IN THE DISTRICT COURT OF THE ______________________ JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF _____________________ ____________________________________, Plaintiff, vs. ____________________________________, Defendant Case No.: ___________________ PARTIAL SUM CERTAIN JUDGMENT Partial judgment is hereby awarded in favor of the [ ] Plaintiff [ ] Defendant, named _____________________________________, against the [ ] Plaintiff [ ] Defendant, named _____________________________________, in the amount of $____________, to reimburse for: [ [ ] Medical Expenses for their child/ren not otherwise covered by insurance; ] Work-related Child Care Expenses for their child/ren; and/or [ DATED: ____________________ ] Payments to Creditors. ______________________________________ Judge CLERK’S CERTIFICATE OF SERVICE I certify that a copy of this Partial Sum Certain Judgment was served on the following persons on this date: ________________________________. Plaintiff: [ ] Mail [ ] Hand-delivery Defendant: [ ] Mail [ ] Hand-delivery [name] [name] [address] [address] [city, state, zip] [city, state, zip] Deputy Clerk PARTIAL SUM CERTAIN JUDGMENT Page 1 CAO 5-7 5/20/2005 American LegalNet, Inc. www.USCourtForms.com