STATE OF NORTH CAROLINA County Name Of Plaintiff Court File No. In The General Court Of Justice District Court Division COVER SHEET Name Of Defendant FOR CHILD SUPPORT CASES (NON-IV-D ONLY) New Child Support Proceeding Motion for Modification of Child Support Order New or Modified Child Support Order G.S. 50-13.4(h) INSTRUCTIONS INSTRUCTIONS TO PARTIES OR ATTORNEYS: Unless a complete and current form is on file in this case, this form, along with a Certification Of Identity For Child Support Cases form (AOC-CV-645), a domestic civil action cover sheet, motion cover sheet, or order cover sheet when required, must be completed in non-IV-D child support cases only and filed with the Clerk of Superior Court if: you are filing a pleading seeking child support (including complaints, answers, or motions in civil actions for domestic violence, divorce, or child custody that include a request for child support), OR you are filing a motion to modify an existing child support order, OR you are submitting a proposed court order (including a voluntary support agreement) establishing or modifying child support. DHHS is redirecting a IV-D case. NOTE: For redirects, the local IV-D office should complete this form and file with the Clerk. INSTRUCTIONS TO CLERK: File this form in the court record for all child support cases. After a child support order is entered or modified: If support is not paid directly to the obligee, enter this information in the clerk's Support Enforcement System. If support is paid directly to the obligee (private case), send a copy of this form to the local IV-D office. First Name PARTY REQUESTING OR RECEIVING CHILD SUPPORT (Custodial Parent or Obligee) Middle Or Maiden Name Last Name Sex DOB Race Suffix (Jr., Etc.) Mailing Address (Include P.O. Box Or Street No., Name, City, State And Zip) Check this box if this person is at risk for domestic violence. First Name PARTY FROM WHOM SUPPORT IS REQUESTED OR ORDERED (Non-Custodial Parent or Obligor) Middle Or Maiden Name Last Name Sex DOB Race Suffix (Jr., Etc.) Mailing Address (Include P.O. Box Or Street No., Name, City, State And Zip) Check this box if this person is at risk for domestic violence. OTHER OR ADDITIONAL PARTICIPANT IN CHILD SUPPORT PROCEEDING Custodial Parent First Name Non-Custodial Parent Or Obligor Middle Or Maiden Name Putative Father Other (specify) Last Name Suffix (Jr., Etc.) DOB Race Mailing Address (Include P.O. Box Or Street No., Name, City, State And Zip) Sex Check this box if this person is at risk for domestic violence. NOTE: List child(ren) for whom support is requested or ordered on reverse side. Name Of Person Completing Form Telephone Number Of Person Completing Form Date NOTE: All filings in civil actions shall include as the first page of the filing a cover sheet summarizing the critical elements of the filing in a format prescribed by the North Carolina Administrative Office of the Courts, and the Clerk of Superior Court shall require a party to refile a filing which does not include the required cover sheet. For subsequent filings, the filing party must either include a Child Support (AOC-CV-640), Motion (AOC-CV-752), or Court Action (AOC-CV-753) cover sheet. AOC-CV-640, Rev. 1/14 © 2014 Administrative Office of the Courts (NOTE: This form may be used in both civil and criminal cases.) (Over) American LegalNet, Inc. www.FormsWorkFlow.com CHILD(REN) FOR WHOM SUPPORT IS REQUESTED OR ORDERED First Name Middle Name Or Initial Last Name Suffix (Jr., Etc.) Sex DOB Race Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial Last Name Suffix (Jr., Etc.) Sex DOB Race Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial DOB Last Name Suffix (Jr., Etc.) Sex Race Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial Race Last Name Suffix (Jr., Etc.) Sex DOB Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial Last Name Suffix (Jr., Etc.) Sex DOB Race Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial Last Name Suffix (Jr., Etc.) Sex DOB Race Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial Last Name Suffix (Jr., Etc.) Sex DOB Race Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial DOB Race Last Name Suffix (Jr., Etc.) Sex Check this box if this child is at risk of child abuse. First Name Middle Name Or Initial Last Name Suffix (Jr., Etc.) Sex DOB Race Check this box if this child is at risk of child abuse. AOC-CV-640, Side Two, Rev. 1/14 © 2014 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com