[ren] during the incarceration, and that [name] has resumed physical possession of the child[ren].
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Include 13. unless the order only modifies child support. |
13.Optimizing Development of Relationship between Parties and Child[ren]
§ 153.601(4)(D)
IT IS ORDERED that [include provisions to optimize the development of a close and continuing relationship between each party and the child[ren]].
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Include 14. if applicable. |
14.Settlement of Future Disputes
Settlement of Future Disputes
The Court finds that the parties agree to the following, as evidenced by their signatures below.
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Select one of the following. |
a.Collaborative Model
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Include the following paragraph if the matter was settled using collaborative law. |
The parties agree that if a future disagreement arises regarding the child[ren], unless the parties agree otherwise or in the event of an emergency, the parties will attempt to resolve this disagreement, within sixty days of the date of written notice given by a party to the other of the nature of the child-related issue, by using the collaborative law model in substantial conformance with the agreements made in the Collaborative Law Participation Agreement that the parties signed on [date], a copy of which is on file with the Court. The parties agree that a child psychologist, on whom they can mutually agree, shall act as the neutral child consultant to help the parties resolve the disagreement by recommending to the parties resolutions that are in the best interest of the child[ren]. The parties will hire individual collaborative lawyers to represent them in the collaborative model. The parties understand and agree that they are not mandated to come to an agreement regarding this dispute; however, if they are unable to agree within the collaborative law process, their collaborative lawyers shall withdraw as their counsel, and then the parties are free, if they desire, to hire trial counsel. The parties further agree that the neutral child consultant may not testify in any subsequent lawsuit, nor may his or her opinions be utilized by any other expert, unless the parties agree in writing otherwise. The parties will share equally the total costs for the neutral child consultant. If an agreement regarding the dispute is not reached after the signing of the collaborative law participation agreement and at least one four-way meeting, either party may withdraw from the collaborative process and proceed to litigation, or, if agreed, the parties may continue to work through the collaborative law process until resolution is achieved or either or both parties withdraw from the collaborative law process. The parties may use the mediation process, if agreed, in connection with the collaborative law process. The obligee of child support shall not be required to use the collaborative law model to enforce a child support obligation, nor shall the obligor be required to use the collaborative law model before filing a petition to decrease child support.
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Or |
b.Mediation/Arbitration
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Tex. Fam. Code §§ 153.133(b) and 153.134 strongly urge the use of alternative dispute resolution procedures. The following language is intended to cover issues of conservatorship and support. |
It is agreed that before setting any hearing or initiating discovery in a suit for modification of the terms and conditions of conservatorship, possession, or support of the child[ren], except in an emergency, the parties shall mediate the controversy in good faith. This requirement does not apply to actions brought to enforce this order or to enforce any subsequent modifications of this order. It is agreed that the party wishing to modify the terms and conditions of conservatorship, possession, or support of the child[ren] shall give written notice to the other party of a desire to mediate the controversy. If, within ten days after receipt of the written notice, the parties cannot agree on a mediator or the other party does not agree to attend mediation or fails to attend a scheduled mediation of the controversy, the party desiring modification shall be released from the obligation to mediate and shall be free to litigate [the/a] suit for modification.
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Include the following if the parties agree to arbitrate future claims or controversies. |
The parties agree that any claim or controversy arising out of this order that cannot be settled by direct negotiation or mediation will be submitted to binding arbitration as provided in chapter 171 of the Texas Civil Practice and Remedies Code. The arbitrator will be selected by mutual agreement, but if no agreement can be reached about the arbitrator, the parties will secure the name of an arbitrator from the court that rendered this order. The cost of the arbitrator will be paid [percent] percent by [name] and [percent] percent by [name].
15.Parenting Coordinator/Facilitator
§§ 153.603(d), 153.605(a), (b), 153.6051(a), (b)
Parenting [Coordinator/Facilitator]
IT IS ORDERED that [name] is appointed parenting [coordinator/facilitator]. [Include appropriate provisions from form 16-18 or 16-19, including findings required under Tex. Fam. Code § 153.605(b) or § 153.6051(b).]
16.Medical Notification
Medical Notification
Each conservator is ORDERED to inform [the/each] other conservator within [number] hours of any medical condition of the child[ren] requiring surgical intervention, hospitalization, or both.
