Fill and Sign the If Temporary Divorce Modification Paternity Juvenile Other Form

IN THE DISTRICT COURT OF COUNTY STATE OF OKLAHOMA PlaintiffVS. District Court Case Number Defendant_____________________________________________________________________________________SUMMARY OF SUPPORT ORDERNature of Action. If Temporary: [ ]Divorce [ ] Modification [ ]Paternity [ ] Juvenile [ ]Other___________ If Final: [ ]Divorce [ ] Modification [ ] Paternity [ ] Juvenile [ ] Other _____________ On the following order was entered: (date) 1 . , Obligor, of the child(ren), (relationship) Obligee, of the child(ren). (relationship) 2.$ to be paid per First payment is due on(M,B,S,W) (date)3. For the following child(ren): FirstMiddle Last Name BirthdateSexSocial Security NumberFirstMiddle Last Name BirthdateSexSocial Security NumberFirstMiddle Last Name BirthdateSexSocial Security NumberFirstMiddle Last Name BirthdateSexSocial Security NumberFirstMiddle Last Name BirthdateSexSocial Security NumberFirstMiddle Last Name BirthdateSexSocial Security Number 4. Obligor also pays: $$$ 5. An income assignment is immediately ordered. [ }The name, mailing address, city/state and zip ofthe obligor's employer is6. Health insurance provided for child(ren) [ ] Obligor [ } Obligor's Employer [ ] Obligee [ ] OtherParty 7. Additional Obligor information: Birthdate Sex Social Security No. Drivers License No. Street Address --------------- CityState Zip8. Additional Obligee information: Birthdate SexSocial Security No.Drivers License No.Street Address _ CityState Zip9. Other Parent Information: First Middle Last Name Birthdate Sex Social Security No. Drivers License No. Street Address CityState ZipDATE: PREPARED BY:FGN, IF AVAILABLE _____________________________________ --COURT CLERK USE ONLY PLEASE SUBMIT THIS FORM TO: *******ADDRESS******* *******FAX NUMBER***INSTRUCTIONS FOR COMPLETING THE SUMMARY OF SUPPORT ORDER FORM FOR CHILD SUPPORT ORDERSPurpose. This form is required pursuant to 43 O.S. Section 112.A, 43 O.S. Section 120 and 43 O.S. Section 413. The Summary of Support Order form must be completed by the attorney who prepares the order or one of the parties if neither is represented by counsel. The form must be submitted and incorporated as a part of all child support orders. Distribution of form. The original copy shall be filed with the child support order and remain in the court file. The court clerk cannot accept and file the child support order unless this form is incorporated with the order. The district court clerk will submit a copy of this form to the State Case Registry. STYLE:Enter the county in which the order was entered.Enter the Plaintiffs name as it appears on the order.Enter the Defendant's name as it appears on the order.Enter the District Court Case Number as it appears on the order.SUMMARY OF SUPPORT ORDER: Nature of Action: If this order is Temporary enter a check in the proper box signifying thenature of the temporary action. If this order in Final enter a check in the proper boxsignifying the nature of the final action.Entry of Order Enter date the order was entered.1. Enter the name of the Obligor (the person who is to pay support). Enter therelationship (e.g., father) of the obligor to the children stated in the order. Enter the nameof the Obligee (the person to whom support is to be paid). ). Enter the relationship (e.g.,mother) of the obligee to the children stated in the order.2. Enter the current child support amount. Enter the frequency of payment -monthly,biweekly, semi-monthly,weekly. Enter the date the first payment is due.3. Enter the full name, birth date, sex, and social security number of all children listed inthe order.4. Enter a description and payment amount of any other type of support or payment listedin the order such as child care, medical payments, Interest, support alimony, fees orcosts.5. Check box if this order provides for immediate Income assignment Enter the name,mailing address, city, state and zip of the obligor's employer.6. If health insurance is provided for the children in the order, check the box(es) indicatingwho is to provide the insurance. If Other Party, enter the name of the other party.7. Enter the Obligor's birth date, sex, social security number, driver's license number, andhome address.8. Enter the Obligee's birth date, sex, social securlity number, drivers license number,and home address.9. If both parents are not identified as either the obligor or obligee, enter the otherparent's full name, birth date, sex, social security number, driver's license number, andhome address. DATE:Enter the date this form is completed.PREPARED BY: The signature of the person preparing this form.FGN: Enter IV-D Case Number if available. (DHS/CSED employees only.)