Forms you may encounter
➠ ➠ ➠ ➠ ➠
Common sections of legal forms The role of a notary Non-lawyer disclosure clause When to use an attorney Sample forms
The following chapter offers you samples of forms you will most likely encounter when you begin child support collection. Although forms vary widely from state to state, and additional forms specific to your state or area may be required, any form filed with the court generally has the same format. The samples in this chapter refer to the various steps involved in the child support collection process, and each one has a blank equivalent in the section titled, “Sample Forms in This Guide.”
Common sections of legal forms
H I N T
For a given legal action, there may be as many types of forms involved for that action as there are states or counties. Even forms produced by the federal government can differ—if only minutely—from city to state to region.
The forms used in collecting child support, for example, are generally state specific, so, depending on the county involved, there could be thousands of variations of the same form. In addition, every court may have its own preferred procedures for filling out and filing forms. However, this does not mean you cannot familiarize yourself with the types of forms you may need to use or you may receive while collecting the support due you. And there are a few sections found on many types of legal forms which, aside from minor format or wording differences, have pretty much the same attributes. We will now take a look at three of the most often found sections of legal forms.
The caption
The caption is found at the top of a legal form and contains basic information regarding a court case. Legal forms that will be filed in court or recorded need to have a caption at the top. Captions always: • identify the court by name and address • identify the parties by name and title (contact the clerk of your local court for the specific titles used when filing in your state) • contain a reference number called a case number
So ____ ate of ____meSt_____ __ County County, State
Some __________ Ci __uit _ Court for In the ____rc____
Jane Pu_________ __ blic In re: __________ Petitioner
vs.
Richard Publ ___ __ ________________ Respondent ic
) ) ) ) ) ) ) ) )
Case No: Division:
Given by Court Clerk
Notary clause
The notary clause is a sworn statement by the notary that he or she witnessed the signature(s) and that the person(s) signing the document is the person(s) he, she, or they claim to be. All persons required to sign a notarized document must swear to their identity and sign the document while in the presence of the notary, or the document is not notarized.
If the person signing the document is not personally known to the notary, ID may be necessary.
SomeState STATE OF ______________________ SomeCounty COUNTY OF_____________________ SomeDate 96 Sworn to (or affirmed) and subscribed before me on________________, 19______ Jane Public by___________________________.
Witness my hand and official seal. _________________________________ Signature of Notary
✔ Affiant: _____known _____Produced ID
Non-lawyer disclosure clause
Anyone who helps you in filling out a legal form—and who is not a lawyer—is now required to fill out this clause. Courts recently began requiring the completion of this section, insisting upon full disclosure of all persons involved in the filling out of a legal form, even if you ask someone to show you where to sign your name.
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM HE/SHE MUST FILL IN THE BLANKS BELOW [FILL IN ALL BLANKS]
Joe Friend I, (name of nonlawyer)_______________________________, a nonlawyer, located at 1300 SomeStreet SomeState 00001 Anytown (street)___________________ (city)____________(state)________________________, (123)456-7890 Jane Public (phone)_______________________, helped (name)_____________________________,
who is the (petitioner) (respondent), fill out this form.
Child support forms
The rest of this chapter will take you through the various forms you are likely to see and use in the child support collection process: • Uniform Support Petition • Order Requiring Payment Through Central Depository • Motion for Health Insurance Coverage • Non-Military Affidavit • Financial Affidavit (Short Form) • Summons • Process Service Memorandum • Motion for Garnishment After Judgment • Final Judgment Modifying Child Support
Please keep in mind that many forms for child support must be supplied by the state and the courts, and may require more than is stated here. Contact the appropriate child support enforcement agency for forms and procedures specific to your state (Resources and Appendix I contain addresses and phone numbers for state offices; Appendix II contains regional offices).
