Print Form 4217 - Continuance - Allowed 4250 - Order, Plaintiff, Defendant or Witness to Appear - Allowed 4253 - Produce Exhibits or Other Records or Documents or Person - Allowed 4284 - Strike or Withdraw Motion or Petition - Allowed 4312 - Finding of Delinquency - Allowed 4324 - Child Support Order Above Statutory Guidelines - Allowed 4325 - Child Support Order Below Statutory Guidelines - Allowed 4386 - Order to Pay Fees - Allowed Clear Form 4435 - Order on Motion to Provide Medical Insurance - Allowed 4512 - Order Arrearage Set - (amount needed) - Allowed 4567 - Order for Child Support - Allowed 4568 - Order Temporary Maintenance - Allowed 4600 - Order Support Payments Made Direct to Petitioner 4601 - Order Support Payments Made Direct to C.C.C./S.D.U. - Allowed 4604 - Order Support Payments Made Direct to Respondent - Allowed (Rev. 10/02/15) CCDR N107 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION __________________________________________________________ Petitioner/q Obligee q Obligor v. __________________________________________________________ Respondent/q Obligee q Obligor Docket No. _________________________________ IV D-No. C _________________________________ Calendar No. ________________________________ q Healthcare and Family Services is, or has been, granted leave to intervene. UNIFORM ORDER FOR SUPPORT q Initial Order q Modification q Enforcement Definitions: Obligor - An individual who owes a duty to make support payments pursuant to an order for support Obligee - An individual to whom a duty of support is owed or the individual's legal representative Payor - Any payor of income to an obligor Unallocated Support - A total amount for maintenance and child support and not a specific amount for either THIS MATTER coming to be heard on Petition for q Rule and/or q Modification q Support q Judgment The Court Finds: The Court has jurisdiction of the parties and the subject matter and that due notice was given by _________________________________________________________ on __________________________. q a. The net income of the Obligor is $__________ per _______________________________________. q b. The amount of arrearage/judgment as of the date of this order is $__________ for child support and $__________ for maintenance or unallocated support as follows: $__________ to Obligee, $__________ to Healthcare and Family Services and/or $__________ to the Petitioning State of ________________________________ . q c. The amount of child support cannot be expressed exclusively as a dollar amount because all or a portion of the Obligor's net income is uncertain as to source, time of payment or amount. q d. Retroactive child support is $__________ from __________________ to _____________________. The q Obligee q Obligee's Attorney q Obligor q Obligor's Attorney q Assistant State's Attorney, being present q This matter being an Interstate Case, q Voluntary Acknowledgment of Paternity was signed on _____________. It is Ordered: q After hearing q By agreement of the parties q By default that: _______________________________________________________________________ , Obligor, is to provide: q Maintenance (Do not complete this section if Unallocated Support is ordered.) Payment Amount: Payment Frequency: Current Maintenance: $__________ q every week q every other week q monthly Arrearage Payment: $__________ q twice each month on ___________ & ____________ Payments Begin: __________________________ (date) q other _________________________________(date) q child Support or q unallocated Support Payment Amount: Payment Frequency: Current Child Support Payment or q every week q every other week q monthly Unallocated Support Payment: $__________ q twice each month on ___________ & ____________ Arrearage/Retroactive Payment: $__________ q other _________________________________(date) Other Payment $__________ Payments Begin: __________________________ (date) Judgment in the amount of $__________ is entered against the Obligor on the arrears. Interest $__________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 6 Uniform Order for Support (Rev. 10/02/15) CCDR N107 B q percentage aMount of child Support (Complete this section only if finding (c) is checked above.) In addition to the specific dollar amount of support ordered above, current child support shall be paid in the amount of __________ % of Obligor's _______________________ payable ____________________________. The Obligor is further ordered to provide income records sufficient to determine and enforce the percentage amount of child support within seven (7) days of receipt of income subject to this percentage assessment, to the q Obligee and q Clerk of the Court. q additional conditionS or findingS q Child Support payment amount deviates from the amount required by statutory minimum guidelines. The amount of support that would have been required under the guidelines is $__________. Reasons for deviation: ___________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ q Child Support is based on the needs of the child. The Child/ren covered by this Order is/are: __________________________________________________________ Date of Birth:_______________ __________________________________________________________ Date of Birth:_______________ __________________________________________________________ Date of Birth:_______________ __________________________________________________________ Date of Birth:_______________ __________________________________________________________ Date of Birth:_______________ __________________________________________________________ Date of Birth:_______________ þ payMent arrangeMentS q (Payments must be sent to the STATE DISBURSEMENT UNIT if this box is checked.) C H A Notice to Withhold Income shall be issued immediately and shall be served on the employer at the adE dress listed in this Order. Payments shall be made payable to the State Disbursement Unit and sent to the C State Disbursement Unit at P. O. Box 5400, Carol Stream, Illinois 60197-5400. Payments must include K CASE NUMBER, COUNTY of the Court issuing this Order, and Obligor's name and social security number. Any subs