(a) A final judgment of divorce shall be prepared so as to conform to the pleadings and the evidence and may restore a maiden or prior name, if requested. It shall be prepared in form substantially as follows:

FINAL JUDGMENT AND DECREE

Upon consideration of this case, upon evidence submitted as provided by law, it is the judgment of the court that a total divorce be granted, that is to say, a divorce a vinculo matrimonii, between the parties to the above stated case upon legal principles.

It is considered, ordered, and decreed by the court that the marriage contract heretofore entered into between the parties to this case, from and after this date, be and is set aside and dissolved as fully and effectually as if no such contract had ever been made or entered into.

Petitioner and Respondent in the future shall be held and considered as separate and distinct persons altogether unconnected by any nuptial union or civil contract whatsoever and both shall have the right to remarry.

Decree and order entered this ______ day of ______________, ____.

_____________________ Judge, Superior Court

(b) Where applicable, any one or more of the following clauses shall be included in the form of the judgment:

The court restores to (Petitioner/Respondent) his/her prior or maiden name, to wit: ____________________________________________.

The court awards custody of the children of the parties as follows: ________________________________________________________.

The court fixes alimony as follows: _____________________________.

(c) In any case which involves the determination of child support and only in such cases, the form of the judgment shall also include provisions substantially identical to the following:

In determining child support, the court finds as follows:

The gross income of the father is __________ dollars monthly.

The gross income of the mother is __________ dollars monthly.

In this case child support is being determined for ______ children.

The applicable percentage of gross income to be considered is:

Number_of Children Percentage_Range_of_Gross_Income 1 17 percent to 23 percent 2 23 percent to 28 percent 3 25 percent to 32 percent 4 29 percent to 35 percent 5 or more 31 percent to 37 percent

Thus, ____ percent of __________ (gross income of obligor) equals _______ dollars per month.

The court has considered the existence of special circumstances and has found the following special circumstances marked with an "X" to be present in this case:

_____ 1. Ages of the children.

_____ 2. A child's extraordinary medical costs or needs in addition to accident and sickness insurance, provided that all such costs or needs shall be considered if no insurance is available.

_____ 3. Educational costs.

_____ 4. Day-care costs.

_____ 5. Shared physical custody arrangements, including extended visitation.

_____ 6. A party's other support obligations to another household.

_____ 7. Income that should be imputed to a party because of suppression of income.

_____ 8. In-kind income for the self-employed, such as reimbursed meals or a company car.

_____ 9. Other support a party is providing or will be providing, such as payment of a mortgage.

_____ 10. A party's own extraordinary needs, such as medical expenses.

_____ 11. Extreme economic circumstances including but not limited to:

_____ (A) Unusually high debt structure; or

_____ (B) Unusually high income of either party or both parties, which shall be construed as individual gross income of over $75,000.00 per annum.

_____ 12. Historical spending in the family for children which varies significantly from the percentage table.

_____ 13. Considerations of the economic cost-of-living factors of the community of each party, as determined by the trier of fact.

_____ 14. In-kind contribution of either parent. _____ 15. The income of the custodial parent.

_____ 16. The cost of accident and sickness insurance coverage for dependent children included in the order.

_____ 17. Extraordinary travel expenses to exercise visitation or shared physical custody.

_____ 18. Any other factor which the trier of fact deems to be required by the ends of justice, as described below:_____.

Having found that no special circumstances exist, or special circumstances numbered ________ exist (delete the phrase which does not apply), the final award of child support which _______________________ shall pay to _______________________ for support of the child or children is __________ dollars per week/month other period (delete those which do not apply and insert as necessary) per child, beginning on the ______ day of ______________, ____, and payable thereafter on the ______ day of ______________ until the child becomes 18 years of age, dies, marries, or otherwise becomes emancipated, except that if the child becomes 18 years of age while enrolled in and attending secondary school on a full-time basis, then such support shall continue until the child completes secondary school, provided that such support shall not be required after the child attains 20 years of age. _______________________ is ordered to provide accident and sickness insurance for the child or children for so long as he or she is obligated by this order to provide support (insert name of party or delete this sentence if the order does not include provision for insurance).

(d) Where applicable, the court shall also include in the order the provisions of Code Section 19-6-30 concerning continuing garnishment for support and language in compliance with Code Section 19-6-32 concerning income deduction orders.