Fill and Sign the Does Not Apply because No Attorneys Fees or Back Child Support Has Been Ordered Form

Order of Child Support (TMORS, ORS) - Page 1 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 Superior Court of Washington County of In re the Parenting and Support of: Child(ren) Petitioner and Respondent. No. Order of Child Support [ ] Temporary (TMORS) [ ] Final Order (ORS) Clerk’s Action Required I. Judgment Summary [ ] Does not apply because no attorney’s fees or back child support has been ordered. [ ] The judgment summary: A. Judgment creditor B. Judgment debtor C. Principal judgment amount (back child support) $ from ______________ [Date] to ______________ [Date] D. Interest to date of judgment $ E. Attorney fees $ F. Costs $ G. Other recovery amount $ H. Principal judgment shall bear interest at __________ % per annum I. Attorney fees, costs and other recovery amounts shall bear interest at __________ % per annum J. Attorney for judgment creditor K. Attorney for judgment debtor L. Other: Order of Child Support (TMORS, ORS) - Page 2 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 II. Basis 2.1 Type of Proceeding This order is entered under an acknowledgment of paternity petition for residential schedule/parenting plan/child support: [ ] judgment and order establishing residential schedule/parenting plan/child support. [ ] order for modification of child support. [ ] hearing for temporary child support. [ ] order of adjustment. [ ] order for modification of a custody decree or parenting plan. [ ] other: 2.2 Child Support Worksheet The child support worksheet which has been approved by the court is attached to this order and is incorporated by reference or has been initiale d and filed separately and is incorporated by reference. 2.3 Other III. Findings and Order It is Ordered: 3.1 Children for Whom Support Is Required Name (first/last) Age 3.2 Person Paying Support (Obligor) Name (first/last): Birth date: Service Address: [You may list an address that is not your residential address where you agree to accept legal documents.] The obligor parent must immediately file with the court and the Washingt\ on State Child Support Registry, and update as necessary, the confidential inform\ ation form required by RCW 26.23.050. Order of Child Support (TMORS, ORS) - Page 3 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 The obligor parent shall update the information required by paragraph 3.\ 2 promptly after any change in the information. The duty to update the inf\ ormation continues as long as any monthly support remains due or any unpaid suppo\ rt debt remains due under this order. [ ] Monthly Net Income: $_______________. [ ] The income of the obli gor is imputed at $_______________ because: [ ] the obligor’s income is unknown. [ ] the obligor is voluntarily unemployed. [ ] the obligor is voluntarily underemployed. [ ] other: 3.3 Person Receiving Support (Obligee) Name (first/last): Birth date: Service Address: [You may list an address that is not your residential address where you agree to accept legal documents.] The obligee must immediately file with the court and the Washington Stat\ e Child Support Registry, and update as necessary, the confidential information \ form required by RCW 26.23.050. The obligee shall update the information required by paragraph 3.3 promp\ tly after any change in the information. The duty to update the information contin\ ues as long as any monthly support remains due or any unpaid support debt remai\ ns due under this order. [ ] Monthly Net Income: $_______________. [ ] The income of the oblig ee is imputed at $_______________ because: [ ] the obligee’s income is unknown. [ ] the obligee is voluntarily unemployed. [ ] the obligee is voluntarily underemployed. [ ] other: The obligor may be able to seek reimbursement fo r day care or special child rearing expenses not actually incurred. RCW 26.19.080. Order of Child Support (TMORS, ORS) - Page 4 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 3.4 Service of Process Service of process on the obligor at the address required by paragraph 3\ .2 or any updated address, or on the obligee at the address required by paragraph \ 3.3 or any updated address, may be allowed or accepted as adequate in any proce\ eding to establish, enforce or modify a child support order between the partie\ s by delivery of written notice to the obligor or obligee at the last address\ provided. 