Montana State Case Registry And Vital Statistics Reporting Form Department Of Public Health And Human Services
Download a blank fillable Montana State Case Registry And Vital Statistics Reporting Form Department Of Public Health And Human Services in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Montana State Case Registry And Vital Statistics Reporting Form Department Of Public Health And Human Services with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4INSTRUCTIONS
Order Information: Check the box that most accurately describes the type of order being entered.
If it is a dissolution of marriage, enter the place of marriage and indicate if child support is ordered.
Temporary support orders and paternity orders that contain child support are categorized as “child
support order, without dissolution.” “Child support order” includes medical support orders. If the
order does not contain a child support order, social security numbers of the parties are not required
and only Parts 1, 2 and 9 need to be completed.
Parts 1 and 2: Provide information about the parties to the order. If there is a child support order,
be sure to check the box that shows whether the party owes support (payer) or will receive support
(payee). If a party is ordered to both pay and receive support, check the box labeled “both.” If there
is no support order, check the box labeled “N/A” for not applicable. If a party is ordered to pay $0
support, that party should be considered a payer.
Part 3: Provide information about the children named in the order and indicate which parent or other
party the children live with. If the parenting plan provides for shared residential parenting, circle “B”
for both. If a child is not living with either parent, circle “O” and list the child’s name and address.
Part 4: Complete this part if support is ordered to be paid to an agency or an individual other than
a parent.
Part 5: Indicate whether any of the parties are protected from each other by a protective or
restraining order. If yes, list the names of the protected parties. This includes any protected children.
Part 6: Provide information about the employment or other source of income of the party who is
ordered to pay child support. If both parties are ordered to pay support, skip Part 6 and complete
Part 10 instead.
Part 7: Provide information about the support order. Check the type(s) of support ordered and
enter the amount and how often it is due. (Example: $100 per week.) All orders should have a
“begin” date; many will not have an “end” date. If both parties are ordered to pay support, skip Part
7 and complete Part 11 instead.
If the order enters a judgment for past due support, show the total amount of the judgment. If the
judgment includes amounts for penalties, fees or interest, list those amounts on the appropriate lines.
List any special conditions of the support order. (Example: support is due until the child graduates
from college.)
Copy the information requested about the guidelines to this form from the guidelines worksheet.
Part 8: Provide information about health insurance coverage for the children. If insurance is not
provided, indicate whether it is available through the employer of either parent. Relationship of the
party providing insurance is the party’s relationship to the children. (Example: mother, father,
mother’s spouse, father’s spouse.) List the terms and conditions of the insurance coverage.
(Example: 80/20 plan, $500 deductible, major medical only.)
Part 9: Provide information about the person completing this form.
Part 10: Employment information for multiple payers. Complete only if both parties are ordered to
pay support. See Part 6 instructions.
Part 11: Order information for multiple payers. Complete only if both parties are ordered to pay
support. See Part 7 instructions.
1
(Revised 7/1/99)
ADVERTISEMENT
0 votes
Related Articles
Related forms
State Of Illinois Certificate Of Child Health Examination - Illinois Department Of Public Health
Medical
Form Ioci 12-234 - Emergency Medical Services (ems) Systems Independent Renewal - Illinois Department Of Public Health
Medical
Form Ioci 12-234 - Emergency Medical Services (ems) Systems Reactivation Request Form - Illinois Department Of Public Health
Medical
Related Categories
Parent category: Legal