Transcript
Form 15-28B (Subrule 15-28(2)) COURT FILE NUMBER
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Clerk's Stamp
COURT OF QUEEN’S BENCH FOR SASKATCHEWAN (FAMILY LAW DIVISION) JUDICIAL CENTRE
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PETITIONER(S)/ CO-PETITIONER(S)
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RESPONDENT(S)
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AGREEMENT AS TO CHILD SUPPORT THE PARTIES AGREE AS FOLLOWS: 1 The income of the payor __________________________________________ is $ ________________. (name)
2 The payor currently resides in _________________________________________________________. (province or, if resident outside of Canada, country)
3 The income of the recipient ________________________________________ is $ ________________. (name)
4 The recipient currently resides in _______________________________________________________. (province or, if resident outside of Canada, country)
(Paragraphs 3 and 4 must be included if special or extraordinary expenses are to be shared or if the amount agreed to differs from the table amount set out in the Federal Child Support Guidelines.) 5 Child support is to be provided for (state names and dates of birth of children for whom child support is to be provided) Name of Child
Date of Birth
and according to the applicable child support table set out in the Federal Child Support Guidelines, the amount of child support payable for that number of children (the “child support table amount”) is $ _____________________________. 6 The payor will pay to the recipient, ______________________________________________________, (name)
child support of $ ______________________________ per month for the children referred to in section 5.
7 (If applicable) The amount of child support agreed on by this agreement differs from the child support table amount because: (state reasons) 8 (If there are expenses pursuant to section 7 of the Federal Child Support Guidelines to be shared) There are special or extraordinary expenses, being ___________________________________________ ___________________________________________________________________________________. (state type of expense)
on behalf of __________________________________________________________________________ (name child)
in the amount of $ _____________________________ per month, and the payor’s share of this expense is $ _________________________ per month.
DATED at _______________________________________, Saskatchewan, this ________________ day of __________________________, 2 ___________.
_______________________________________ (signature of petitioner’s lawyer)
DATED at _______________________________________, Saskatchewan, this ________________ day of __________________________, 2 ___________.
_______________________________________ (signature of respondent’s lawyer)
or
DATED at _______________________________________, Saskatchewan, this ________________ day of __________________________, 2 ___________.
_______________________________________ (witness)
_______________________________________ (signature of petitioner)
DATED at _______________________________________, Saskatchewan, this ________________ day of __________________________, 2 ___________.
_______________________________________ (witness)
_______________________________________ (signature of respondent)