3.5 Transfer Payment The obligor parent shall pay the following amounts per month for the following children: Name Amount $ $ $ $ Total Monthly Transfer Amount $ [ ] The parents’ combined monthly net income exceeds $7,000 and the court sets child support in excess of the advisory amount because: [ ] If one of the children changes age brack ets, the child support shall be as follows: [ ] This is a downward modification that has caused an overpayment of $ ________. This amount shall be repaid or credited as follows: [ ] This is an upward modification that has caused an underpayment of $_______. This amount shall be paid as follows: [ ] Other: The obligor parent’s privileges to obtain or maintain a license, cert\ ificate, registration, permit, approval, or other similar document issued by a li\ censing entity evidencing admission to or granting authority to engage in a prof\ ession, occupation, business industry, recreational pursuit, or the operation of\ a motor vehicle may be denied or may be suspended if the obligor parent is not i\ n compliance with this support order as provided in Chapter 74.20A Revised\ Code of Washington. Order of Child Support (TMORS, ORS) - Page 5 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 3.6 Standard Calculation $_______________ per month. (See Worksheet line 15.) 3.7 Reasons for Deviation from Standard Calculation [ ] The child support amount ordered in paragraph 3.5 does not deviate from the standard calculation. [ ] The child support amount ordered in paragra ph 3.5 deviates from the standard calculation for the following reasons: [ ] Income of a new spouse of the pare nt requesting a deviation for other reasons; [ ] Income of other adults in the household of the parent requesting a deviation for other reasons; [ ] Child support actually paid or received for other children from other relationships; [ ] Gifts; [ ] Prizes; [ ] Possession of wealth; [ ] Extraordinary income of a child; [ ] Tax planning which results in greater benefit to the children; [ ] A nonrecurring source of income; [ ] Extraordinary debt not voluntarily incurred; [ ] A significant disparity in the living costs of the parents due to conditions beyond their control; [ ] Special needs of disabled children; [ ] Special medical, educational, or psychological needs of the children; [ ] The child spends a significant amount of time with the parent who is obligated to make a support transfer payment. The deviation does not result in insufficient funds in the receiving parent’s household to meet the basi c needs of the child. The child does not receive public assistance; [ ] Children from other relationships; [ ] Costs incurred or anticipated to be in curred by the parents in compliance with court- ordered reunification efforts or under a voluntary placement agreement with an agency supervising the child; [ ] The obligor has established that it is unjust or inappropriate to apply the presumptive minimum payment of $25.00 per child. [ ] Other: The factual basis for these reasons is as follows: [ ] Other: Order of Child Support (TMORS, ORS) - Page 6 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 3.8 Reasons why Request for Deviation was Denied [ ] Does not apply. A deviation was ordered. [ ] A deviation was not requested. [ ] The deviation sought by the [ ] obligor [ ] obligee was denied because: [ ] no good reason exists to justify deviation. [ ] other: 3.9 Starting Date and Day to Be Paid Starting Date: _______________ Day(s) of the month support is due: _______________ 3.10 Incremental Payments [ ] Does not apply. [ ] This is a modification of child support. Pursuant to RCW 26.09.170 (9)(a) and (c), the obligation has been modified by more th an 30 percent and the change would cause significant hardship. The increase in the child support obligation set forth in Paragraph 3.5 shall be implemented in two equal increm ents, one at the time of this order and the second on _______________ [Date], six months from the entry of this order. 3.11 How Support Payments Shall be Made Select Enforcement and Collection, Payment Processing Only, or Direct Payment : [ ] Enforcement and collection: The Division of Child Support (DCS) provides supp\ ort enforcement services for this case because: [ ] Th is is a public assistance case, [ ] this is a case in which a parent has requested servi ces from DCS, [ ] a parent has signed the application for services from DCS on the last page of this support order. (Check all that apply.) Support payments shall be made to: Washington State Support Registry P. O. Box 45868 Olympia, WA 98504 Phone: 1-800-922-4306 or 1-800-442-5437 [ ] Payment services only: The Division of Child Support will process and keep a record of all payments but will not take any collection action. Support payments shall be made to: Washington State Support Registry P. O. Box 45868 Olympia, WA 98504 Phone: 1-800-922-4306 or 1-800-442-5437 Order of Child Support (TMORS, ORS) - Page 7 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 [ ] Direct Payment: Support payments shall be made directly to: Name Mailing Address ________________________________________ A party required to make payments to the Washington State Child Support Registry will not receive credit for a payment made to any other part y or entity. The obligor parent shall keep the registry informed whether he or she has access to health insurance coverage at reasonable cost and, if so, to provide the health insurance policy information. 