Uniform Support Petition
This basic form outlines exactly what the custodial parent is seeking from the court. The petitioner is the one who is asking for the support and, by using a series of checkmarks, can answer the court’s questions. This form often begins the legal process of obtaining child support, medical coverage, back support (arrearage), payment of court costs and attorney fees, and establishing paternity. It is signed by the custodial parent whose signature must be notarized.
Circuit SomeCounty SomeState In the ___________ Court for ____________ County, State of _____________
Jane Public In re: _____________________ Petitioner
vs. _____________________ Respondent
Richard Public
) ) ) ) ) ) ) ) )
Case No:
Names Given by Carl Court Clerk Public _____________________________ _____________________________ _____________________________ _____________________________
Date of Birth ______________ 00/00/00 ______________ ______________ ______________
Division:
3. Petitioner and the respondent were [check one only]:
UNIFORM SUPPORT PETITION
Jane Public 1. This petition of petitioner, ________________________ (name), respectfully shows
_______ Never married to each other _______ Married on this ______ (day) of _______________ (month), 19_______.
the court that this petition is for [check all that apply]:
_______ Divorce is pending (date filed __________) in ______________ County, ___________ (State).
_____ Support ✔
✔ _____ Medical coverage ______ Arrearage
✔ SomeDay 96 _______ Divorced on _____________ (day) of ________________ (month), 19_______ in SomeMonth SomeState SomeCounty County, ___________ (State). __________
_____ Reimbursement _____ Establishment of paternity ✔ _____ A Paternity Affidavit is attached for reference _____ The General Testimony for URESA is attached for reference
4. Respondent resides at:
2200 SomeStreet _____________________________________________________________ Othertown, SomeState 00005 _____________________________________________________________
2. Petitioner, _______________ (name), resides at ______________________________ Jane Public 1300 Somewhere St.,Anytown
6. Since custody of the following respondent has not provided support for __________________ (address) and hasthe date of _________________ dependents of the respondent: the SomeState 00001 named dependents. 7. a. ____ The respondent is not under a court order to pay child support.
SomeDate
Respondent’s last known employer and address of employer is
1900 SomeStreet _____________________________________________________________
Anytown, SomeState 00002 b. ____ The respondent is under a court order to pay _____________________________________________________________. support (see attached order).
✔ 5. The the depenc. ____ The respondent should pay the amount of ongoing support fordependents are entitled to support and/or medical coverage from the respondent.
Respondent has a legal obligation to pay support pursuant to the laws of the initiating state, dents in an amount as permitted by the law of the responding state. which is enforceable under the following reciprocal support status reference:
Wherefore, the petitioner requests an order for the following: [check all Code ___________________. State that apply]
✔ ____ Child support in the amount prescribed by law.
____ Registration and enforcement of the attached current support order. ____ Medical coverage. ____ Arrearage as prescribed by law from the date of ______________. ____ Payment of costs and attorney’s fees by the respondent. Under penalties of perjury, all information and facts stated in this petition are true to the best of my knowledge and belief.
✔ ✔
By:
________________________ (signed) ________________________ (printed)
Jane Public
STATE OF ______________________ COUNTY OF_____________________
SomeCounty
SomeState
Sworn to (or affirmed) and subscribed before me on________________, 19______ by___________________________. Witness my hand and official seal.
Jane Public
SomeDate
96
_________________________________ Signature of Notary Affiant: _____known _____Produced ID Type of ID ___________________________
✔
Order Requiring Payment Through Central Depository
This form provides the custodial parent (obligee) with the option of having all child support payments paid directly to the court, which then transfers payment to the custodial parent. In some states the payments must be made to the child support enforcement agency or the state attorney general’s office. This arrangement guarantees that an accurate and official record of payments and amounts is kept. Such a record can be useful if the non-custodial parent (obligor) is reluctant to pay, pays erratically, disputes the amount, does not pay on time, or owes back support (arrearage). Circuit SomeCounty SomeState In the ___________ Court for ____________ County, State of _____________
) ) ) ) ) ) ) ) )
Jane Public In re: _____________________ Petitioner
Case No:
Given by Court Clerk
vs. _____________________ Richard Public Respondent
Division:
ORDER REQUIRING PAYMENT THROUGH CENTRAL DEPOSITORY [check all which apply and fill in all blanks that apply]
be made the way this order says they will be paid and in the amount this order says will be
IT IS ORDERED AND ADJUDGED
unless and until this court orders something else.
that all payments of child support shall be as follows: _______ Obligor will make the payments ordered - Fill out A & B below, NOT C.
