IN THE CIRCUIT/CHANCERY COURT OF SHELBY COUNTY TENNESSEE Plaintiff, ____________________________________ Vs. DOCKET NO: ___________________ Defendant, __________________________________ PETITION AND AFFIDAVIT TO ENFORCE CHILD SUPPORT (4 pages) Comes now the Petitioner, __________________________________________, under T.C. A. Title 36, Chapter 5, stating that: 1. Petitioner is a resident of_________________________________ and lives at County ___________________________________________________, Zip code____________ Street Address, City, State Petitioner’s date of birth ____/____/________ Social Security #____________________ 2. Respondent is a resident of_____________________________ and lives at County _____________________________________________________, Zip code__________ Street Address, City, State Respondent’s date of birth ____/____/____ Social Security #_______________________ 3. The child(ren) for whom support is sought is (are): Name____________________________________ Birth date ______/_______/________ Name____________________________________ Birth date ______/_______/________ Name____________________________________ Birth date ______/_______/________ Name____________________________________ Birth date ______/_______/________ 4. This (these) child(ren) reside at ___________________________________________ 5. Petitioner’s relationship to the (these) child(ren) is ____________________________ 6. When and how much was his/her last contribution for support? __________________ _____________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com 7. Is there an order for support in any Court? ______ . If so, name the Court, amount and docket number. ____________________________________________________ _____________________________________________________________________ 8. Respondent is employed by: (Give company name and address) ______________________________________________________________________ ______________________________________________________________________ 9. Petitioner seeks to: (Check appropriate items) ______ (a) enforce support ______ (b) recover arrearages due in the amount of $______________ The above facts are true and correct to the best of my knowledge and belief. Petitioner’s Signature: _____________________________________________________ Address: _______________________________________________________________ Telephone Number: ______________________________________________________ State of Tennessee County of Shelby Sworn to and Subscribed before me on this ______day of __________________20____. __________________________________________ Notary Public or Deputy Clerk Respondent’s Signature ____________________________________________________ Address: _______________________________________________________________ Telephone Number: ______________________________________________________ State of Tennessee County of Shelby Sworn to and Subscribed before me on this ______day of __________________20____. __________________________________________ Notary Public or Deputy Clerk 2 American LegalNet, Inc. www.USCourtForms.com ________________________________________________________________________ FIAT ________________________________________________________________________ To the Clerk and Master of the Shelby County Chancery Court: Issue notice to the respondent that a hearing regarding the above petition will be heard in Part ____ of Chancery Court on the ____ day of ____________, 20___ at ____: ____ ___. M. _______________________________ JUDGE/CHANCELLOR ___________________________________________ DATE ________________________________________________________________________ REFERENCE TO DIVORCE REFEREE ______________________________________________________ The above matter is referred to the Divorce Referee for a hearing regarding the above requested relief. This cause is set for Hearing on the _________day of __________________, 20______, at 1:00 p.m. at the following location: Shelby County Courthouse 140 Adams, Room 327 Memphis, TN 38103 Phone: 901-545-4036 ____________________________________ JUDGE/CHANCELLOR ____________________________________ DATE CERTIFICATE OF SERVICE certify that a copy of this Petition, with Hearing date included, was mailed to the Respondent at__________________________________ by United States Mail prepaid this __________day of __________________________, 20_____. I ___________________________________________ DEPUTY COURT CLERK 3 American LegalNet, Inc. www.USCourtForms.com IN THE CIRCUIT/CHANCERY COURT OF SHELBY COUNTY TENNESSEE__ Plaintiff, ________________________________ Vs. DOCKET NO: ________________ Defendant, ______________________________ RECOMMENDATIONS OF DIVORCE REFEREE ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ___________________________________ at the ____ plaintiff’s ____ defendant’s cost. _________________________________ DIVORCE REFEREE ____________________________________ DATE ________________________________________________________________________ ORDER TO ENFORCE CHILD SUPPORT The above recommendations of the Divorce Referee are confirmed and so ordered by the court. ____________________________________ JUDGE/CHANCELLOR ____________________________________ DATE Form: P0-09/04 4 American LegalNet, Inc. www.USCourtForms.com