Within [number] days after receipt of a written request from [the other/another] conservator, the conservator receiving the request is ORDERED to execute—
1.all necessary releases pursuant to the Health Insurance Portability and Accountability Act (HIPAA) and 45 C.F.R. section 164.508 to permit the other conservator[s] to obtain health-care information regarding the child[ren]; and
2.for all health-care providers of the child[ren], an authorization for disclosure of protected health information to the other conservator[s] pursuant to the HIPAA and 45 C.F.R. section 164.508.
Each conservator is further ORDERED to designate [the/each] other conservator as a person to whom protected health information regarding the child[ren] may be disclosed whenever the conservator executes an authorization for disclosure of protected health information pursuant to the HIPAA and 45 C.F.R. section 164.508.
17.Parent Education and Family Stabilization Course
Parent Education and Family Stabilization Course
IT IS ORDERED that [name] and [name] shall each individually register to attend a parent education and family stabilization course with [name of individual or facility] at [address and telephone number] on or before [date].
On completion of the course, [name] and [name] shall each obtain a certificate of completion. The certificate must state the name of the participant; the name of the course provider; the date the course was completed; and whether the course was provided by personal instruction, videotape instruction, instruction through an electronic means, or a combination of those methods.
Within ten days after completion of that parent education and family stabilization course, [name] and [name] are each ORDERED to file a certification of completion or other comparable proof of completion of the course with the clerk of this Court and to mail a copy to the other party.
IT IS ORDERED that each party shall pay for the costs of that party’s own attendance at the course.
18.Coparenting Website Program
Coparenting Website Program
IT IS ORDERED that [name] and [name] each shall, within ten days after this order is signed by the Court, obtain at [his or her/his/her] sole expense a subscription to the [name of coparenting website] program on the website at [website address]. IT IS FURTHER ORDERED that [name] and [name] each shall maintain that subscription in full force and effect for as long as [the/any] child is under the age of eighteen years and not otherwise emancipated.
IT IS ORDERED that [name] and [name] shall each communicate through the [name of coparenting website] program with regard to all communication regarding the child[ren], except in the case of an emergency or other urgent matter.
IT IS ORDERED that [name] and [name] each shall timely post all significant information concerning the health, education, and welfare of the child[ren], including but not limited to the child[ren]’s medical appointments, the child[ren]’s schedule[s] and activities, and requests for reimbursement of uninsured health-care expenses, on the [name of coparenting website] website. However, IT IS ORDERED that neither party shall have any obligation to post on that website any information to which the other party already has access through other means, such as information available on the website[s] of the child[ren]’s school[s].
IT IS FURTHER ORDERED that [name] and [name] shall each timely post on the [name of coparenting website] website a copy of any e-mail received by the party from the child[ren]’s school[s] or any health-care provider of the child[ren], in the event that e-mail was not also forwarded by the school[s] or health-care provider to the other party.
For purposes of this section of this order, “timely” means on learning of the event or activity, or if not immediately feasible under the circumstances, not later than twenty-four hours after learning of the event or activity.
By agreement, the parties may communicate in any manner other than using the [name of coparenting website] program, but other methods of communication used by the parties shall be in addition to, and not in lieu of, using the [name of coparenting website] program.
19.Permanent Injunctions as to Persons
Injunctive Relief
The Court finds that, because of the conduct of [name], a permanent injunction against [him/her] should be granted as appropriate relief because there is no adequate remedy at law.
The permanent injunction granted below shall be effective immediately and shall be binding on [name]; on [his/her] agents, servants, employees, and attorneys; and on those persons in active concert or participation with them who receive actual notice of this order by personal service or otherwise.
IT IS ORDERED that [name] is permanently enjoined from:
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Select as required by petition. |
1.Threatening Other Party
Causing physical contact or bodily injury to [name] or threatening [name] with imminent bodily injury.
2.Communicating
Communicating in person, by telephone, or in writing with [name], except for arranging visitation or notifying [name] of circumstances affecting the best interest of the child[ren].
3.Entering Residence or Place of Employment
Coming within [feet] feet of, entering, or remaining on the premises of the residence of [name], located at [address], or place of employment of [name] at [name and address of employment] for any purpose, except to exercise visitation granted in this order.
4.Interfering with Possession of Child[ren]
Interfering in any way with Managing Conservator’s possession of the child[ren] or taking or retaining possession of the child[ren], directly or in concert with other persons, except as permitted by order of the Court.
