This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. DV - CSO 129.1 Page 1 of 5 (04/18) STATE OF ILLINOIS , ORDER FOR SUPPORT For Court Use Only CIRCUIT COURT Initial COUNTY Modification Instruction s Directly above, enter the county where you filed this case. Enter the full name of Petitioner, Respondent, and the case number as listed on the Petition for Dissolution of Marriage/Civil Union (Divorce with Children). P etitioner ( First, middle, last name ) v. IV - D Case Number Respondent ( First, middle, last name ) Case Number Enter the IV-D case number if you know it. DO NOT complete the rest of this form. You MUST BRING the social security numbers of both Petitioner and Respondent to the court hearing. THE COURT FINDS : 1. Petitioner Respondent must pay support. The person paying support is called 223Obligor224 in this Order . The person receiving support is called 223Obligee224 in this Order . 2. The children covered by this O rder are: 3. The combined gross income does does not exceed the uppermost levels of the schedule of basic support obligations. 4. The net income of Obligor is $ per calculated by the standardized tax amount . the individualized tax amount . t he agreement of the parties. 5. The net income of Oblig ee is $ per calculated by the standardized tax amount . the individualized tax amount . the agreement of the parties. 6. The adjusted net income for Obligor is: $ per . 7. The adjusted net income for Oblig ee is: $ per . 8. The Basic Combined Support Obligation is: $ per . 9. Obligor222s income is at or below 75% of the Federal Poverty Guidelines for a family of 1 person. Child support is capped at $40 per month per child up to a maximum of $120 per month. 10. Obligor receives only means tested assistance or cannot work due to a medically proven disability, incarceration or institutionalization . 11. Shared physical care: Each parent exercises 146 or more overnights per year. Basic Child Support Obligation is: $ per (multiply amount in paragraph 8 x 1.5) . 12. Split care: E ach of the parents has physical care of at least one, but not all of the children. American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: DV - CSO 129.1 Page 2 of 5 (04/18) 13. The amount of child support arrearage is: $ as of plus an interest amount of: $ Date 14. The amount of maintenance arrearage is: $ as of plus an interest amount of: $ Date 15. The amount of retroactive child support is: $ from to Date Date 16. The amount of retroactive maintenance is: $ from to Date Date 17. The amount of child support cannot be stated only in a dollar amount because some or all of the net income of Obligor is uncertain as to source, time of payment, or amount. IT IS ORDERED: A. That Obligor will pay: 1. Maintenance a. The current maintenance payment is: $ b. The maintenance arrearage/retroactive payment is: $ c. The total maintenance payment is: $ d. Maintenance is to be paid: Once a week Once every other week Once a month Twice a month on: and . Date Date e. Maintenance payments begin on: . Date f. This maintenance order ends on: . Date 2. Child Support a . The current child support payment is: $ b . The child support arrearage/retroactive payment is: $ c . The total child support payment is: $ d . Child support is to be paid: Once a week Once every other week Once a month Twice a month on: and . Date Date e . Child support payments begin on: . Date f . Obligor must also pay : % of their . Type of Additional Income This must be paid as follows: Obligor must also give Obligee and/or the Clerk of the Court proof of their within 7 days of receiving the income. Type of Additional Income 3. Other Support Orders : B. Payment of Maintenance and Child Support : 1. A n Income Withholding f or Support may immediately be served on Obligor222s employer. Until the Income Withholding f or Support takes effect Obligor is required to pay directly to the State Disbursement Unit. Payments by Obligor or the employer must be made payable to: STATE DISBURSEMENT UNIT and sent to: P.O. Box 5400, Carol Stream, IL 60197-5400. Payments must include: 1) the case number, 2) the name of the county of the Court issuing this Order for American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: DV - CSO 129.1 Page 3 of 5 (04/18) Support , and 3) Obligor222s name and social security number. A new court Order is not necessary to serve an Income Withholding for Support on any future employer of Obligor. 2. Obligor will make payments: Directly to the State Disbursement Unit according to the schedule in S ection A. Payments by Obligor must be made payable to the STATE DISBURSEMENT UNIT and sent to: P.O. Box 5400 , Carol Stream, IL 60197 - 5400. Directly to Obligee as the parties have agreed according to the schedule in S ection A. If Obligor falls behind in payments, an Income Withholding f or Support may be prepared and served on Obligor222s employer . Obligor will then have to make payments to the State Dis bursement Unit as stated in S ection B1. 3. Obligor must also pay a $36 per year c hild s upport c ollection f ee. This fee is not maintenance or child support and cannot be subtracted from the support to be paid . This fee must be paid directly to the Circuit Clerk of the c ounty i ssuing this Order for Support . C. Payment of Main tenance Only : 1. Obligor will make payments Directly to Obligee Directly to the Circuit Clerk of this county 2. If payments are made to the Circuit Clerk, Obligor must also pay a $36.00 per year support collection fee. This is not maintenance and cannot be subtracted from the support to be pa i d. This fee must be paid directly to the Circuit Clerk of the c ounty issuing this order. D . Delinquency ( m aintenance or c hild s upport) : 1. Delinquency Payments If Obligor is delinquent in making a support payment after this Order for Support is entered, Obligor must a. Continue to make current maintenance and child support payments, AND b. Pay the sum of: $ for child support per payment period ordered in S ection A2 d , PLUS $ for maintenance per payment period ordered in S ection A1 d , until the delinquent amount is paid in full. A maintenance or child support payment, or part of a payment, that is due and remains unpaid for 30 days or more will accrue interest at the rate of 9% each year. E . Child Support Termination : 1. This child support order ends on: unless changed by a written order of the court. Date 2. Unpaid Child Support at Termination If Obligor owes an arrearage or delinquency on the termination date that is equal to at least one month222s support payment, Obligor must continue to make payments. The payment amount must be the same as the amount Obligor was ordered to pay in Section A2 c . F . Health Insurance : 1. Decision Reserved 2. a. Obligor Obligee will provide h ealth insurance for the children by: Enrolling them in health insurance coverage available through their employer. Providing other insurance dental orthodontic vision prescription medication other: . Giving a copy of the insurance policy and the insurance card to the other parent within 45 days of the date of this Order . b. The cost of the insurance will be paid by: American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: DV - CSO 129.1 Page 4 of 5 (04/18) Obligor: % Obligee: % NOTE: H ealth insurance premiums are added to the Basic Support Obligation and then divided pro rata. If Obligor222s paying the premium, the amount that is Obligee222s responsibility must be subtracted from Obligor222s support obligation. If Obligee is paying the premium, Obligor's support obligation shall be increased by Obligor's share of the premium. c. The cost of healthcare expenses not covered by insurance will be paid by: Obligor and Obligee e qually Obligor: % Obligee: % G . Child Care Expenses : 1. Decision Reserved 2. a. Child care expenses are reasonably necessary for Petitioner Respondent t o be employed, attend educational or vocational training to improve employment opportunities, or to look for work. b. The cost of c