Payments shall _______ Payment will be by income deduction order and6. payor is not the obligor ✔
be sent to:
CLERK OF COURT, CENTRAL DEPOSITORY
1000 Legal Avenue Address_____________________________
____________________________________ Anytown, SomeState 00002 City State Zip
(123) 444-5555 Telephone No. ______________________ (123) 444-6666 Telefax No. ______________________
7.
Payment shall be made by cash, check, or money order. For identification and account-
ing purposes, you must write the court case number on each payment made by check or money order and be attached on a separate sheet of paper with any case payment. If payment is made by check, the clerk may require the payor to fill out a form.
Circuit SomeCounty SomeState In the ___________ Court for ____________ County, State of _____________
Respondent application, I gave written notice of my intent to seek this order to ____________________ by
✔ [check one only]____certified mail ____personal service.
Jane Public In re: _____________________ Petitioner
vs.
Richard Public _____________________ Respondent
) ) ) ) ) ) ) )
____ b.
The requirement of written notice has been waived by the other party.
Case No:
Given By Court Clerk
3.
I ask the court to order the employer, or other person providing health insurance cover-
age to enroll or maintain the child(ren) on any health insurance coverage available to father/mother. I CERTIFY THAT THE MOTION FOR HEALTH INSURANCE COVERAGE WAS: ✔ ( check one only) ____ mailed, ____telefaxed and mailed, or ____ hand delivered to the per96 SomeDate son(s) listed below on ____________________,19_____.
Division:
MOTION FOR HEALTH INSURANCE COVERAGE 1.
SomeDate 96 On ______________________19___, this court ordered the child(ren)’s
Party or their attorney (if represented) Name________________________ SomePerson
Other Name________________________ Address______________________ ____________________________ City State Zip Telephone No._______________ Telefax No.________________
✔ [check one only] _____ father or _____ mother to provide health insurance coverage for the following child(ren): Name Carl Public ___________________ ___________________ ___________________ ___________________ ___________________ Date Of Birth __________________ 00/00/00 __________________ __________________ __________________ __________________ Age _______ 6 _______ _______ _______ _______ Soc. Sec. No. 454-45-5454 _____________ _____________ _____________ _____________ _____________
1111 SomeStreet Address______________________ Othertown, SomeState 00005 ____________________________ City State Zip (321) 098-7654 Telephone No._________________
Telefax No.___________________ (000) 123-4567
SomeDate DATED:_____________________________
______________________________________ Signature of party signing certificate and pleading
Jane Public Printed name___________________________ 1300 Somewhere Street Address________________________________
2.
Notice to [check one only] [check one only] ✔ ____
____ Petitioner or
____ Respondent: ✔
Anytown, SomeState 00001 _______________________________________ City State Zip (123)456-7890 _______________________________________ Telephone (area code and number) (123)456-7891 _______________________________________ Telefax (area code and number)
SomeDate a.On ________________________, which is at least 15 days before filing this
Motion for Health Insurance Coverage
Once the court has ordered the non-custodial parent to provide health insurance coverage for the child(ren), this form asks the court to order the employer or other insurance provider (through an order for health insurance coverage) to enroll or maintain the child(ren) in any program available to the non-custodial parent.
SomeState STATE OF ______________________ SomeCounty COUNTY OF_____________________ 96 SomeDate Sworn to (or affirmed) and subscribed before me on________________, 19______ Jane Public by___________________________.
