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Motion And Affidavit For Entry Of Partial Judgment In Sum Certain Form. This is a Idaho form and can be use in District Court Statewide.
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Tags: Motion And Affidavit For Entry Of Partial Judgment In Sum Certain, CAO 5-5, Idaho Statewide, District Court
Full Name of Party Filing this Document
Mailing Address (Street or Post Office Box)
City, State and Zip Code
Telephone Number
IN THE DISTRICT COURT OF THE ____________________ JUDICIAL DISTRICT OF THE
STATE OF IDAHO, IN AND FOR THE COUNTY OF _____________________
,
Plaintiff,
vs.
,
Defendant.
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)
)
)
)
)
)
Case No.
MOTION AND AFFIDAVIT FOR
ENTRY OF PARTIAL JUDGMENT IN A
SUM CERTAIN
STATE OF IDAHO
)
: ss
County of __________________)
To obtain a partial judgment in a sum certain, I swear under oath:
[
1.
] Section One: Health Care or Work-related Child Care Expenses.
The Order/Decree in this case provides for a sharing of [ ] health care expenses not paid
by insurance, and/or [ ] work-related child care costs, in the following percentages: _______% to
be paid by father and ______% to be paid by mother.
2.
I have paid the total sum of [
] $______________ in medical expenses and/or [
] in
work-related child care costs and, despite having submitted proof of payment to the other
parent, I have not been reimbursed.
3.
(name)
____________________________ owes me the sum of $___________ for his/her
portion of health care expenses not paid by insurance or work-related child care expenses
incurred to (date), _____________________, and a partial judgment should be entered
against him/her in that amount.
[
] Section Two: Payments to Creditors.
MOTION AND AFFIDAVIT FOR PARTIAL JUDGMENT IN A SUM CERTAIN
CAO 5-5 Revised 6/2006
Page 1
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1.
The Order/Decree in this case provides for the payment of the following account/s by my
former spouse:
.
2. I have paid the total sum of $______________ for this/these accounts and, despite having
submitted proof of payment to my former spouse, I have not been reimbursed.
3.
(name)
____________________________ owes me the sum of $___________ for his/her
portion of creditor payments made by me to ____________________ (date), and a partial judgment
should be entered against him/her.
[
] Section Three. Request for Partial Judgment.
I ask that Partial Judgment be entered against (other party’s name) ________________________ in
favor of (your name) ____________________________in the amount of $________________, for
[ ] health care expenses [
] work-related child care costs [
] payments to creditors.
I have attached copies of receipts reflecting the above amounts, which are true and correct
amounts to the best of my knowledge and belief.
(Attach receipts and/or any other documentation used to verify the
amount requested.)
Date:
Signature
SUBSCRIBED and SWORN to before me this _____ day of
, 20____.
Notary Public for
Residing at
Commission Expires:
CERTIFICATE OF SERVICE
I certify I served a copy to: (name the other party or their attorney in the case)
[ ] By Mail
(Name)
[ ] By fax to (number) _________________
(Street or Post Office Address)
[ ] By personal delivery
(City, State, and Zip Code)
Date: ___________________________
_________________________________
Signature
________________________________
Typed/printed Name of Party Signing
MOTION AND AFFIDAVIT FOR PARTIAL JUDGMENT IN A SUM CERTAIN
CAO 5-5 Revised 6/2006
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