CHAD A. ROCHE, CLERK OF THE SUPERIOR COURT PINAL COUNTY, STATE OF ARIZONA Child Support Arrears Calculation Request packet The Pinal County Clerk of the Superior Court’s Child Support Financial Team is responsible for maintaining system and records integrity wit all court orders including, but not limited to; all orders of the court pertaining to monthly obligations, judgments, fees and interest. Among the services provided to the constituency by the Clerk’s Child Support Financial Team are debt reviews. Concerned parties, for example; the non custodial parent (NCP), custodial parent (CP), an attorney for either party or State IV-D agency, may at anytime request a review of the debts by the Child Support Financial Team. As of August 1, 1999, any request for an arrearage calculation must be in writing and must include pertinent information to assist in the identification and location of the proper court file. For your convenience, an Arrears Calculation Request form is attached. The arrearage calculation request form will be reviewed an audit prepared in the order it is received. Time allowance for a response is approximately four (4) to six (6) weeks, depending on the number of requests solicited from the court. We ask that you do not call to inquire about the status of your request, as this will only result in further delays. Once the arrearage calculation is complete, you will receive a status report that will include outstanding balances fees and any interest that may be due. If you disagree with our determination, you may call the team supervisor, who will explain any misunderstanding that may have occurred and the procedures used to calculate the accrued arrearage. The Pinal County Clerk’s Office experiences a very high volume of requests. If after (6) weeks, you have not received the results of your inquiry, please feel free to contact the Clerk’s office at (520) 866-5300 and inquire with Child Support Department. We will be happy to discuss any circumstances creating the response delay. Pursuant to ARS 12-284 subsection A Class E, a fee will be assessed as follows: • • • A letter of arrearage determination must include a self-addressed stamped envelope. A complete copy of arrears calculation including a payment history * $26.00 A complete copy of arrears calculation including a certified payment history * $52.00 No fee will be assessed for a “Notice of Determination of Child Support Arrearage”; however, you must submit a self-addressed stamped envelope with your request. REQUESTS SHOULD BE MAILED TO: Chad A. Roche, Superior Court Clerk Child Support Financial Team P.O. Box 628 Florence AZ 85132 Page 1 of 3 DO_CSA_COSCPinal_09.08.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com CHAD A. ROCHE, CLERK OF THE SUPERIOR COURT PINAL COUNTY, STATE OF ARIZONA Child Support Arrear Calculation Request Packet Requester’s Information: Name: Address: City: State: Phone Number: ( Zip: ) Social Security No: Your Relationship to Case: Case Information: Non Custodial Parent: Custodial Parent: Case Number: DO Atlas Number: -OR- Children: -OR- SE Date(s) of Birth: Projected Graduation Date(s): Reason for Request: Page 2 of 3 DO_CSA_COSCPinal_09.08.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com PLEASE CHECK ONE: Complete Arrears Calculation (Includes a certified copy of payment history) NO CHARGE 26.00 $ Complete Arrear Calculation (Includes a copy of payment history) $ $ A Letter of Arrearage Determination (A self-addressed stamped envelope must be provided) 52.00 Please include Check or Money Order payable to Clerk of the Superior Court, with your request. If you are only requesting a letter of arrearage determination, you MUST provide a self-addressed stamped envelope. By signing this request you are giving the Clerk permission to: ● Retain a complete arrear calculation worksheet as a permanent part of the courts case record, ● Issue to any requesting party, a copy of the court’s determination and ● Make the calculation available to all requesting parties. Signature Printed Name Page 3 of 3 Date Signed DO_CSA_COSCPinal_09.08.