State of Alabama Unified Judicial System FINDINGS / RECOMMENDATIONS / ORDER OF SUPPORT CS-4R Rev. 3/2009 . Page 1 of 2 IN THE ____________ Court Case Number COURT OF_______________ COUNTY, ALABAMA STATE OF ALABAMA, ex rel. Plaintiff ________________________ Address ________________________ ________________________________________ v. Defendant _____________________ 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 Plaintiff’s Attorney _______________________ Defendant: Pro se Defendant’s Attorney _____________________ State’s 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 insurance is 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 insurance policy or health insurance coverage at his or her place of employment and shall provide proof of the coverage within thirty (30) days of the date of the Judge’s 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 insurance policy or health insurance coverage which he or she shall purchase and shall provide proof of the coverage within thirty (30) days of the date of the Judge’s 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 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 30 days 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 insurance is not accessible, not available, or is not available at a reasonable cost. Other arrangements regarding health insurance: ______________________________________________. COURT RECORD ATTORNEY DEFENDANT American LegalNet, Inc. www.FormsWorkflow.com State of Alabama Unified Judicial System FINDINGS / RECOMMENDATIONS / ORDER OF SUPPORT CS-4R Rev 3/2009 . Page 2 of 2 Court Case Number 5. The Defendant shall notify _______________ County Department of Human Resources as to any change of address, employment, or lapse or change in health insurance 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, the entry of which is required of this Court by law, and is recommended that it be specifically incorporated herein as a part of this Court’s 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 paid as provided in Ala.Code 1975, Section 12-19-26, with each periodic payment. 12. Other: ___________________________________. NOTICE Pursuant to Rule 2.1 of the Alabama Rules of Juvenile Procedure and Ala.Code 1975, Section 12-15-106, the findings and recommendations of the Referee do not constitute an order until they ar e ratifie d by the original signature of the Judge. Within fourteen (14) days of the Referee’s findings and recommendations being filed in t he Clerk’s Office, any party may file with the Clerk a written request 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 COURT RECORD Signature of Judge ATTORNEY DEFENDANT American LegalNet, Inc. www.FormsWorkflow.com