Fill and Sign the This Form Must Be Completed and Given to Time Clerk or the Court with a Copy of the Final Order Attached

CHILD SUPPORT ORDER SUMMARY FORMCAO 1-14 Effective 7/99 Child Support Order Summary Form This form must be completed and given to time Clerk or the Court, with a copy of the final order attached. SUPPORT PAYMENTS UNDER THIS ORDER MUST BE SENT TO THE STATE OF IDAHO, CHII.D SUPPORT RECEIPTING, P.O. BOX 70008, BOISE, ID 83707 Case # ____________________________________ County _______________________ Date of Order ___________________Who is ordered to pay child support? (full name) ________________________________________________________________How much? $ ___________ How often: _____weekly _____ monthly Beginning date: ________________________Special child support terms in this order (check all that apply): _____Cost of living increases_____Modification of a previous order _____Decrease for visitation _____Other _____________________________Is there an order for Wage Assignment? _____Yes _____ No (If yes, please attach a copy of the Wage Assignment Order)Plaintiff’s full name _________________________________________________________ _____Male _____FemaleSocial Security # _________________________ Date of Birth ____________________ Phone Number______________________Mailing address ___________________________________________________________________________________________Residence address (if different than mailing) ____________________________________________________________________Employer name and address ________________________________________________________________________________Plaintiff's attorney: ______________________________Phone _____________________ City/State _______________________Defendant's full name __________________________________________________________ _____ Male _____ FemaleSocial Security # _______________________ Date of birth ______________________ Phone number _____________________Mailing address ____________________________________________________________________________________________Residence address (if different than mailing) _____________________________________________________________________Employer name and address __________________________________________________________________________________Defendant's attorney: ___________________________ Phone ________________________ City/State ______________________Children for whom support is ordered in this order: Child's Full Name Social Security # Date of Birth Sex______________________________________ _________________________ _______________________ ___________________________________________________ _________________________ _______________________ ___________________________________________________ _________________________ _______________________ ___________________________________________________ _________________________ _______________________ _____________If support is ordered for more than four children, please attach a separate sheet of paper with the information.Print name of person who completed this form: ___________________________________________ Date: __________________