3.12 Wage Withholding Action Withholding action may be taken against wages, earnings, assets, or benefits, and liens enforced against real and personal property under the child support statutes of this or any other state, without further notice to the obligor parent at any time after entry of this order unless an alternative provision is made below: [If the court orders immediate wage withholding in a case where DCS does not provide support enforcement services, a mandatory wage assignment under Chapter 26.18 RCW must be entered and support payments must be made to the Support Registry.] [ ] Wage withholding, by notice of payro ll deduction or other income withholding action under Chapter 26.18 RCW or Chapter 74.20A RCW, without further notice to\ the obligor, is delayed until a payment is past due, because: [ ] the parties have reached a written agreement which the court approves that provides for an alternate arrangement. [ ] the Division of Child Support provides support enforcement services for this case [see 3.11] and there is good cause [as stated below under "Good Cause"] not to require immediate income withholding which is in the best interests of the child and, in modification cases, previously ordered child support has been timely paid. [ ] the Division of Child Support does not provide support enforcement services for this case [see 3.11] and there is good cause [as stated below under "Good Cause"] not to require immediate income withholding. Good Cause: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ 3.13 Termination of Support Support shall be paid: [ ] provided that this is a temporary order, until a subsequent child support order is entered by this court. Order of Child Support (TMORS, ORS) - Page 8 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 [ ] until the child(ren) reach(es) the age of 18 or as long as the child(ren) remain(s) enrolled in high school, whichever occurs last, except as otherwise provided below in Paragraph 3.14. [ ] until the child(ren) reach(es) the age of 18, except as otherwise provided below in Paragraph 3.14. [ ] after the age of 18 for ______________________________ [Name] who is a dependent adult child, until the child is capable of self-support and the necessity for support ceases. [ ] until the obligation for post secondary support set forth in Paragraph 3.14 begins for the child(ren). [ ] other: 3.14 Post Secondary Educational Support [ ] The right to petition for post secondary suppor t is reserved, provided that the right is exercised before support terminates as set forth in paragraph 3.13. [ ] The parents shall pay for the post secondary educational support of the child(ren). Post secondary support provisions will be decided by agreement or by the court. [ ] No post secondary educati onal support shall be required. [ ] Other: 3.15 Payment for Expenses not Included in the Transfer Payment [ ] Does not apply because all payments, ex cept medical, are included in the transfer payment. [ ] The mother shall pay __________% and the father __________% (each parent’s proportional share of income from the Child Support Schedule Worksheet, line 6) of the following expenses incurred on behalf of the children listed in Paragraph 3.1: [ ] day care. [ ] educational expenses. [ ] long distance transportation expenses. [ ] other: Payments shall be made to [ ] the provider of the service [ ] the parent receiving the transfer payment. [ ] The obligor shall pay the following amounts each month the expense is incurred on behalf of the children listed in Paragraph 3.1: [ ] day care: $_______________ payabl e to the [ ] day care provider [ ] other parent; [ ] educational expenses: $_______________ payable to the [ ] educational provider [ ] other parent; Order of Child Support (TMORS, ORS) - Page 9 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 [ ] long distance transportation: $______________ payable to the [ ] transportation provider [ ] other parent. [ ] other: 3.16 Periodic Adjustment [ ] Does not apply. [ ] Child support shall be adjusted periodically as follows: [ ] Other: 3.17 Income Tax Exemptions [ ] Does not apply. [ ] Tax exemptions for the child ren shall be allocated as follows: [ ] The parents shall sign the federal income tax