5.Coming to Day Care or School
Coming within [feet] feet of, entering, or remaining on the premises of the child[ren]’s day-care facility, [name and address]; school, [name and address]; or other day-care facility or school about which [name] receives written notice.
•Service of Writ
TRCP 689
Petitioner and Respondent waive issuance and service of the writ of injunction, by stipulation or as evidenced by the signatures below. IT IS ORDERED that Petitioner and Respondent shall be deemed to be duly served with the writ of injunction.
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Continue with the following. |
20.Information Regarding Parties
§ 105.006(a)
Required Information
The information required for each party by section 105.006(a) of the Texas Family Code is as follows:
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If the court finds that requiring a party to give certain items of this information to another party is likely to cause the child or a conservator harassment, abuse, serious harm, or injury, or to subject the child or a conservator to family violence, as defined by Tex. Fam. Code § 71.004, the court may make any orders it considers necessary regarding the information. Tex. Fam. Code § 105.006(c). Information regarding the child appears in 7. rather than here, because the child is not a party. |
Name: [name of petitioner]
Social Security number:
Driver’s license number and issuing state:
Current residence address:
Mailing address:
Home telephone number:
Name of employer:
Address of employment:
Work telephone number:
Name: [name of respondent]
Social Security number:
Driver’s license number and issuing state:
Current residence address:
Mailing address:
Home telephone number:
Name of employer:
Address of employment:
Work telephone number:
Name: [name of any other party]
Social Security number:
Driver’s license number and issuing state:
Current residence address:
Mailing address:
Home telephone number:
Name of employer:
Address of employment:
Work telephone number:
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Repeat as needed for other parties. |
21.Required Notices
§§ 105.006(e), (e–1), (e–2), 105.007
Required Notices
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Include the following four paragraphs of 21. unless an exception exists under Tex. Fam. Code § 105.006(c). Tex. Fam. Code § 105.007(c) provides for waiver of the requirement of notice of change of information on motion by a party if the court finds the giving of notice would be likely to expose the child or the party to harassment, abuse, serious harm, or injury. See also Tex. Fam. Code § 105.006(c). |
Each person who is a party to this order is ordered to notify each other party, the Court, and the state case registry of any change in the party’s current residence address, mailing address, home telephone number, name of employer, address of employment, driver’s license number, and work telephone number. The party is ordered to give notice of an intended change in any of the required information to each other party, the Court, and the state case registry on or before the 60th day before the intended change. If the party does not know or could not have known of the change in sufficient time to provide 60-day notice, the party is ordered to give notice of the change on or before the fifth day after the date that the party knows of the change.
The duty to furnish this information to each other party, the Court, and the state case registry continues as long as any person, by virtue of this order, is under an obligation to pay child support or entitled to possession of or access to a child.
Failure by a party to obey the order of this Court to provide each other party, the Court, and the state case registry with the change in the required information may result in further litigation to enforce the order, including contempt of court. A finding of contempt may be punished by confinement in jail for up to six months, a fine of up to $500 for each violation, and a money judgment for payment of attorney’s fees and court costs.
Notice shall be given to the other party by delivering a copy of the notice to the party by registered or certified mail, return receipt requested. Notice shall be given to the Court by delivering a copy of the notice either in person to the clerk of this Court or by registered or certified mail addressed to the clerk at [address]. Notice shall be given to the state case registry by mailing a copy of the notice to State Case Registry, Contract Services Section, MC046S, P.O. Box 12017, Austin, Texas 78711-2017.
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Include the following paragraph if the order provides for possession of or access to a child. |
Notice to any peace officer of the state of Texas: You may use reasonable efforts to enforce the terms of child custody specified in this order. A peace officer who relies on the terms of a court order and the officer’s agency are entitled to the applicable immunity against any claim, civil or otherwise, regarding the officer’s good faith acts performed in the scope of the officer’s duties in enforcing the terms of the order that relate to child custody. Any person who knowingly presents for enforcement an order that is invalid or no longer in effect commits an offense that may be punishable by confinement in jail for as long as two years and a fine of as much as $10,000.
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Include the following paragraph if the order provides for child support. |
The Court may modify this order that provides for the support of a child, if:
(1)the circumstances of the child or a person affected by the order have materially and substantially changed; or
(2)it has been three years since the order was rendered or last modified and the monthly amount of the child support award under the order differs by either 20 percent or $100 from the amount that would be awarded in accordance with the child support guidelines.
