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Username: Password: Register Original Case Number: Atlas Number: Date of original Order: Original Case Judge Is the Department of Economic Security (DES) providing child support enforcement services to at least one of the parties? Yes No Unknown The petitioner in the original case was? Father Mother This form is being completed by? Father Mother Who currently pays the child support? Father Mother Who do the children live with now? Father Mother How many days of visitation does the non custodial parent get per year? Father Name Address City State Zip Phone DOB SSN Job Title Current Employer Payroll Address City, State, Zip Telephone Fax Mother Name Address City State Zip Phone DOB SSN Job Title Current Employer Payroll Address City, State, Zip Phone Fax Enter the following amounts from the current support order: Child Support per monthhalf monthtwo weeksweek Spousal Maintenance per monthhalf monthtwo weeksweek Other per monthhalf monthtwo weeksweek Payments in arrears: per monthhalf monthtwo weeksweek Please enter current monthly income and expenses: These must be monthly figures: Father Mother Gross income Income is Estimated or Attributed? NoYes NoYes Spousal Maintenance paid Spousal Maintenance received Child Support paid(other children) Adjustment for Other Children Medical Insurance is paid by FatherMother Work Related child care is paid by FatherMother Extraordinary Child Expenses Please enter information about the minor children, starting with the oldest.: NameFirst M.Last Gender DOBmm/dd/yyyy SSN123-45-6789 1) MaleFemale 2) MaleFemale 3) MaleFemale 4) MaleFemale 5) MaleFemale 6) MaleFemale Site designed By MediaRites.com
Is the Department of Economic Security (DES) providing child support enforcement services to at least one of the parties?
Yes No Unknown
The petitioner in the original case was?
Father Mother
This form is being completed by?
Who currently pays the child support?
Who do the children live with now?
How many days of visitation does the non custodial parent get per year?
Father
Name
Address
City
State
Zip
Phone
DOB
SSN
Job Title
Current Employer
Payroll Address
City, State, Zip
Telephone
Fax
Mother
Enter the following amounts from the current support order:
per monthhalf monthtwo weeksweek
Spousal Maintenance
Other
Payments in arrears:
Please enter current monthly income and expenses:
Gross income
Income is Estimated or Attributed?
Spousal Maintenance paid
Spousal Maintenance received
Child Support paid(other children)
Adjustment for Other Children
Medical Insurance is paid by FatherMother
Work Related child care is paid by FatherMother
Extraordinary Child Expenses
Please enter information about the minor children, starting with the oldest.:
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