Fill and Sign the South Carolina Child Support 497325973 Form

STATE OF SOUTH CAROLINA ) IN THE FAMILY COURT )       JUDICIAL CIRCUIT COUNTY OF       ) ) )       ) SUPPORT INFORMATION SHEET Plaintiff, ) vs. ) )       ) Defendant. ) Docket No.       Check appropriate box: No spousal or child support ordered. (No other items should be completed.) If support is ordered to be paid directly or through the Court, you must complete BOTH pages (as applicable). Obligation Type Child Support Medical Support Spousal Support Amount $       $       $       Collection Costs (5%) $       $       $       Payment Frequency Payment Start Date       Weekly Bi-weekly Monthly Semi-monthly (1st & 16th) Semi-monthly (15th & 30th) Total Arrearage Amount $       $       $       Wage Withholding Required by S.C. Code Ann. §63-17-1420 Ordered Not Ordered Name of Custodial Parent (if applicable):       *****OBLIGOR’S DESIGNATION STATEMENT: PAYMENT OF COURT COSTS***** I acknowledge that S.C. Code Ann. § 63-3-370 requires that I pay and the Family Court has ordered that I pay court costs in an amount equal to five (5) percent of any support payment made through the Clerk of Court or the centralized wage withholding system. I owe and will pay these costs in addition to my support obligation. To meet my duty to pay court costs, I designate an amount equal to five (5) percent of the support payment I make to be applied and distributed in payment of court costs, not support. I acknowledge the Clerk of Court or, if payments are withheld from my income, the centralized wage withholding system to deduct the fee from every payment made by me or on my behalf. I acknowledge that should I not pay the full amount due, that an arrearage will accrue and that the Clerk of Court may take enforcement action against me for failure to pay all amounts ordered by the Court. If an amendment to the law changes the amount of court costs, this designation authorizes deduction of court collection costs in the amount established by law. Date: ___________________, 20_____ Signature of Person paying Support** **NOTE TO CLERK: FILE AND PROCESS THIS FORM EVEN IF SIGNATURE OF PERSON PAYING SUPPORT IS NOT PROVIDED.** SCCA 446 (4/2010) IDENTIFYING INFORMATION ON THIS PAGE A. OBLIGEE/PAID TO: Name:       Address:       City:       State:       Zip:       Email Address:       Phone:       SSN:       Gender:       Race:       Height:       Weight:       Date of Birth:       Scars:       Driver’s License Number:       Driver’s License Issuing State:       Employer:       Employer Address:       B. OBLIGOR/PAID BY: Name:       Address:       City:       State:       Zip:       Email Address:       Phone:       SSN:       Gender:       Race:       Height:       Weight:       Date of Birth:       Scars:       Driver’s License Number:       Driver’s License Issuing State:       Employer:       Employer Address:       C. CHILDREN CHILDREN’S NAMES DATE OF BIRTH SSN 1.                   2.                   3.                   4.                   5.                   6.                   PREPARED BY TITLE DATE SCCA 446 (4/2010)