State of Alabama Unified Judicial System CS-11 Rev. 7/2019 Page 1 of 2 MODIFICATION 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 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 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, 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 care coverage is unavailable, 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 day of , be modified as follows: 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 care coveragepolicy at his or her place of employment and shall provide proof of the coverage within thirty (30) days of the date of this orderto 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 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 bemade 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 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-11 Rev. 7/2019 Page 2 of 2 MODIFICATION ORDER OF SUPPORT 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 care coverage. 6.The Defendant is ordered to pay the sum of $ representing child support, spousal support, or medical support arrearages and $ in interest owed as of under the prior Court222s Order 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 judgmentuntil 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 isrequired of this Court by law, and which is specifically incorporated herein as a part of this Court222s 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 $1.00administrative fee as provided in Ala.Code 1975, Section 12-19-26, with each periodic payment.10.Any provisions of this Court222s 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 American LegalNet, Inc. www.FormsWorkFlow.com