Form Csf 01 0100 - Uniform Income & Expense Statement
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[ ] STATE OF OREGON, Child Support Program, by the Administrator (ORS 25.010)
County:
Court #:
CSP #:
[ ] Other state
Case #:
Children:
Obligor:
Obligee:
[ ] Other parties:
Uniform Income & Expense Statement
Name
Other Name(s) Used
Mailing Address and Physical Address
City
State
Zip
Daytime Telephone Number
Lawyer's Name:
Phone:
The address you list above will be your "contact address." We will use it to send documents to you. It will also appear in legal papers
given to the other parent and in court records. If you do not want your residence or mailing address to be given to the other party or
appear in court records, you must give us a different address in your state for the CSP to use as your "contact address." If the address
you give now is different than one you gave us before, we will use the new one from now on.
Do you have any other support orders for these children?
[ ] Yes
[ ] No
•
If yes, explain and attach the most recent copy of any orders if available:
Do you have a parenting time order or written agreement for these children?
[ ] Yes
[ ] No
•
Attach a copy of the agreement or order.
Do you support any other children?
[ ] Yes [ ] No
This includes biological and adopted children, but not stepchildren unless you have an order to support the
stepchild.
•
If yes, list these children:
Is there an order for you to pay support?
Name
Date of
Relationship
If yes, list state, county & court number.
(first & last)
Birth
(son, daughter, etc.)
•
If you have more children you support, list them at the end of this form. If you wish to provide more
information, explain in the "Additional/Reduced Expenses/Needs" section of this form.
Do you pay and/or receive spousal support?
[ ] Yes
[ ] No
•
List person's name to whom support is paid.
Amount: $
•
List person’s name who is ordered to pay.
Amount: $
Page 1 of 4 - UNIFORM INCOME & EXPENSE STATEMENT
CSF 01 0100 (Rev. 06/02/10)
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