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com Cse-1129AFORPF (10-05) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Division of Child Support Enforcement Arizona State Disbursement Unit ELECTRONIC PAYMENT AUTHORIZATION Check applicable box(es): New Direct Deposit Authorization New Electronic Payment Card Changes to Account Information Only If you fail to provide all the information requested on this form, your request will not be processed and this form will be returned to you. IV-D cases (If you receive or have received cash assistance in the past, and/or have applied for IV-D services, or if you have an open case with DCSE, then your case is considered a IV-D case.) Non IV-D cases (ALL NON-DCSE IV-D cases where only the local court is involved) COURT ORDER NUMBER DO# ATLAS CASE NUMBER NAME (Last, First, M.I.) SOCIAL SECURITY NUMBER CURRENT MAILING ADDRESS (No., Street, P.O. Box, City, State, Zip) CONTRACT’S TELEPHONE NUMBER ( ) - CUSTODIAL PARENT’S DATES OF BIRTH (MM/DD/YYYY) I herby authorize the Arizona State Disbursement Unit (SDU) or its agent designated to initiate credit entries and, if necessary, debit entries and adjustments for any credit entries made in error to my (our) Checking, Savings Account indicated below, to credit and/or debit the same to such account for the purpose of support payments. IMPORTANT! DIRECT DEPOSIT ONLY Please attach a copy of a voided check from your account or a letter from your financial institution if a check is not available. BANK ROUTING NUMBER ACCOUNT NUMBER 1ST NAME ON ACCOUNT (Last, First, M.I.) FINANCIAL INSTITUTION’S NAME 2ND NAME ON ACCOUNT (Last, First, M.I.) All of your child support payments and, if applicable, spousal maintenance will go through direct deposit. They will be deposited into one account only, which can be a savings or checking account. If you wish funds to be deposited to your checking account, please must attach a personal check marked “VOID” and complete the following information. If you wish funds to be deposited to your savings account, please provide a letter from your financial institution with your routing and account number. This authority is to remain in full force and effect until DCSE has received written notification from me of its termination in such time and in such manner as to afford DCSE a reasonable opportunity to act on the notice. This authority may also be terminated by DCSE or its agent by mailing notice to the last mailing address I provided to DCSE or it agent. I will keep the Arizona State Disbursement Unit (SDU) or its agent informed of any address change that may occur. I understand that failure to do so will result in undelivered support payments. Please sign and mail or fax the completed form to you local Clerk of Court Office or the Arizona State Disbursement Unit (SDU), as appropriate. Attached is a listing of local Clerks of Court and/or Arizona State Disbursement Unit (SDU) PRINT YOUR NAME Return Signed Form To: YOUR SIGNATURE PINAL COUNTY SUPERIOR COURT CHILD SUPPORT DEPARTMENT P.O. BOX 628 FLORENCE, AZ 85132 DATE 520.866.5300 520.866.5377 (FAX) American LegalNet, Inc. www.FormsWorkFlow.com CHAD A. ROCHE  PO BOX 628  FLORENCE, ARIZONA 85132  TELEPHONE (520) 866‐5300    PINAL COUNTY  CLERK OF THE SUPERIOR COURT  JURY COMMISSIONER            FAX (520) 866‐5377  CHANGE OF ADDRESS/EMPLOYMENT FORM    NAME  CASE #  SSN                DATE    DOB        CHANGE OF RESIDENTIAL/MAILING ADDRESS            CHANGE OF EMPLOYER INFORMATION              PHONE #    SIGNATURE      (HOME)   (WORK)         Fax to 520.866.5377 Attn: Child Support Department or mail to PO Box 628, Florence, AZ 85132    American LegalNet, Inc. www.FormsWorkFlow.com Name of Person Filing: Street Address: City, State, Zip Code: Telephone Number: Email Address: ATLAS Number (if applicable) Representing Self (No Attorney) or Represented by Attorney If Attorney, Bar Number: SUPERIOR COURT OF ARIZONA PINAL COUNTY CASE NUMBER: Petitioner vs. AFFIDAVIT OF DIRECT PAYMENT Respondent HONORABLE: I received a total of $ from for child support payments for the months of OR I would like to waive all arrears owed to my to my case against STATE OF ARIZONA COUNTY OF PINAL ) ) SIGNED: Petitioner’s Signature SUBSCRIBED AND SWORN TO before me this My Commission Expires: day of , 20 By Deputy Clerk/Notary Public Page 1 of 1 DO_ADP_COSCPinal_09.07.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com