Witness my hand and official seal. _________________________________ Signature of Notary ✔ Affiant: _____known _____Produced ID ✔ Type of ID SomeState Driver’s License ___________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM HE/SHE MUST FILL IN THE BLANKS BELOW [FILL IN ALL BLANKS] I, (name of nonlawyer)_______________________________, a nonlawyer, located at Joe Friend (street)___________________ (city)____________(state)________________________, 1300 SomeStreet Anytown SomeState, 00001 (phone)__________________, helped (name)_____________________________, Jane Public (123)456-7890 who is the (petitioner) (respondent), fill out this form.
Non-Military Affidavit
If either parent is in the military, professional advice should be sought. The rules and regulations allowing military personnel to participate in civil actions vary widely from state to state. Use this form when you know that neither parent is on active military service.
Circuit SomeCounty SomeState In the ___________ Court for ____________ County, State of _____________ By: ___
____________ ___
____________
____________ ) _ (printed) ) Jane Public In re: _____________________ ST ) Case No: ATE OF ______ Petitioner ) ____________ Given by ____ Court Clerk ) COUNTY OF___ vs. ) __________________ Division: ) Richard Public _____________________ ) Respondent Sworn to (or affirmed) and ) by__________ ____________ Witness my han
____________
_ (signed)
subscribed bef ore me on____ ____________ , 19______ _____.
NON-MILITARYd and official seal. AFFIDAVIT STATE OF ___________________ ) SomeState SS # of Respondent:
SomeCounty COUNTY OF _________________ )
____________ ___ Signature of No __________________ tary Affiant: _____k now Type of ID ___ n _____Produce d ID
BEFORE ME, the undersigned authority, personally appeared ____________________,__________________ Jane Public who upon oath, deposes and says: 1. I am the Petitioner (or Attorney of record for the Petitioner, if represented) in the above-styled cause. 2. Based upon information, I state that the Respondent,_________________, is not at Richard Public the present time in the military services of the United States or any of its allies.
______
FURTHER AFFIANT SAYETH NOT.
Circuit SomeState In the ___________ Court for SomeCounty County, State of _____________ ____________ PAY PERIOD: ___________________________________________________
RATE OF PAY: __________________________________________________ LESS MONTHL ) Y DEDUCTION S ) If you are employed but expecting soon to become unemployed or change jobs, describe the Federal, ASSEal om Jane Public In re: _____________________ state and locTSinc) e taxCase No: (OW es change you expect and why and how it willNERSH(corrected for currently unemployed, affect your income.Given by If filing Petitionerstatus and actu IP: IF M UNDERnum)ber ARITA al PE L Clerk Court PU ) of withho T how soon lding alloto be, employed, and describe yourFICA orto find employment, ITIONER, you expect wances) T ONE-H the pay efforts AND O self©employme ) ALF O ___________ NAME nt vs. Division: F THE tax THE IT (annualized) NE-HALF TOTAL UNDER you expect to receive. ) EM IS IN.) VALUE Mandatory uni RESPO ___________ on dues NDENT Richard Public _____________________ ) NO MA _________________________________________________________________ TTER W Mandatory D Respondent retirement ) ___________ ESCRIP HOSE TION _________________________________________________________________ Health insuran ___________ Ccehpayments VALUE as on hand Business income from sources such as self-employment, partnerships,PETITION close corporations, Court ordereCasAFFIDAVIT (SHORT FORM) FINANCIAL E ___ ___R _____ d support payme _____ h in bank RESP s nts for ______ and/or independent contracts (gross receipts minus ordinary and necessary expenses required to ONDENT the children Stoc ____ actuks/b paid _____ ally on ______ ds ______ ____ produce income.) TOTAL ____ ___ STATE OF __________________ NotCTION SomeState DEDU es ___ _____ _____ S ______ ______ ____ TOTAL NE ____ ___ COUNTY OF________________Real esOME $__ _____ SomeCounty T INC ta _____ te: ______ ______ ____ Disability benefits ___________ ____ $__________ Homes: ______ ____ Workers’AVERAG compensation ___________ E________ ____________________,who being duly sworn, MONTHL BEFORE ME, this day personally appearedY EXPEN Public Jane ___ SES Unemployment compensation ___________ HO __ D: _____ deposes and says that theUSEHOL__information is true and correct according to his/her best following ______ _ ______ Pension,Mtg or ren or annuity payments retirement ___________ ____ _____ t paymeut knowledge and belief. Ants ob ______ om ile ______ ____ s: Social Security benefits ___________ ____ ___ Property ____ taxes____ ________ ___ ______ ____ SpousalInsurancereceived from previous marriage support __ ___________ _____ __ ___________ EMPLOYMENT AND INCOME_______ ______ InterestElectricityth and dividends ___________ ____ O er pe _____ ___________ rsonal pr ______ AnyJob op OCCUPATION: __________________________________________________ ______ ____ er ordinary any ____ Rental Waste, gar incomeCon receipts minus ty: (gross ___________ bagnts of er te e & sew ______ home AnyCompany EMPLOYED BY: _________________________________________________ ____ necessaryephone required to produce income) ___________ Tel expensesry Jewel _____ ___________ 4200 AnyStreet, Anytown, SomeState 00003 ADDRESS: ______________________________________________________ ______ ____ Income fromLife ___________ Fuel royalties, trusts or estates _____ ___________ Ins./ ca ______ sh 232-32-2323 ______ SOC. SEC. ______________________________________________________ ____ ____ Reimbursedsurren expenses Barber/beautde and in kind payments to the ________ __ y parlor ___ r value ______ AnyDate DATE OF BIRTH: ________________________________________________ __ extent that Otherreduce personal living expenses they/toi ___________ Cosmetics as _____ ___________ letrts: se ies ______ ____ Gains derived from dealing in property (not Holida__gifts y ______ ___________ ___ ______ ____ including ______ ___________ Other non-recurring gains) _____ expenses:__ ___________ __ _ ______ ____ TOTAL MONT ___________ HLY PAYMENT _____ ______ S TO CREDITO ________ ____ RS __ TO MO TOTALTAL NT $_______ __ ASSET EXPEN HLYS _____ SES ______ $____ $ $_____ ____ $_____ ____
©E
Financial Affidavit
This is an example of the kind of detailed information your state will require both parents to provide. Since every state has its own guidelines for determining the amount of child support, a financial affidavit listing current assets and liabilities allows the court to determine a reasonable amount of support.
Summons
This form is the document served upon the non-custodial parent, commanding him or her to appear in court. The manner in which it may be served varies from state to state, but typically it may be served in person, by certified mail, first-class return receipt requested, or by publication in a newspaper of general circulation. Service by publication is usually used when an ex-spouse can’t be located.
If you ch oose to file a w response ritten re to the co sponse urt you yourself must al , at the named so mail same tim below. or take e you fil In the ___________ Court for ____________ County, State of _____________ py Circuit SomeCounty SomeState co a e your w of your ritten written response to the pe rson WARN ) ING: T he State party in of ____ this law ) suit acce Case No: ____________ Jane Public In re: _____________________ ) ss to or ___ requ can resu copies of ires that lt in the Petitioner ) Given certain by you prov court ta docum ide to th striking ) king action Court Clerk ents an e other d inform against of pleadi you, incl ation. Fa ngs )(thr Division: vs. uding di owing ou ilure to smissal do this t part of ) (throwin your ca g out yo se). Richard Public _____________________ ) ur case) or ____ Respondent __ ) __ Petitione __________ ______ r ______ ______ ______ ______ ____ Mailing____________ ______ Address SUMMONS: PERSONAL SERVICE ON AN INDIVIDUAL ______ ______ ______ ______ ______ ____ City/Sta __ te/Zip C __________ ______ ode Richard Public TO:______________________________________________________________ ______ ______ ____ 2200 SomeStreet, Othertown, SomeState 00005 _________________________________________________________________ THE ST ATE OF ______ ______ TO EA _ CH SH ERIFF IMPORTANT OF THE of the co STATE mplaint : You ar e co after this A lawsuit has been filed against in this Yousuit 20 calendar daysmmande summons is you. law have d to serv on the ab e this ove nam ed with served on you to file a written response to the attached complaint/petitiondefendthe clerk of thissummons and DATED ant. a copy : ______ ______ __ Your written response, including the case numcircuit court. A phone call will not protect you. ______ _____ ______ ber given above and As Cle ________parties, must be filed if you want the court to hear your side the names of the __ __ rk of th e Court __________ of the case. If youBy:____file your written response ____ do not on time, you may lose the case, and your __ Deputy ____________ Clerk wages, money, and property may thereafter____taken without further warning from the court. be ____ ___
There are other legal requirements. You may want to call an attorney right away. If you do not know an attorney, you may call an attorney referral service or a legal aid office (listed in the phone book).
