State of Alabama Unified Judicial System CS-4R Rev. 7/2019 Page 1 of 2 FINDINGS / RECOMMENDATIONS / ORDER OF SUPPORT Court Case Number IN THE COURT OF COUNTY, ALABAMA STATE OF ALABAMA, ex rel. Plaintiff v. Defendant Address Address FINDINGS: This case having been heard on the day of , , this Referee finds that the Court has jurisdiction over the parties and the subject matter. This Referee further finds that the Defendant was properly served with a summons and petition by: personal service; certified mail. The following persons were present: Plaintiff: Pro se Plaintiff222s Attorney Defendant: Pro se Defendant222s Attorney State222s Attorney Other This case being submitted upon the pleadings and upon the evidence presented or upon the agreement reached by the parties, the Referee finds that the Defendant is obligated to pay support for the minor child(ren) named as follows: . This Referee finds that health care coverage is unavailable, unavailable at reasonable cost, or is not accessible. (If applicable): The Defendant is also obligated to pay support for , spouse/former spouse. IT IS THEREFORE RECOMMENDED BY THE REFEREE AS FOLLOWS: 1.The Defendant shall pay the sum of $ per commencing on for the support and maintenance of the minor child(ren) named above. That the award of child support made herein was determined by application of the Child Support Guidelines established by Rule 32, Alabama Rules of Judicial Administration. The Child Support Guidelines (CS-42) and the Child Support Obligation Income Statement/Affidavit (CS-41) forms have been filed herein and are made a part of the record in this case. The Referee finds that deviation is appropriate based on the Child Support Guidelines established by Rule 32, Alabama Rules of Judicial Administration. The findings are noted in the Child Support Guidelines Notice of Compliance (CS-43). 2.The child support payments shall continue until discharged as provided by law. 3.The child support payments shall be made payable to: Alabama Child Support Payment Center at P.O. Box 244015, Montgomery, AL 36124-4015. 4. The Defendant OR the Plaintiff, wherever employed, shall include the child(ren) named above on any health care coveragepolicy at his or her place of employment and shall provide proof of the coverage within thirty (30) days of the date of theJudge222s signature on this form to the other party in non-Title IV-D cases OR to the County Department of Human Resources in Title IV-D cases. The Defendant OR the Plaintiff shall include the child(ren) named above on any health care coverage policy which he or sheshall purchase and shall provide proof of the coverage within thirty (30) days of the date of the Judge222s signature on this form tothe other party in non-Title IV-D cases OR to the County Department of Human Resources in Title IV-D cases. The Defendant shall pay % and the Plaintiff shall pay % of all unreimbursed health expenses. The parties must submit within 30 days any unreimbursed health expenses to the other party and payment of the expenses must be made within 30days of this submission. The Defendant shall pay the sum of $ per commencing on for the medical support of the minor child(ren) named above, as health care coverage is not accessible, not available, or is not available at a reasonable cost. Other arrangements regarding health care coverage: . COURT RECORD ATTORNEY DEFENDANT American LegalNet, Inc. www.FormsWorkFlow.com State of Alabama Unified Judicial System CS-4R Rev. 07/2019 Page 2 of 2 FINDINGS / RECOMMENDATIONS / ORDER OF SUPPORT Court Case Number 5.The Defendant shall notify County Department of Human Resources as to any change of address, change in health care coverage.6.The Defendant shall pay the following: $ representing retroactive child support to be paid at the rate of $ per commencing on . $ representing previous medical expenses to be paid at the rate of $ - per commencing on . These sums are hereby reduced to a judgment for which let execution issue. Interest will continue to accrue on this judgment until it has been satisfied in full as provided in Ala.Code 1975, Section 8-8-10. 7.(If applicable) The Defendant shall pay the sum of $ per commencing on for the support and maintenance of spouse/former spouse which support shall continue until further Order of the Court. 8.(If applicable) The spousal support payments shall be made payable to: Alabama Child Support Payment Center at P.O. Box 244015, Montgomery, AL 36124-4015. 9.Costs of these proceedings are taxed as follows: against Plaintiff, for which let execution issue; against Defendant, for which let execution issue; waived. 10.Reference is hereby made in this Findings / Recommendations / Order of Support to a separate income withholding order, theentry of which is required of this Court by law, and is recommended that it be specifically incorporated herein as a part of thisCourt222s Order in this case.11.In cases where payments are ordered paid directly to the Clerk of the Court, an additional $1.00 administrative fee shall be paidas provided in Ala.Code 1975, Section 12-19-26, with each periodic payment.12.Other: . NOTICE Pursuant to Ala.Code 1975, Section 12-15-106 and Section 12-15-330, as amended by Act 2019-163 , the findings and recommendations of the Referee do not constitute an order until they are ratified by the original signature of the Judge. Within fourteen (14)days of the Referee222s findings and recommendations being filed in the Clerk222s Office, any party may file with the Clerk a writtenrequest for a rehearing before the Judge. Recommended this the day of , . Signature of Referee The findings and recommendations of the Referee are hereby ratified and shall constitute a final order in this case. Date Signature of Judge COURT RECORD ATTORNEY DEFENDANT American LegalNet, Inc. www.FormsWorkFlow.com