22.Warnings to Parties
§ 105.006(d)
Warnings
Warnings to Parties: Failure to obey a court order for child support or for possession of or access to a child may result in further litigation to enforce the order, including contempt of court. A finding of contempt may be punished by confinement in jail for up to six months, a fine of up to $500 for each violation, and a money judgment for payment of attorney’s fees and court costs.
Failure of a party to make a child support payment to the place and in the manner required by a court order may result in the party’s not receiving credit for making the payment.
Failure of a party to pay child support does not justify denying that party court-ordered possession of or access to a child. Refusal by a party to allow possession of or access to a child does not justify failure to pay court-ordered child support to that party.
23.Attorney’s and Ad Litem Fees
Attorney’s [and Ad Litem] Fees
23.A.Petitioner’s Attorney
IT IS ORDERED that good cause exists to award [name of attorney] judgment in the amount of [number] dollars ($[amount]) for reasonable attorney’s fees, expenses, and costs incurred by [name of party], with interest at [percent] percent per year compounded annually from the date the judgment is signed until paid. The judgment, for which let execution issue, is awarded against [name of respondent], Respondent. Respondent is ORDERED to pay the fees, expenses, costs, and interest to [name of attorney] at [address] by cash, cashier’s check, or money order on or before [date]. [Name of attorney] may enforce this judgment for fees, expenses, and costs in [his/her] own name by any means available for the enforcement of a judgment for debt.
•Attorney’s Fees on Appeal
IT IS FURTHER ORDERED that [name] is awarded a judgment of [number] dollars ($[amount]) against [name] for attorney’s fees on appeal for the benefit of [his/her] attorney, [name]. The judgment shall bear interest at [percent] percent per year compounded annually from the date the award is made final by the appropriate appellate court’s judgment, for which let execution issue.
IT IS FURTHER ORDERED that the judgment of attorney’s fees on appeal rendered against [name] is conditioned on [his/her] pursuit of an ultimately unsuccessful appeal.
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Following are some of the levels of attorney’s fees that may be included in the appellate process. For a more complete listing that should be considered in proving up appellate attorney’s fees, see the practice notes at section 20.23. |
IT IS ORDERED that [name] shall be entitled to a remittitur of [number] dollars ($[amount]) if a petition for review is granted by the Supreme Court of Texas but oral argument is not granted.
IT IS ORDERED that [name] shall be entitled to a further remittitur of [number] dollars ($[amount]) if briefing on the merits is not requested by the Supreme Court of Texas.
IT IS ORDERED that [name] shall be entitled to a further remittitur of [number] dollars ($[amount]) if a responsive brief to the petition for review is not requested by the Supreme Court of Texas.
IT IS ORDERED that [name] shall be entitled to a further remittitur of [number] dollars ($[amount]) if a petition for review is not filed with the Supreme Court of Texas.
IT IS ORDERED that [name] shall be entitled to a further remittitur of [number] dollars ($[amount]) if there is no oral argument in the court of appeals.
IT IS ORDERED that [name] shall be entitled to a further remittitur of [number] dollars ($[amount]) if an appellate brief is not filed with the court of appeals.
IT IS ORDERED that [name] shall be entitled to a further remittitur of [number] dollars ($[amount]) if an appeal is not perfected to the court of appeals.
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Include the following if applicable. |
23.B.Ad Litem/Amicus for Child[ren]
The Court finds that [name of attorney or professional] has satisfactorily discharged all of [his/her] duties and obligations under chapter 107 of the Texas Family Code, and IT IS ORDERED that [he/she] is hereby discharged and relieved of any further rights, duties, and responsibilities in this case. IT IS FURTHER ORDERED that [name of attorney or professional] is awarded [number] dollars ($[amount]) as [legal/professional] fees for services rendered as [guardian ad litem/attorney ad litem/amicus attorney]. [Include if applicable: The Court finds that the fees are necessaries for the benefit of the child[ren].] These fees are taxed as costs, and [name], [Petitioner/Respondent], is ORDERED to pay the fees to [name of attorney or professional] by cash, cashier’s check, or money order on or before [date]. [Name of attorney or professional] may enforce this order for fees in [his/her] own name.
