Page 1 of 4 FORM 13.00 (Eff. 3/28 /19 ) LANGUAGE FOR ALL CHILD SUPPORT AND CASH MEDICAL SUPPORT ORDERS The full name and date of birth of each child who is the subject of this child support and cash medical support order is/are: IT IS ORDERED, ADJUDGED and DECREED that for purposes of this Order, (Plaintiff/Defendant, etc...) is the Child Support Obligor (Plaintiff/Defendant, etc...) is the Child Support Obligee IT IS FURTHER ORDERED, A DJUDGED and DECREED that the worksheet used to compute child support and cash medical support under R.C. 3119.02 is attached and incorporated herein by reference. This Order for child support and medical support is effective . IT IS FURTHER ORDERED, ADJUDGED and DECREED that the Child Support Obligor shall pay current child support for the minor child(ren) of $ per month per child for children for a total of $, and cash medical support of $per month per c hild for children for a total of $ , plus 2% processing fee for a total order of $ per month . IT IS FURTHER ORDE RED, ADJUDGED AND DECREED that c hild support shall be paid until: (1) the child reaches age 18, if the child is not attending a recognized and accredited high school on a full - time basis; (2) the child reaches age 19, so long as the child is attending a recognized and accredited high school on a full - time basis; or (3) until further order of the Court. Support shall be paid by check or money order and any payment shall include all of the following: (1) obligor = s name; (2) the court case number; (3) the SETS number (starts with a 70 number); and (4) the obligor = s social security American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4 FORM 13.00 (Eff. 3/28 /19 ) number. Payments shall be made to: Ohio Chi ld Support Payment Central, P.O. Box 182372, Columbus, Ohio 43218 - 2372. The obligor may contact the Ashland County Child Support Enforcement Agency (CSEA) at 15 W. Fourth Street, Ashland, Ohio 44805, (Ph: 419 - 282 - 5000), for further information about where and how to remit support payments. The obligee is enjoined from accepting and the obligor is enjoined from making any support payments which are not paid through Ohio Child Support Payment Central or the Ashland County Child Support Enforcement Agency. Any current or delinquent support payment made directly by the obligor to the obligee shall be deemed a gift. MONTHLY ADMINISTRATION OF THE ORDER: Regardless of the frequency or the amount of support payments to be made under this Order, the Ashland County Child Support Enforcement Agency shall administer it on a monthly basis, in accordance with Ohio Revised Code Sections 3121.51 to 3121.54. For purposes of Ohio Revised Code Section 3121.52, the monthly amount due under this support order for purposes of its monthly administration is $ (incl uding a 2% processing fee). Payments under this order are to be made in the manner ordered by this Court or the Ashland County Child Support Enforcement Agency. If the payments are to be made other than on a monthly basis, the required monthly administra tion of the Order does not affect the frequency or the amount of the support payments to be made under this Order. WITHHOLDING AND DEDUCTION : All support under this Order shall be withheld or deducted from the income or assets of the obligor pursuant to a withholding or deduction notice or appropriate court Order issued in accordance with Chapters 3119, 3121, 3123 and 3125 of the Revised Code or a withdrawal directive issued pursuant to sections 3123.24 to 3123.38 of the Revised Code and shall be forwarded to the obligee in accordance with Chapters 3119, 3121, 3123 and 3125 of the Revised Code. NOTIFICATION REGARDING TERMINATION OF ORDER: The residential parent and legal custodian of the child(ren) subject to this Order, or the person who otherwise has custody of said child(ren) shall immediately notify, and the obligor may notify, the Ashland County Child Support Enforcement Agency of any reason for which this child support order should terminate. Nothing within this order shall preclude a person from notifying the Ashland County Child Support Enforcement Agency that a reason for which a child support order should terminate is imminent. Wi th American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4 FORM 13.00 (Eff. 3/28 /19 ) respect to this Order, a willful failure to notify the Child Support Enforcement Agency is contempt of Court. The reason for which a child support should terminate including all of the following: (A) the child attains the age of majority if the child no longer attends an accredited high school on a full - time basis and the child support order requires support to continue past the age of majority only if the child continuously attends such a high school after attaining that age; (B) t he child ceases t o attend an accredited high school on a full - time basis after attaining the age of majority, if the child support order requires support to continue past the age of majority only if the child continuously attends such a high school after attaining that age ; (C) a termination condition specified in the child support order has been met for a child who reaches nineteen years of age; (D) the child = s death; (E ) the child = s marriage; (F ) the child = s emancipation; (G ) the child = s enlistment in the armed services; (H ) the child = s deportation; change of legal custody of child; (I) change of legal custody; (J) (L) marriage of the obligor under a child support order to the oblige, if the obligor and oblige reside together with the child EACH PARTY TO THIS SUPPORT ORDER MUST NOTIFY THE CHILD SUPPORT ENFORCEMENT AGENCY IN WRITING OF HIS OR HER CURRENT MAILING ADDRESS, CURRENT RESIDE NCE ADDRESS, CURRENT RESIDENCE TELEPHONE NU CHANGES IN THAT INFORMATION. EACH PARTY MUST NOTIFY THE AGENCY OF ALL CHANGES UNTIL FURTHER NOTICE FROM THE COURT OR AGENCY, WHICHEVER ISSUED THE SUPPORT ORDER. American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4 FORM 13.00 (Eff. 3/28 /19 ) IF YOU ARE THE OBLIGOR UNDER A CHILD SUPPOR T ORDER AND YOU FAIL TO MAKE THE REQUIRED NOTIFICATIONS, YOU MAY BE FINED UP TO $50 FOR A FIRST OFFENSE, $100 FOR A SECOND OFFENSE, AND $500 FOR EACH SUBSEQUENT OFFENSE. IF YOU ARE AN OBLIGOR OR OBLIGEE UNDER ANY SUPPORT ORDER ISSUED BY A COURT AND YOU WIL LFULLY FAIL TO GIVE THE REQUIRED NOTICES, YOU MAY BE FOUND IN CONTEMPT OF COURT AND BE SUBJECTED TO FINES UP TO $1,000 AND IMPRISONMENT FOR NOT MORE THAN 90 DAYS. IF YOU ARE AN OBLIGOR OR OBLIGEE AND YOU FAIL TO GIVE THE REQUIRED NOTICES TO THE CHILD SUPPO RT ENFORCEMENT AGENCY, YOU MAY NOT RECEIVE NOTICE OF THE CHANGES AND REQUESTS TO CHANGE THE CHILD SUPPORT AMOUNT, HEALTH CARE PROVISIONS, OR TERMINATION OF THE CHILD SUPPORT ORDER. IF YOU ARE AN OBLIGOR AND YOU FAIL TO GIVE THE REQUIRED NOTICES, YOU MAY NOT RECEIVE NOTICE OF THE FOLLOWING ENFORCEMENT ACTIONS AGAINST YOU: IMPOSITION OF LIENS AGAINST YOUR PROPERTY; LOSS OF RECREATIONAL LICENSE; WITHHOLDING FROM YOUR INCOME; ACCESS RESTRICTION A ND DEDUCTION FROM YOUR ACCOUNTS IN FINANCIAL INSTITUTIONS; AND ANY OTHER ACTION PERMITTED BY LAW TO OBTAIN MONEY FROM YOU TO S ATISFY YOUR SUPPORT OBLIGATION. American LegalNet, Inc. www.FormsWorkFlow.com