OFFICE OF THE CLERK OF THE COURT CHILD SUPPORT AND MAINTENANCE COURT ORDER WORK SHEET – Regular PAY TO: ______________________________ FROM: ____________________________________ ______________________________ ____________________________________ ______________________________ ____________________________________ ______________________________ PAYOR’S SS # _____________________________ CASE # EMPLOYER’S NAME AND ADDRESS: ___________________________________________________ ___________________________________________________ CHILD SUPPORT PAYMENT Amount : $___________.____ (end date must be provided – MM/DD/YY) Effective Date: ____/____/____ End Date : ____/____/____ Frequency: _____Weekly _____ Monthly _____ Annually ______ Bi-Weekly (every two weeks) ______ Semi-Monthly (two times a month) MAINTENANCE (SPOUSAL) Amount: $__________.____ Effective Date: ____/____/____ Frequency: _____Weekly _____ Monthly _____ Annually End Date: ____/____/____ (provide if possible) ______ Bi-Weekly (every two weeks) ______ Semi-Monthly (two times a month) ARREARAGES (end date must be provided – MM/DD/YY) Total Arrearage: $___________.____ Periodic Payment Amount: $____________.____ Effactive Date: ____/____/____ End Date: ____/____/____ Frequency: _____Weekly _____ Monthly _____ Annually ______ Bi-Weekly (every two weeks) ______ Semi-Monthly (two times a month) ______ Other (Please Specify)________________ __________________________________ CHILD MAINTENANCE Amount: $__________.____ Effective Date: ____/____/____ Frequency: _____Weekly _____ Monthly _____ Annually End Date: ____/____/____ (provide if possible) ______ Bi-Weekly (every two weeks) ______ Semi-Monthly (two times a month) Prepared by Attorney ________________________ American LegalNet, Inc. www.FormsWorkflow.com