Child Support Order Summary Form
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1Child Support Order Summary Form
This form must be completed and given to time Clerk or the Court, with a copy of the final order attached.
SUPPORT PAYMENTS UNDER THIS ORDER MUST BE SENT TO THE STATE OF IDAHO,
CHII.D SUPPORT RECEIPTING, P.O. BOX 70008, BOISE, ID 83707
Case # ____________________________________ County _______________________ Date of Order ___________________
Who is ordered to pay child support? (full name) ________________________________________________________________
How much? $ ___________
How often: _____weekly _____ monthly
Beginning date: ________________________
Special child support terms in this order (check all that apply): _____Cost of living increases
_____Modification of a previous order
_____Decrease for visitation
_____Other _____________________________
Is there an order for Wage Assignment?
_____Yes
_____ No (If yes, please attach a copy of the Wage Assignment Order)
Plaintiff’s full name _________________________________________________________
_____Male _____Female
Social Security # _________________________ Date of Birth ____________________ Phone Number______________________
Mailing address ___________________________________________________________________________________________
Residence address (if different than mailing) ____________________________________________________________________
Employer name and address ________________________________________________________________________________
Plaintiff's attorney: ______________________________Phone _____________________ City/State _______________________
Defendant's full name __________________________________________________________
_____ Male _____ Female
Social Security # _______________________ Date of birth ______________________ Phone number _____________________
Mailing address ____________________________________________________________________________________________
Residence address (if different than mailing) _____________________________________________________________________
Employer name and address __________________________________________________________________________________
Defendant's attorney: ___________________________ Phone ________________________ City/State ______________________
Children for whom support is ordered in this order:
Child's Full Name
Social Security #
Date of Birth
Sex
______________________________________
_________________________ _______________________ _____________
______________________________________
_________________________ _______________________ _____________
______________________________________
_________________________ _______________________ _____________
______________________________________
_________________________ _______________________ _____________
If support is ordered for more than four children, please attach a separate sheet of paper with the information.
Print name of person who completed this form: ___________________________________________ Date: __________________
CHILD SUPPORT ORDER SUMMARY FORM
CAO 1-14 Effective 7/99
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