© Lega l Forms Forms and the 1996. Before you retailer make no use this form, rea represen tation or d it and fill in the warranty blanks. , expres Co s or imp nsult a lawyer lied, wit if h respe you doubt the ct to th for
’
PROCESS SERVICE MEMORANDUM
TO:
SomeCounty SomeState Sheriff of ___________________ County, State of ______________, SomeDivision ______________ Division:
Process Service Memorandum
Since it is often impossible to serve the summons and petition personally, a process server may be called upon to deliver the document. Typically the county sheriff performs this task. This form provides the particulars for delivering the summons. The summons and the petition may be mailed to the sheriff’s office in the county where your ex-spouse resides.
RE:
Jane Public __________________________________________, Petitioner
and __________________________________________, Respondent Richard Public
SomeCounty ____________________Circuit Court, County of _______________________ SomeCourt
Case No. _______________________________ Given By Court Clerk Please serve the Summons and Petition herein, in the above-styled cause upon: Respondent: _____________________________ Richard Public
2200 SomeStreet Home Address: ___________________________________________________ Othertown, SomeState 00005 _________________________________________________________________
Work Address: _____________________________________________________ 1900 SomeStreet
Anytown, SomeState 00002 _________________________________________________________________
Thank you.
SPECIAL INSTRUCTIONS: ____________________________________ Signature of party ____________________________________ Jane Public Printed name 1300 Somewhere St.,Anytown ____________________________________ Address SomeState 00001 ____________________________________ City State Zip ____________________________________ (123)456-7890 Telephone (area code and number) (123)456-7891 ____________________________________ Fax (area code and number)
g to cordin er ac answ ove to ed ab Circuithee nam SomeCounty SomeState In the ___________ Court for ____________ County, State of _____________ arnis the G ding mman ent, co hm ) arnis t of G ed. ) a Wri provid issue Jane Public In re: _____________________ ) Case No: cased such ed) Given By w in Petitioner ) (sign the la ___ Court Clerk ) ___ ted) ____ ___ vs. ___ (prin ) Division: ____ ___ _ _ _c __ ) ____ ubli P____ By: __ _ Richard Public J _ne _ _____________________ ) ___a ____ Respondent )
Motion for Garnishment After Judgment
With this form, the custodial parent asks the court to attach money that is not in the physical possession of the non-custodial parent. Money may be in bank or trust accounts, or it may be coming from judgments or insurance payoffs. (This form is not used for wage attachments.) If support payments are in arrears, first the court will determine the exact amount owed and a judgment will be entered for that amount. Upon determining that the money is not in the possession of the non-custodial parent, the court, using a writ of garnishment, will order the person or institution holding the money to pay it to the custodial parent.
MOTION FOR GARNISHMENT AFTER JUDGMENT
Jane Public Petitioner, ___________________________, by and through the undersigned states that: Richard Public 1. Judgment has been entered herein against the Respondent, _____________________, 4,200 96 SomeDate in the amount of $_________________ plus interest from _____________________, 19____ 12 (date debt came due) at the rate of _____ percent per annum. To date, Respondent has not sat-
isfied any portion of the judgment.
