ARIZONA SUPERIOR COURT, COUNTY OF (1) (2) Petitioner/Plaintiff (4) Case No. ATLAS No. DOB (3) Respondent/Defendant CHILD SUPPORT ORDER DOB THE COURT FINDS THAT: 1. (5) owe a duty to support the following children: (7) Name Mother and (6) Date of Birth Father 2. The required financial factors and any discretionary adjustments pursuant to the Arizona Child Support Guidelines are as set forth in the Parent's Worksheet for Child Support Amount, attached and incorporated by reference. 3. [ ] Mother [ ] Father a. b. Is obligated to pay support to In the amount of $ Per Month THE COURT FURTHER FINDS THAT: Deviation (only in applicable cases) Application of the Arizona Child Support Guidelines in this case is inappropriate or unjust. The Court has considered the best interests of the child(ren) in determining that a deviation is appropriate. The child support amount before deviation is: The child support amount after deviation is: $ $ 1 childsupport-child support order. form Revised 10.01.10 American LegalNet, Inc. www.FormsWorkFlow.com [ ] The Court finds the guidelines amount is inappropriate or unjust because: [ ] Attached written agreement incorporated [ ] Other: Arrears Child support arrears exist: a. In the amount of b. For the period of $ , , Past Care and Support A judgment for past care and support should be entered: a. In the amount of b. For the period of $ , , IT IS ORDERED THAT: 1. [ ] Mother [ ] Father shall pay child support: a. In the amount of b. To c. First payment is due on the 1st day of , , $ Per Month to to d. Presumptive termination date 2. [ ] Mother [ ] Father owes child support arrears: a. In the amount of b. For the period of $ , , c. Judgment is ordered in favor of And against In the principal amount of [ ] Mother [ ] Father shall pay $ $ the child support arrears amount until paid in full. Per Month toward to 3. [ ] Mother [ ] Father owes past care and support: a. In the amount of b. For the period of $ , , to 2 childsupport-child support order. form Revised 10.01.10 American LegalNet, Inc. www.FormsWorkFlow.com c. Judgment is ordered in favor of And against In the principal amount of [ ] Mother [ ] Father shall pay $ $ , Per Month toward the past care and support amount until paid in full. 4. All payments shall be made through the Support Payment Clearinghouse pursuant to an Order of Assignment signed this date. Any time the full amount of support ordered is not withheld, the obligor (person ordered to pay support) remains responsible for the full monthly amount ordered. Payments not made directly through the Support Payment Clearinghouse shall be considered gifts unless otherwise ordered. All payments shall be made payable to and mailed directly to: Support Payment Clearinghouse P.O. Box 52107 Phoenix, AZ 85072-2107 Payments must include the obligor's name, Social Security Number and the ATLAS number. 5. Pursuant to A.R.S. § 25-322, the parties shall submit current address information in writing to the Clerk of the Superior Court and the Support Clearinghouse immediately. The obligor shall submit the names and addresses of the obligor's employers or other payors within 10 days. The parties shall submit address changes within 10 days of the change. 6. [ ] Mother [ ] Father is responsible for providing medical insurance for the child(ren). 7. The costs of medical/dental/vision expenses not paid by insurance shall be shared as follows: Mother % Father %. A request for payment or reimbursement must be provided to the obligated parent(s) within 180 days after the services occurred. The obligated parent must pay or make payment arrangements within 45 days after receipt of the request. 8. The costs of travel related to parenting time over 100 miles one way shall be shared as follows: Mother % Father % 9. The parties shall exchange financial information such as copies of tax returns, earnings statements, a Parent's Worksheet for Child Support Amount, residential addresses and the names and addresses of their employers every 24 months. 10. The court allocates the federal tax exemption(s) for the dependent child(ren) as follows: Each year, the obligor may claim these exemptions only if the obligor has paid all child support and arrears ordered for the year by December 31 of that year. 3 childsupport-child support order. form Revised 10.01.10 American LegalNet, Inc. www.FormsWorkFlow.com IMPORTANT INFORMATION: If this is a modification of child support, all other prior orders of this Court not modified remain in full force and effect. Pursuant to Arizona Revised Statutes § 25-503(I), the right to get a judgment for unpaid child support ends three years after all children included in the Child Support Order have emancipated. To collect the unpaid support, the person owed child support must file a court action to obtain a written judgment for the unpaid amount before the end of the three-year period. (Limited exceptions exist and are found in A.R.S. § 25-320(B).) Although the obligation to pay support may continue, a child is emancipated: On the date of the child's marriage On the child's 18th birthday When the child is adopted When the child dies Date Judicial Officer 4 childsupport-child support order. form Revised 10.01.10 American LegalNet, Inc. www.FormsWorkFlow.com