District Court Denver Juvenile Court ___________________ County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-Petitioner/Respondent: Division Courtroom COURT USE ONLY Case Number: SUPPORT ORDER Petitioner: Mailing Address: Residential Address: Name of Employer: Employer Address: Date of Birth: _______________________ Co-Petitioner/Respondent: Mailing Address: Residential Address: Name of Employer: Employer Address: Date of Birth: _______________________ The following are the minor children who are the subject of this Order: Full Name of Child Sex Date of Birth The Court Orders the Petitioner Co-Petitioner/Respondent to pay child support and/or maintenance (spousal/partner support) to (name of party). a. Payments shall be paid weekly bi-weekly twice a month monthly other: _________________. b. The first payment is due on ____________________________ (date). c. Total arrears owed as of _____________________ (date) for Child Support $____________ and/or Maintenance (spousal/partner support) $___________. d. Total retroactive support as of _______________________ (date) that accrued prior to the entry of a support order for the time period of ________________ to _______________ shall be $______________. e. Emancipation occurs when the last or only child reaches the age of 19; unless the child is still in high school, in which case support continues until the end of the month following graduation; or until the child(ren) otherwise emancipate as may be determined by the Court. Child support may be changed or amended upon motion of a party when any of the children reach 19. JDF 1117 R7/13 SUPPORT ORDER © 2013 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com The total monthly obligation is as follows: $ _____________ Current Child Support $ _____________ Current Maintenance (spousal/partner support) $ _____________ Payment toward Arrears (child support) $ _____________ Payment toward Arrears (maintenance) $ _____________ Payment toward Retroactive Support For a total monthly payment of $ ___________ Upon payment in full of the Retroactive Support and/or Arrears, the monthly payment is reduced to $_______________. The Court orders the immediate activation of an income assignment against the Obligor, pursuant to §14-14111.5, C.R.S. The income assignment must be paid through the Family Support Registry, pursuant to §26-13-114(6)(a), C.R.S. . or This Order is not subject to the immediate activation of an income assignment because either: Both parties have entered into a written agreement that provides for an alternative arrangement. If a payment is missed, or late, an income assignment shall immediately be activated pursuant to §14-14-111.5, C.R.S. . The Court finds there is good cause not to require the immediate activation of an income assignment because: The Court orders the Petitioner or Co-Petitioner/Respondent, or Either party to secure and maintain medical or medical and dental and/or other: 115(10), C.R.S. insurance coverage for the child(ren), when it is provided by his/her employer or acquired individually, at a reasonable cost as defined in §14-10Each party shall cooperate and exchange information necessary to provide insurance If not all children, please identify the names of the children that this party will be benefits for the child(ren). providing insurance for: The Court finds medical or medical and dental insurance is not currently available to either party at a reasonable cost and does not order either party to provide coverage for the children at this time, but does order the parties to provide coverage when it becomes available at a reasonable cost. Payments shall continue until further Order of the Court. Payments shall be: Mailed to the Family Support Registry or Mailed directly to the appropriate party. P. O. Box 2171 Denver, CO 80201-2171 Date: ________________________________ ______________________________________ Judge Magistrate JDF 1117 R7/13 SUPPORT ORDER © 2013 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com