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And/Or |
23.C.Ad Litem for Absent Party
IT IS ORDERED that [name of attorney] is awarded [number] dollars ($[amount]) as attorney’s fees for legal services rendered for [name of absent party], who received process by substituted service but did not otherwise appear. These fees are taxed as costs, and [name], [Petitioner/Respondent], is ORDERED to pay the fees to [name of attorney] by cash, cashier’s check, or money order on or before [date]. [Name of attorney] may enforce this order for fees in [his/her] own name.
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Repeat for each additional attorney ad litem as needed. |
24.Costs
TCPRC § 31.007
Costs
24.A.One Party Due—No Judgment
All costs of court in this case are adjudged against [name], for which let execution issue.
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Or |
24.B.One Party Due—Judgment
IT IS ORDERED that [Petitioner/Respondent], [name], is awarded a judgment of [number] dollars ($[amount]) against [Respondent/Petitioner], [name], for costs of court incurred in this case, with interest at [percent] percent per year compounded annually from the date the judgment is signed until paid, for which let execution issue.
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Or |
24.C.Party Incurring
IT IS ORDERED that costs of court are to be borne by the party who incurred them.
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Or |
24.D.Half to Each Party
IT IS ORDERED that all costs of court expended in this case are taxed one-half against Petitioner, [name of petitioner], and one-half against Respondent, [name of respondent], for which let execution issue.
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Include the following if applicable. |
24.E.Frivolous Suit
§ 156.005
The Court finds that the suit to modify was filed frivolously or designed to harass [Respondent/Cross-Respondent] and orders attorney’s fees of [number] dollars ($[amount]) taxed as costs against [name].
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Include 25. if applicable. |
25.Merger of Settlement Agreement
Merger of [Mediated/Collaborative Law] Settlement Agreement
This order is stipulated to represent a merger of a [mediated/collaborative law] settlement agreement dated [date] between the parties. To the extent there exist any differences between the [mediated/collaborative law] settlement agreement and this order, this order shall control in all instances.
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Include 26. if applicable. |
26.[Discharge from] Discovery Retention Requirement
TRCP 191.4(d)
[Discharge from] Discovery Retention Requirement
IT IS ORDERED that the parties and their respective attorneys are discharged from the requirement of keeping and storing the documents produced in this case in accordance with rule 191.4(d) of the Texas Rules of Civil Procedure.
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Or |
IT IS ORDERED that any persons required to serve discovery materials shall maintain, for a period of [number] months after this order is signed, the originals or exact copies of all discovery materials produced during the pendency of this matter and not filed with the Court. If an appeal is begun within that [number]-month period, IT IS FURTHER ORDERED that the discovery materials shall be maintained while the appeal is pending.
27.Relief Not Granted
•Required in All Orders
Relief Not Granted
IT IS ORDERED that all relief requested in this case and not expressly granted is denied. All other terms of the prior orders not specifically modified in this order shall remain in full force and effect.
28.Date of Order
Date of Order
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Select one of the following. |
SIGNED on ___________________________________.
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Or |
This order judicially PRONOUNCED AND RENDERED in court at [city, county] County, Texas, on [date] and further noted on the court’s docket sheet on the same date, but signed on ______________________________.
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Continue with the following. |
JUDGE PRESIDING
29.Approvals
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Include the following in all orders unless there is a motion to sign order. |
APPROVED AS TO FORM ONLY:
[Name]
Attorney for Petitioner
State Bar No.:
[E-mail address]
[Address]
[Telephone]
[Fax]
[Name]
Attorney for Respondent
State Bar No.:
[E-mail address]
[Address]
[Telephone]
[Fax]
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Include the following if applicable. |
[Name]
[Guardian Ad Litem/Attorney Ad Litem/ Amicus Attorney]
State Bar No.: [if applicable]
[E-mail address]
[Address]
[Telephone]
[Fax]
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If the parties agree to all the terms of the order and do not intend to appeal, include the following. |
APPROVED AND CONSENTED TO AS TO BOTH FORM AND SUBSTANCE:
Petitioner
Respondent
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Complete information on suit affecting the family relationship (form 56-18), parent-child relationship information sheet (form 56-19), income withholding for support (form 9-3), and medical support notice (form 9-1). If the statement regarding health and dental insurance information described in Tex. Fam. Code §§ 154.181(b) and 154.1815(c) (form 56-2) is required and has not been filed, it should be filed before this order is presented. |