REQUEST FOR VIRGINIA REGISTRATION OF FOREIGN SUPPORT ORDER Commonwealth of Virginia VA. CODE § 20-88.67 Case No. .......................................................................................................................................... DCSE ID NO. ............................................................................................................................ ........................................................................................................................................................................................................................... CITY/COUNTY Juvenile and Domestic Relations District Court ........................................................................................................................................................................................................................................................................................................................................................................ COURT ADDRESS Name and Address of Obligee: ................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................................................................................................................................ Name and Address of Obligor: ................................................................................................................................................................................................................................................................................... ................................................................................................................................................................................................ Obligor DOB: .............................................................................................................................. Obligor SSN: ........................................................................................................................... Other Sources of Income: .............................................................................................................................. Name/Address of Obligor's Employer: .............................................................................................................................................................................................................................................................. ........................................................................................................................................................................................................................................................................................................................................................................ Description /Location of Obligor's property within Virginia: Agency/person to whom payment remitted: .................................................................................................................................................................................................... .................................................................................................................................................................................................................................................. I request that the clerk of the above-named court register the attached certified Order(s), described below for the purposes of [ ] Enforcement and/or [ ] Modification. Two copies (including at least one certified copy) of each order are attached. TYPE OF ORDER (Support, Divorce, Income-Withholding, etc.) SUPPORT AMOUNT FREQUENCY COURT/AND ENTRY DATE 1. ___________________________________ 2. ___________________________________ 3. ___________________________________ ........................................................................................................................... DATE 1. _____________________________ 2. _____________________________ 3. _____________________________ 1._________________________________ 2._________________________________ 3._________________________________ ___________________________________________________________________________________ SIGNATURE OF REGISTERING PARTY [ ] OBLIGEE [ ] OBLIGOR CERTIFICATION OF ARREARAGE [ ] I swear or affirm that the total amount of the arrearage through ................................................................................................. is $ ....................................................................... ___________________________________________ SIGNATURE OF REGISTERING PARTY [ ] I CERTIFY THAT I AM THE CUSTODIAN OF THE PAYMENT RECORD AND THAT THE TOTAL AMOUNT OF ARREARAGE THROUGH ___________________________________________________ IS ______________________________________________________ ..................................................................................................................... DATE ______________________________________________________________________ SIGNATURE/TITLE State of ___________________________________ County of _________________________________; Subscribed and sworn to before me this ______ day of ______________________________________, ___________. ____________________________________________ NOTARY PUBLIC FORM DC-685 (MASTER, PAGE ONE OF TWO) REVISED 7/01 American LegalNet, Inc. www.FormsWorkflow.com CONFIRMATION ORDER Pursuant to Va. Code § 20-88.73, the Request for Registration of the above-mentioned Foreign Support Order(s) is: [ ] Confirmed on Court motion following failure of non-registering party to contest validity or enforcement of such order(s) within twenty (20) days of mailing or personal service of notice of registration. [ ] Confirmed following hearing for the purposes of [ ] enforcement [ ] modification [ ] Not confirmed because: [ ] the issuing tribunal lacked personal jurisdiction over the contesting party: [ ] the order was obtained by fraud; [ ] the order has been vacated