Court Case Number: _____________________
Instructions: Place an “X” on the appropriate line to notate which paragraph(s) are being used.
__________________________ shall pay $______________ per ________________ toward the
support of the minor child(ren) of the parties until the youngest child reaches the age of 18; or until
the youngest child reaches the age of 19; if the child is pursuing a high school education or its
equivalent; or until further order of the court commencing on
__________________________ shall provide copies of tax returns and supporting documentation,
including copies of all W-2's and 1099's, no later than April 16th of each year following judgment, to
the Wood County Child Support Agency
A party who fails to furnish the information as required by the court may be proceeded against for
contempt of court under Chapter 785, Wis. Stats. If the court finds that a party has failed to furnish
the information, the court may award to the party bringing the action costs and reasonable attorney
fees. Failure by a party to timely furnish the financial information shall authorize the court to accept
as accurate any information provided in the statement of the other party or obtained under s.
49.22(2m), Wis. Stats., by the department or the child support agency under s. 59.53(5), Wis. Stats.
__________________________ shall furnish evidence of seeking work by maintaining a list of 10
jobs per week if unemployed or underemployed for which he/she has applied. He/she shall submit
the list to the Wood County Child Support Agency on a monthly basis. Upon obtaining
employment, he/she shall notify the Wood County Support Agency immediately.
Both parents shall name and maintain the child(ren) as a covered dependent on any health care
insurance that is available at a reasonable cost. Both parents shall provide the child(ren)'s custodian
and the child support agency with copies of policy information and insurance cards. Both parents
shall assign any benefits to providers of health care who render service to the child(ren). Such
coverage shall continue until the parental duty to support is terminated. Both parents shall inform the
child support agency about any change in his/her employment and the availability of insurance.
The mother and father shall divide equally any uninsured medical and dental expenses.
___________________________ shall pay any outstanding debts, arrears, and/or costs found by the
court at the rate of $________________ per _________________, commencing on