Form Nhjb-2066-Fp - Judicial Branch - State Of New Hampshire Page 2
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6Case Name:
Case Number:
UNIFORM SUPPORT ORDER
4.3 Medical arrearage of $
as of
,
payable $
per
(week, month, etc.)
4.4 SPOUSAL SUPPORT (ALIMONY): $
per
(week, month, etc.)
4.5 Arrearage of $
as of
,
payable $
per
(week, month, etc.)
4.6 Alimony shall terminate
5. Payments on all ordered amounts shall begin on
. All ordered amounts
shall be payable to
Obligee
Division of Child Support Services
Other
6.
This order complies with the child support guidelines. RSA 458-C.
This order, entered upon obligor’s default, is based on a reasonable estimate of obligor’s
income. Compliance with the guidelines cannot be determined.
The following special circumstances warrant an adjustment from the guidelines (Enter
applicable circumstances below. See Standing Order 6):
7. Support ordered is payable by immediate income assignment.
8. The Court finds that there is good cause to suspend the immediate income assignment
because:
Obligor and obligee have agreed in writing.
Payments have been timely and it would be in the best interest of the minor child(ren)
because:
9
. Obligor is unemployed and MUST REPORT EFFORTS TO SEEK EMPLOYMENT.
A
(See Standing Order 9A).
9
Upon employment the Obligor shall bring the matter forward for recalculation of support.
B.
Failure to do so may result in a recalculated support order effective the date of employment.
MEDICAL SUPPORT FINDINGS (Paragraphs 10 through 15)
10. OBLIGOR’S medical support reasonable cost obligation: $
per
(week,
month, etc.)
10
.
The medical support reasonable cost obligation is adjusted from the presumptive
A
amount because of the following special circumstances (Enter applicable circumstances
below. See Standing Order 6):
11. Private health insurance coverage
is not available
is available to the OBLIGOR in an
amount equal to or less than the amount of the medical support reasonable cost
obligation ordered in paragraph 10.
12.
Private health insurance coverage available to the OBLIGOR is not accessible to the
child(ren).
13. OBLIGEE’S medical support reasonable cost obligation:$
per
(week,
month, etc.)
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NHJB-2066-FP (07/14/2014)
Page 2 of 6
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