In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois (Petitioner) VS. } , states as follows; (Date) Case Number: (Defendant) AFFIDAVIT IN SUPPORT OF PETITION FOR RULE TO SHOW CAUSE (Name) 1. 2. 3. 4. 5. 6. An Order of Support was entered on . The Judgment provided for payment of child support in the amount of $ to be paid (insert weekly, biweekly, or monthly). As of this date the total of child support paid is $ As of this date the total of child support owed is $ . . The Judgment/Order provided that medical insurance and/or medical expenses were to be paid. As of this date, the amount demanded and unpaid is $ . has failed and refused to follow prior Judgment/Order of the Court (Name) in the following ways (use extra paper if necessary): . Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth above are true and correct, except to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true. Petitioner/Defendant American LegalNet, Inc. www.FormsWorkFlow.com