American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com Case No. If there is an unpaid arrearage or delinquency equal to at least one month’s child support obligation on the termination date, then the periodic amount required to be paid for current child support prior to the termination date shall automatically continue to be an obligation toward satisfaction of the unpaid arrearage or delinquency until paid in full. This payment shall be in addition to any periodic payment required for the satisfaction of the arrearage or delinquency which payments shall continue until such amounts are paid in full. Other: ________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ The “Child Support Data Sheet” attached hereto, as Exhibit 1, is a part of this Order. It is ordered the Clerk of the Court impound Exhibit 1 until further order of this Court. FAILURE TO OBEY ANY OF THE PROVISIONS OF THIS ORDER MAY RESULT IN A FINDING OF CONTEMPT OF COURT _______________________ Date ____________________________________________________ Judge Prepared by:_________________________ Attorney for:_________________________ Address:____________________________ ___________________________________ Telephone:__________________________ Attorney No:________________________ Form approved by Conference of Chief Circuit Judges Page 4 of 4 Revised 4/28/06 American LegalNet, Inc. www.FormsWorkflow.com