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Child Support Order Form. This is a Arizona form and can be use in Domestic Relations Statewide.
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Tags: Child Support Order, Arizona Statewide, Domestic Relations
ARIZONA SUPERIOR COURT IN
COUNTY
Case No.
Petitioner
ATLAS No.
Date of Birth (Month, Date, Year)
CHILD SUPPORT ORDER
Respondent
A.R.S. § 25-503
Date of Birth (Month, Date, Year)
THE COURT FINDS THAT:
1. Mother:
and
Father:
owe a duty to support the following children:
Child(ren)’s Name(s)
Date of Birth
DO NOT WRITE BELOW THIS LINE. THE COURT PERSONNEL WILL COMPLETE
THE FORM.
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.
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Case No.
3.
Mother
Father is obligated to pay support to:
In the amount of:
$
per month
4. 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:
$
The Court finds the guidelines amount is inappropriate or unjust because:
The attached written agreement is made part of this order by reference
Other Reasons for Deviation from Guideline Amount:
Arrears
Child support arrears exist in the amount of:
For the period
of:
$
Interest
Interest in the amount of:
$
For the period
of:
to
to
Past Care and Support
A judgment for past care and support should be entered in the amount
of: $
For the period
of:
to
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Case No.
IT IS ORDERED THAT:
1.
Mother
Father shall pay child support in the amount of: $
per month, to:
First payment is due on the 1st day of:
2.
Mother
Father owes child support arrears in the amount of: $
For the period of:
to
Judgment is ordered in favor of:
and against:
In the principal amount of: $
Case No.
Mother
Father shall pay
$
arrears until paid in full, OR
Arrears not addressed.
3.
Mother
per month toward child support
Father owes past care and support in the amount of: $
For the period of:
to
Judgment is ordered in favor of:
and against:
In the principal amount of:
$
Mother
Father shall pay $
the past care and support amount until paid in full, OR
Past care and support not addressed.
per month toward
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
person obligated to pay (the obligor) remains responsible for the full monthly amount ordered.
Payments not made directly through the Support Payment Clearinghouse shall be considered gifts
unless otherwise ordered by the Court or by a written Affidavit of Direct Payments signed by all
parties to the case and filed with the Clerk of the Court or the Support Payment Clearinghouse. 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 payor’s name, ATLAS number or Social Security 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 payor shall within 10
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Case No.
days, submit the names and addresses of employers or other persons or organizations from which he
or she is entitled to receive payment.
6. The parties shall submit address changes within 10 days of the change.
7. MEDICAL, DENTAL, VISION CARE INSURANCE FOR MINOR CHILDREN
Mother is responsible for providing
medical
dental
vision care insurance.
Father is responsible for providing
medical
dental
vision care insurance.
8. The costs of medical/dental/vision care expenses not paid by insurance shall be shared as follows:
Mother ____________ %
Father ____________%.
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.
9. The costs of travel related to parenting time over 100 miles one way shall be shared as follows:
Mother ____________ %
Father ____________%
10.
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.
11.
The court allocates the federal tax exemption(s) for the dependent child(ren) as follows:
Date of Birth
(Month, Day,
Parent Entitled
Year)
Child’s Name
to Deduction
Mother
Mother
Mother
Mother
For Calendar
Year
Father
Father
Father
Father
For years following those listed above while this Child Support Order remains in effect, the parties
shall repeat the pattern above of claiming deductions for each child.
Each year, the person obligated to make payments (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.
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.
Date
Judicial Officer
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CHILD SUPPORT ORDER
INSTRUCTIONS
An automated child support calculator is available on the Supreme Court’s website at
http://www.supreme.state.az.us/childsup.htm. Assuming your computer is connected to a printer, the online
calculator will provide you with a printout that you may use in place of this form.
COMPLETE THIS FORM IF:
•
You are a party to a court action to establish a child support obligation or to modify an existing order for
child support.
DEFINITIONS
•
Custodial Parent – The parent designated by the court as having physical custody of the child(ren) or if a
custody order has not been established, the parent with whom the child lives with most of the time.
•
Non-custodial Parent - The parent that has not been granted physical custody of the child(ren) or if a
custody order has not been established, the parent who is not the primary caretaker of the child(ren).
•
Physical Custody - Rights and responsibilities to determine where the child lives and who cares for the
child.
HOW TO COMPLETE THIS FORM:
TYPE OR PRINT NEATLY USING BLACK INK. Match each numbered item in the instructions with the
same numbered item on the Child Support Order.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Type or print the name of the county in which this Child Support Order is being filed.
Type or print the first, middle and last name and date of birth of the person shown as the
Petitioner/Plaintiff on the original petition to establish support or on the Order that established support.
Type or print the first, middle and last name and date of birth of the person shown as the
Respondent/Defendant on the original petition to establish support or on the Order that established
support.
Type or print the case number assigned to your case. If you do not have a case number, leave this item
blank.
Type or print the ATLAS number, if one has been assigned to your case; otherwise leave this item
blank.
Type or print the first, middle and last name of the mother of the child(ren).
Type or print the first, middle and last name of the father of the child(ren).
Type or print the first, middle and last name and date of birth of each child for whom support is being
requested.
The Judicial Officer or Clerk of the Superior Court will complete the remaining items, date and sign the order.
WHEN YOU HAVE COMPLETED THE CHILD SUPPORT ORDER:
W INST: CS ORDER09/21/06
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