 District Court  Denver Juvenile Court
______County, Colorado
Court Address:
In re the Marriage of:
In re the Parental responsibilities concerning:
______
Petitioner:
v.
Respondent/Co-Petitioner: /

COURT USE ONLY

Case Number:
Division Courtroom

SUPPORT ORDER

Petitioner:

Date of Birth: Social Security No.:

Mailing Address:

Residential Address:

Name of Employer: ______Address: ______

Respondent/Co-Petitioner:

Date of Birth: Social Security No.:

Mailing Address:

Residential Address:

Name of Employer: ______Address: ______

THE COURT ORDERS the  PetitionerCo-Petitioner/Respondent, ______to pay child support maintenance to ______(name of party) commencing on ______(date). Payments are due on ______(specify time period, i.e. monthly). Total arrears owed as of ______(date) for Child Support $______and/or Maintenance $______.

The total monthly obligation is as follows:$ ______Current Child Support

$ ______Current Maintenance

Total Retroactive Child Support $ ______$ ______Retroactive Support

$ ______Payment Toward Arrears (child support)

$ ______Payment Toward Arrears (maintenance)

For a total monthly payment of$ ______

Upon payment in full of the Retroactive Support, the monthly payment is reduced to $ ______.

The children of this marriage for whom child support is ordered are: (State name, sex, date of birth and Social Security number of each child):

Name of Children / Sex / Date of Birth / Social Security Number

The Court orders the immediate activation of an income assignment against the Obligor, pursuant to §14-14-111.5, C.R.S.

Income assignments must be paid through the Family Support Registry, pursuant to §26-13-114(6)(a), C.R.S.

The income assignment shall be paid directly to the Obligee.

OR

This Order is not subject to the immediate activation of an income assignment because either:

Both parties have agreed in writing to an alternative arrangement.

OR

The Court finds there is good cause not to require the immediate activation of an income assignment because:

The Court further orders the Petitioner Co-Petitioner/Respondentto provide medical insurance for the children through the employer. Policy Number: ______, Name of Insurer: ______, Address of Insurer: ______; and/or dental insurance for the children through the employer. Policy Number: ______, Name of Insurer: ______, Address of Insurer: ______

The Court finds health/dental insurance is not currently available to either party at a reasonable cost and does not order either party to provide coverage for the children at this time, but does order the parties to provide coverage when it becomes available at a reasonable cost

Payments shall continue until further Order of the Court. Payments shall be:

Mailed to the Family Support Registry OR  Mailed directly to the appropriate party.

P. O. Box 2171

Denver, CO 80201-2171

Dated:

 District Court Judge

 District Court Magistrate

JDF 1117 R9/03 SUPPORT ORDERPage 1 of 2