Child Support Order Summary Form This form must be completed and given to time Clerk or the Court, with a copy of the final order attached. SUPPORT PAYMENTS UNDER THIS ORDER MUST BE SENT TO THE STATE OF IDAHO, CHII.D SUPPORT RECEIPTING, P.O. BOX 70008, BOISE, ID 83707 Case # ____________________________________ County _______________________ Date of Order ___________________ Who is ordered to pay child support? (full name) ________________________________________________________________ How much? $ ___________ How often: _____weekly _____ monthly Beginning date: ________________________ Special child support terms in this order (check all that apply): _____Cost of living increases _____Modification of a previous order _____Decrease for visitation _____Other _____________________________ Is there an order for Wage Assignment? _____Yes _____ No (If yes, please attach a copy of the Wage Assignment Order) Plaintiff’s full name _________________________________________________________ _____Male _____Female Social Security # _________________________ Date of Birth ____________________ Phone Number______________________ Mailing address ___________________________________________________________________________________________ Residence address (if different than mailing) ____________________________________________________________________ Employer name and address ________________________________________________________________________________ Plaintiff's attorney: ______________________________Phone _____________________ City/State _______________________ Defendant's full name __________________________________________________________ _____ Male _____ Female Social Security # _______________________ Date of birth ______________________ Phone number _____________________ Mailing address ____________________________________________________________________________________________ Residence address (if different than mailing) _____________________________________________________________________ Employer name and address __________________________________________________________________________________ Defendant's attorney: ___________________________ Phone ________________________ City/State ______________________ Children for whom support is ordered in this order: Child's Full Name Social Security # Date of Birth Sex ______________________________________ _________________________ _______________________ _____________ ______________________________________ _________________________ _______________________ _____________ ______________________________________ _________________________ _______________________ _____________ ______________________________________ _________________________ _______________________ _____________ If support is ordered for more than four children, please attach a separate sheet of paper with the information. Print name of person who completed this form: ___________________________________________ Date: __________________ CHILD SUPPORT ORDER SUMMARY FORM CAO 1-14 Effective 7/99 American LegalNet, Inc. www.USCourtForms.com