Plaintiff Obligor Obligee Hearing Date / / With appearance by: PL VS Defendant Superior Court of New Jersey Chancery Division � Family Part Obligor Obligee Welfare / U.I.F.S.A. # Atty for PL Civil Action Order County Docket # CS # DEF Atty for DEF County Probation Division County Welfare Agency Probation Division Family Division Enforcement Modification/Increase/Decrease IV-D Atty This matter having been opened to the court by: Plaintiff Defendant for an ORDER for: Paternity Support Visitation Custody Termination/Continuation Status Review 1. 2A. 2B. 2C. 2D. 3. 4. 5. PATERNITY of child(ren) (# above) A Certificate of Parentage has been filed for child(ren) # State with Continuing Exclusive Jurisdiction: Child's Name Birth Date Child's Name Birth Date / / / / / / / / 2E. 2F. 2G. 2H. / / / / / / / / is hereby established and an ORDER of paternity is hereby entered. above. It Is Hereby ORDERED That: The obligor shall pay support to the New Jersey Family Support Payment Center in the amount of: + Child Support Spousal Support + Arrears Payment = Total payable Frequency effective / Date / 6. 6A. 7. 8. 9. 10. 11. NOTE: Child support is subject to a biennial cost-of-living adjustment in accordance with R. 5:6B Child Support Guidelines Order Deviation reason: Worksheet attached. Support order shall be administered and enforced by the Probation Division in the county of Venue, . ARREARS calculated at establishment hearing are based upon amounts and effective date noted above and total $ ARREARS indicated in the records of the Probation Division, are $ . / / as of GROSS WEEKLY INCOMES of the parties, as defined by the Child Support Guidelines, upon which this ORDER is based: . OBLIGEE $ OBLIGOR $ INCOME WITHHOLDING is hereby ORDERED on current and future income sources, including: Name of Income Source: Address of Income Source: 12. 12A. 12B. 13. OBLIGOR SHALL, however, make payments AT ANY TIME that the full amount of support and arrears is not withheld. Medical Support coverage as available at reasonable cost shall be provided for the child(ren) spouse, Obligor Obligee Both by The parties shall pay unreimbursable health care expenses of the child(ren) which exceed $250.00 per child per year as follows: % Obligor % Obligee Pursuant to R 5:6A the obligee shall be responsible for the first $250.00 per child per year. If coverage is available, Medical Insurance I.D. card(s) as proof of coverage for the child(ren)/spouse shall be provided immediately upon availability to the Probation Division by the: Obligee Obligor Insurance currently provided by a non-party: Health insurance benefits are to be paid directly to the health care provider by the insurer. GENETIC TESTING to assist the court in determining paternity of the child(ren) (# ) is hereby ORDERED. The county welfare agency or the foreign jurisdiction in the county of residence of the child shall bear the cost of said testing, without prejudice to final allocation of said costs. If defendant is later adjudicated the father of said child(ren), defendant shall reimburse the welfare agency for the costs of said tests, and pay child support retroactive to / / . Issues of reimbursement reserved. 13B. Issue of retroactive order reserved. American LegalNet, Inc. www.FormsWorkFlow.com 13A. Effective: 02/01/2017, CN 10284 page 1 of 2 DOCKET # 14. CS# Hearing Date / / Page 2 of 2 This matter is hereby RELISTED for a hearing on / / before . A copy of this ORDER shall serve as the summons for the hearings. No further notice for appearance shall be given. Failure to appear may result in a default order, bench warrant, or dismissal. Reason for relist: AN EMPLOYMENT SEARCH MUST BE CONDUCTED BY THE OBLIGOR. Written records of at least # employment contacts per week must be presented to the Probation Division. If employed, proof of income and the full name and address of employer must be provided immediately to the Probation Division. SERVICE upon which this order is based: Personal Service Certified Mail: Date: / / Signed by: Refused Returned Unclaimed Regular Mail (not returned) Other 15. 16. 17. A BENCH WARRANT for the arrest of the obligor is hereby ORDERED. The obligor was properly served with notice for court appearance on / / , and failed to appear. (Service noted above). An amount of $ shall be required for release. THE OBLIGOR IS HEREBY INCARCERATED in the County Jail until the obligor pays $ or until further notice of this court. The obligor was found to be not indigent and had the ability to pay the support order for reasons indicated below. 18. 19. 20. 21. 22. 23. EFFECTIVE / / warrant, without further notice. A LUMP SUM PAYMENT OF $ issued without further notice. FUTURE MISSED PAYMENT(S) numbering must be made by the obligor by / or more may result in the issuance of a / , or a bench warrant may be . . / This complaint / motion is hereby DISMISSED: (reason) Order of Support is hereby TERMINATED effective / / , as Arrears accrued prior to effective date, if any, shall be paid at the rate and frequency noted on page number one of this ORDER. THIS ORDER IS ENTERED BY DEFAULT. The and failed to appear. It is further ORDERED: 22A. obligor obligee was properly served to appear for a hearing on / Affidavit of Non-Military Service is filed. Except as Provided Herein, All Prior Orders of the Court Remain in Full Force and Effect. I hereby declare that I understand all provisions of this ORDER recommended by a Hearing Officer and I waive my right to an immediate appeal to a Superior Court Judge: Plaintiff Attorney for Plaintiff 24. 25. INTAKE CONFERENCE BY AUTHORIZED COURT STAFF: PROBATION PREPARED CHILD SUPPORT ORDER The parties request the termination of all Title IV-D services and consent to direct payment of support. They are advised that all monitoring, collection, enforcement and location services available under Title IV-D of the Social Security Act are no longer in effect. I understand I may reapply for Title IV-D services. obligee 26. Copies provided at hearing to obligee obligor 26A. Copies to be mailed to obligor obligee obligor Defendant Attorney for Defendant TAKE NOTICE that the attached New Jersey Uniform Support Notices are incorporated into this Order by reference and are binding on all parties. So Recommended to the Court by the Hearing Officer: Date: / / H.O. Signature So Ordered by the Court: Date: / / Judge Signature American LegalNet, Inc. www.FormsWorkFlow.com , J.S.C. Effective: 02/01/2017, CN 10284 page 2 of 2