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,6. This Court reserves jurisdiction for the purpose of determiaing the amount due
frc~m the Respondent to the Petitioner, if any, as reimbursement for past AFI?C payme~ts
c~eceived by or on behalf of the the child(ren) s?amed herein.
7, Additionally, it is further ordered that Respondent/Payor shall promptly notify
the Department of Health and Rehabilitative Services of alI changes in his/her mailing
address, and all changes in the name and address of his/her employer within seven (7)
days of such change. .
- RESPONDENT OWES AN AFDC REIMBURSF~lENT IN THE AMOUNT OF $ AS OF
AND WILL PAY $ PER CANaIENCING •
~ 8, (Applies only if bax is checked)
The Court finds that the Obligor has access at a reasonable rate to group health
insurance. It is thereupon ordered and adjudged that said Obligor shall, in addition to
all other terms of this Order, provide health insurance for the child(ren) set forth
herein for so long as the child(ren) are dependent under Florida Law. Z~e Obligor shall
file proof of said health insurance coverage in this file and send a dopy to all parties
within fifteen (15) days of the date of this Order.
9. That the Respondent is additionally ordered to pay total costs and attorney
fees in the amount of $ , made payable to: Department of Health and Rehabilitative
Services, 1102 South U.S. ~1 Ft. Pierce, FL 34950, within ~^days from the date
af this Order.
IX?NE AND ORDERED at Fort Pierce, St. Lucie County, Florida~ on this
day of ~ ,19~C.2
(
W~~~~~M Trr'
G~~~ CIRCUIT JUDGE
Copies furnished to:
Al1 parties hereto.
Copy delivered to Obligor in open court on date of this Order
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