State of Alabama Unified Judicial System Court Case Number MODIFICATION ORDER OF SUPPORT CS-11 Rev. 3/2009 . Page 1 of 2 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 Court finds that it has jurisdiction over the parties and the subject matter. This Court 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, this Court finds that since the ___________Court of ___________County ordered the Defendant to pay the sum of $ _____________ per on the day of _________ , , for the support of the minor child(ren) named as follows: ________ , the needs of the minor child(ren) have increased and/or there has been a material change in circumstances in that _______________. This Court finds that health insurance is unavailable at reasonable cost or is not accessible. IT IS hereby ORDERED by the Court that the previous Order of Child Support rendered on the be modified as follows: day of , 1. The Defendant is ORDERED to 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 Court 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 this order 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 this order 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 is ordered to pay % and the Plaintiff is ordered to 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 is ordered to 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 Court Case Number MODIFICATION ORDER OF SUPPORT CS-11 Rev. 3/2009 . Page 2 of 2 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 is ordered to pay the sum of $ in interest owed as of arrearages and $ $ per commencing on representing child support, spousal support, or medical support under the prior Court’s Order to be paid at the rate of . 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. Costs of these proceedings are taxed as follows: against Plaintiff, for which let execution issue; against Defendant, for which let execution issue; waived. 8. Reference is hereby made in this Modification Order of Support to a separate income withholding order, the entry of which is required of this Court by law, and which is specifically incorporated herein as a part of this Court’s Order in this case. 9. In cases where support payments are ordered paid directly to the Clerk of the Court, there shall be paid an additional $1.00 administrative fee as provided in Ala.Code 1975, Section 12-19-26, with each periodic payment. 10. Any provisions of this Court’s previous Order of Support not modified by the Order remain in full force and effect. 11. Other: __________________________ . Ordered this the day of , . Signature of Judge COURT RECORD ATTORNEY DEFENDANT DHRFileNo2 CaseNum2 WkrID2 American LegalNet, Inc. www.FormsWorkflow.com