2. Movant does not believe that said Respondent has in his possession visible property on which a levy can be made sufficient to satisfy the judgments herein.
AnyBank 3. Petitioner suggests that _________________________________________________ 3000 SomeStreet, Anytown, SomeState 00001 ____________________________________________________________________________
(name and address of Garnishee) is indebted to, or has tangible or intangible property of the Respondent in its hands, possession or control, and moves that the Clerk of the above Court
K115-8A
8B K115-
Final Judgment Modifying Child Support
Child support payments may be modified to reflect changes in child support guidelines or changes in the circumstances of the parent(s). This form is used by the court when it decides to grant or deny a request for an increase or decrease in child support. If the court exceeds or fails to meet the guidelines, it must justify its decision with facts. Therefore, it is necessary to answer all questions truthfully and provide the court with full explanations. This form is completed by the court and signed by the judge.
________ ________
________
________ ________ ________ ________ ________ __ ________ [check all that apply] ________ g. _____Medi ________ cal insurance [ch Therefore, _. eck one upon co Circuit c. Court for ____________ County, Stateonly] ___is or ____is not SomeCountynsid SomeState the ____ IIn the [check one only] ____ has or of _____________ 5. There ___________ Child support ____ has not been a substantial change in the circum- sonably ava er the rea should be set byation of th ilable to child support guidelines e above fin ORDERE D dings, itof ____________ the entry of the AN order governing is he eck stances of the parties since ______. only] ___ D ADJUDGED child support, specifically:reby last A. [che Peone Th that: tition/Requ __ petitioner or _____ resp ) est to Mod ondent for the one d. The calcu ____ only] _____ pet child(ren) _____________________________________________________________________________ and ify Child itioner or _______ lations and conclusion included ppor child [ch Su in the ) GRANTE _____ respondent should is [chesupport guidelines worksheet eck t be ck on require to pro D ) __ Case No: or Jane Family Law Form Public In re: __________________________________________________________________d e onlyvide it. _____________________ 12.901(g)) filed in this case _ DE ____by ] [check one only] ____ petiti NIED. Given by oner or ____ Petitioner ) respondent h. _____D are adoptedental insu __________________________________________________________________ by this court )and B. CHILD eck one only] Court SUPPOR rance [chincorporated in this order.Clerk T the [check one vs. ) Division: ___is or ____is only] ___ __________________________________________________________________ not reasonably ava ilable to 1. ______ __ petitioner or _____ ) respondent for Ch the [ch RT one THE COUeck MUST MAK ild support the chi only] _____ pet IFIC, WRIT__ __________________________________________________________________. ld(ren) and E SPEC ) ner of $_ TEN petitio Richard Public ner _____________________ or __ itio ____ FINDINGS or _____ resp_____ to WHY AWARDIN ___ re ondent should id G THE be pa beby AMORespondent D SUPPspondent [che ) UNT OF CHIL required to pro the [c _____twi ck one on ORT REQUIRED BY THE vide ce a ly] ____ UTES OF ____ heck one onit. ] __ STAT ly __weekly ___________, ___ 8. THE COUR month ____ WOU only] ____ isTST OR is not __monbest __ that the 6. It [check one LD BE UNJUor ____INAPPROPRIAT interest of the minor child(ren)___biwee in MUST MAKE the thly.E kly SPECIFIC,IF THE AMOUNT AWARDE WRITTEN FIN D IS WH THE GUID FROM Y ATTORNELIN DINGS OF FAC DIFFERENT current child support order beEYS’ES AMOUNT BY PLUS changed S AR T EXPLAINING FEE This su E BEING GRAN SUPPORT OR MINUS FIVE PERC FINAL JUDGMENTt MODIFYING CHILD TED ENT (5%). AND THE AMOUNT ppor shall contin ue un blanks because:__________________________________________________________ INING THE BASIS AWAR [check, all which apply and fill in all til the that apply] EXPLA of 18 or OF first of th if the ch DED. ild(ren) ar e parties’ 1. ____ e. The [chsupport m e Child _________________________________________________________________ inor children forming in eck one should___ between ththe only] not_be set by e ages reaches th husband’s orchild support guide good of e age ____ 18 19______ upon wife’s req andt ar 19 THIS CAUSE wasis DENIE ____________________________, and96 ueslines ofthe heard on faith _________________. The with SomeDate a reasonab e fees and _________________________________________________________________ for still in high ts D. the age of basis for ordering expecta le [check one 19. At th tion only]_____ more or ____ cosschool of gr the _____ [chamount of Petition ch Modification of Child aduation, Having _____ Petitioner’s2. SuTheRespondent’s at time thefor ild Support. ✔ _________________________________________________________________. until the _ less than perguidelines eck one onl child support pursupportowi su ant t pport Gu the Statutes ideline y] ____husband’s or____wifbe reco of ____________ child(ren) reache ll mpu and financial s ____ of the parties, D. s. reviewed GRANTEhaving heard the testimony ________________________ the court file in e’s request for feedeand e ___ is: this actionted un s r th costs th is ____________________ __________________ en-current Child [ch____all that eck and being ____ affidavits Child ____ parties apply] ________________ 7. of theSupport ________ otherwise fully advised, it is ORDERED AND ADJUDGED 2. ______ ____________________ __________ The [check _____ that: sum of that apply] [fill in ________Attorneys’__________ suitone ____] __ all blanks ________ fees, ___ ________ only ____ $_______ __ ____________ ____ money, and/or petitione _____ cosor be __ __________ r ts __ _____ petitio____ per ____________net income_______ for __ awardedonde resp for past du ________________ _____matter a. jurisdiction of or parties______________________. OR is: and the subject ch 1. The Court has Petitioner’se ner the_____ respondent ____________of this proceeding. to: [chshallone onl nt eck pa ildren, fo____________ y] child supp . ____ r y the ______ past due ort shall ________ ____ suppor home ____ the ____________ __ there is significant ch upon the t. is: for __ __ SomeState Petitioner’s in state net income last______________________, based ild supporfol2. ____________ is thet____imputedof ____minor child(ren) or________ and teres ____ ______ ________ connection This pa yment __________ t are paid ______ m The basis for gra . Interest ____________________ onths/yea at accordingly nting this awa ________ st lowing: andthe rate on pa du with this State ___________________________________________________________ rs, until all pa it jurisdiction to determine echild custody, visitation, and rd ____ child of ____has ________ and for the det____________________ st due __ ermination pport su of thesh ____ ____________ ___________________ ___% per annum amount is: __ all be ___ ______ until pa 3. support_________________________________________________________________. added to obligor’s under the Uniform Child________________________________________ Custody _______________ _____ Un Jurisdiction Act. id. ___ ________ ___ ______ debt usual or _________Due ______________ ed by:Past _________Support/Arrearages. d Child _________ uninsure [check on ✔ m Theedical/d 3.Respondent [check one only]e____ was or ____ _________[checkental only] ____ petiti ___ a only] ____ ___ was not duly ___one ___process of law and ____ ___ served by pens ___ ex ____________ respondent has a total income is: petitione _ _____________________. OR____________ or es for theoner _________ suppo de ea b. ntRespondent’s net child______rt arrea r or __ ___ child _________ of ___ ________ default ____ was or ch paywas notlfproperly entered.rage ___$___responde ____, this is based ren be provid✔ ___ ____ one-ha ____________ or nt ____________ mentRespondent’s imputed net income is: _________________, ____________ following s missed on the following _____ the___ upon pay____________ in the follow based uponpetitione dates ing amounts: SomeDate 96 4. The last order governing child support was_____________________ entered on _________________, 19 ______. r and respon_________ _______ ____________________ _______________________________________ ______________ ________ ________ ________
________
________
A copy of that order is attached.