dependency exemption waiver. [ ] Other: 3.18 Medical Insurance for the Children Listed in Paragraph 3.1 Unless one or more of the alternatives below are checked, each parent shall maintain or provide health insurance coverage if: (a) Coverage that can be extended to cover the child(ren) is or becomes available to each parent through employment or is union-related; and (b) The cost of such coverage for the mother does not exceed $____ (25 percent of mother’s basic child support obligation on Worksheet line 7), and the cost of such coverage for the father does not exceed $____ (25 percent of father’s basic ch ild support obligation. See Worksheet line 7). [ ] Alternative 1: The parent below shall maintain or provide health insurance coverage if coverage that can be extended to cover the child (ren) is or becomes available to that parent through employment or is union-relate d and the cost of such coverage does not exceed $__________ (25 percent of that parent's basic child support obligation. See Worksheet line 7). [ ] mother [ ] father [ ] Alternative 2: The parent below shall maintain or pr ovide health insurance coverage if coverage that can be extended to cover the child (ren) is or becomes available to that parent through employment or is union-re lated even if such coverage exceeds $______ (25 percent of that parent's basic child support obligation. See Worksheet line 7.). [ ] mother [ ] father Order of Child Support (TMORS, ORS) - Page 10 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 [ ] Alternative 3: The parent below is not obligated to provide health insurance coverage: [ ] mother [ ] father This parent is not obligated to provi de health insurance coverage because: [ ] the other parent provides insurance coverage [ ] other: The parent(s) shall maintain health insurance c overage, if available for the children listed in paragraph 3.1, until further order of the court or until health insurance is no longer available through the parents’ employer or union and no conve rsion privileges exist to continue coverage following termination of employment. A parent who is required under this order to provide health insura nce coverage is liable for any covered health care costs for which that parent receives direct payment from an insurer. A parent who is required under this order to provide health in surance coverage shall provide proof that such coverage is available or not availa ble within 20 days of the entry of this order to the physical custodian or the Washington State Support Registry if the parent has been notified or ordered to make payments to the Washington State Support Registry. If proof that health insurance coverage is ava ilable or not available is not provided within 20 days, the obligee or the Department of Social and Health Services may seek direct enforcement of the coverage through the obligor’s employer or union without further notice to the obligor as provided under Chapter 26.18 RCW. 3.19 Extraordinary Health Care Expenses The Obligor shall pay __________ percent of extraordinary health care expenses (the obligor’s proportional share of income from the Child Support Schedule Worksheet, line 6), if monthly medical expenses ex ceed $_______________ (5 percent of the basic support obligation from Worksheet line 5). 3.20 Back Child Support [ ] No back child support is owed at this time. [ ] Back child support that may be owed is not affected by this order. [ ] The obligee parent is awarded a judgment against the obligor parent in the amount of $_______________ for back child support for the period from _______________ [Date] to _______________ [Date]. [ ] Other: Order of Child Support (TMORS, ORS) - Page 11 of 11 WPF PS 15.0700 (6/2006) - RCW 26.09.105, RCW 26.26.375, RCW 26.19 3.21 Back Interest [ ] No back interest is owed at this time. [ ] Back interest that may be owed is not affected by this order. [ ] The obligee parent is awarded a judgment against the obligor parent in the amount of $_______________ back interest for the period from _______________ [Date] to _______________ [Date]. [ ] Other: 3.22 Other Dated: Judge/Commissioner Presented by: Approved for entry: Notice of presentation waived: Signature of Party or Lawyer/WSBA No. Signature of Party or Lawyer/WSBA No. Print or Type Name Print or Type Name [ ] I apply for full support enforcement services from the DSHS Division of Child Support. Signature of Party [ ] Approval required in Public Assistance cases. The DSHS’ Division of Child Support received notice required by RCW 26.23.130. This orde r has been reviewed and approved as to: [ ] Current Child Support [ ] Back Child Support [ ] Medical Support [ ] Other: Deputy Prosecuting Attorney/WSBA No. Print or Type Name