4A-303. Child support obligation and order. STATE OF NEW MEXICO COUNTY OF ____________________ ____________________ JUDICIAL DISTRICT _____________________________________, Petitioner, v. No. __________ _____________________________________, Respondent. CHILD SUPPORT OBLIGATION AND ORDER1 ________________________ and ________________________ are the parents of the children listed below. I. IDENTIFICATION AND CONTACT INFORMATION Parent's name _____________________ Physical address and phone number ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ Year of birth ______________________ ______________________ ______________________ Place of employment and phone number ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ Age ________ ________ ________ _____________________ Child's name _____________________ _____________________ _____________________ [] The parents shall advise each other of any change to this contact information within ten (10) days of new information becoming available. II. CHILD SUPPORT2 A. Child Support Worksheet.3 A signed child support worksheet is attached to this plan. (Complete and sign a child support worksheet prior to completing this section.) Child support: __________________________ pays ________________________ American LegalNet, Inc. www.FormsWorkFlow.com $____________ per month. Payments shall begin on ________________ (date) and shall be paid in the amount of $____________ every [ ] week [ ] two weeks [ ] month. Payments shall continue each month until the youngest child turns eighteen (18); however, if the youngest child turns eighteen (18) while still attending high school, payments shall continue until the month the child graduates or turns nineteen (19), whichever occurs first.4 (Choose 1 or 2) [ ] 1. This amount is the amount shown on the worksheet; (Or) [ ] 2. This is a deviation from the amount shown on the child support worksheet because (fill in the reason here)5 ____________________________________________________________ ___________________________________________________________. B. Health insurance coverage6 (Choose 1, 2, or 3) [ ] 1. _______________________ (name of parent) shall keep the minor children covered by health and dental insurance under the policy of insurance available to [him] [her] from [his] [her] employer or other group health care insurance plan. (Or) [ ] 2. Neither parent has private health or dental insurance coverage available at a reasonable cost. If the children are covered under Medicaid, the child support obligor shall pay a cash medical support payment as determined at a subsequent hearing in which the State of New Mexico, Child Support Enforcement Division ("CSED"), has been given sufficient notice, or upon the stipulation of the parties and with the agreement of CSED. The notification to and agreement of CSED is required only for cash medical support. (Or) [ ] 3. Other health insurance coverage shall be provided as follows: ____________________________________________________________ ____________________________________________________________ ___________________________________________________________. C. Additional healthcare expenses to be determined by percentage. The parents shall split the cost of uncovered necessary healthcare expenses in proportion to their income on American LegalNet, Inc. www.FormsWorkFlow.com the child support worksheet. D. Wage withholding of child support. (Choose and complete 1 or 2) [ ] 1. Withhold wages for child support. Child support payment shall be withheld from ___________________________'s paycheck.7 (Choose a or b) [ ] a. Attached is a completed Form 4A-304 NMRA Wage Withholding Order which directs all withheld payments to the Child Support Enforcement Division ("CSED"). (Or) [ ] b. ___________________________ (name of parent) shall take a copy of this child support obligation after it is signed by the Court to CSED to open a case and to request that CSED issue a notice of wage withholding on [his] [her] behalf. (Or) [ ] 2. Other plan. Wage withholding is not appropriate at this time as the parents have made the following alternate arrangements for the payment of support (describe alternate payment arrangements, subject to approval by the Court): ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ E. Health and dental insurance. The parents shall do the following: 1. follow the insurance plan in selecting a doctor or dentist; 2. use doctors and dentists who are part of the insurance plan; 3. make sure each parent has a copy of the insurance card and policy; and 4. cooperate and work together to promptly submit all insurance forms. F. Exchange of information. Once a year either parent can ask, in writing, for both parents to exchange the following information (this paragraph is required by statute, Section 404-11.4 NMSA 1978):8 1. federal and state tax returns for the prior year; 2. W-2 statements for the prior year; 3. IRS form 1099s for the prior year; 4. work related day care statements for the prior year; 5. dependent medical insurance premiums for the prior year; and American LegalNet, Inc. www.FormsWorkFlow.com 6. wage and payroll statements for the four months prior to the request. G. Tax issues.9 This is the plan about tax issues, such as the dependency exemption, that relate to the children: [ ] Follow IRS regulations; or [ ] Adopt another plan as follows: _______________________________________________________________ ______________________________________________________________. H. Other expenses. Each parent shall provide the children with items they need while they are with that parent. [ ] (If applicable) The parents shall pay for special activities as follows: _______________________________________________________________ ______________________________________________________________. VERIFICATION I affirm under oath and penalty of perjury under the laws of the State of New Mexico that I have read this document, that I agree with everything in it, and that the statements in it are true and correct to the best of my knowledge and belief. ________________________________ Name of parent (print) ________________________________ Parent's signatur