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STATE OF SOUTH CAROLINA COUNTY OF

vs.

) ) ) ) ) Plaintiff ) ) ) Defendant. )

IN THE FAMILY COURT JUDICIAL CIRCUIT SUPPORT COMPLAINT FILE NO. Date of Birth: Date of Birth: respectfully shows that: in in County, South Carolina County, South Carolina .

Plaintiff: Defendant: The Complaint of 1. 2. 3. 4.

SSN: SSN:

The plaintiff resides at The defendant resides at

The relationship between the plaintiff and the defendant is that of

The plaintiff and the defendant are the parents of the following children, each of whom are dependent upon the defendant for support: Dependant's Full Name Age Date of Birth

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 5.









That the defendant has failed to provide fair and reasonable support for said dependent(s) according to his/her means and capacity, and that he/she is an able-bodied person capable of earning a livelihood. 1. Requiring the defendant to pay support for the above-named dependents; 2. Requiring the defendant to include and maintain said dependents under any individual or group health and/or dental insurance policy(ies) which he/she now holds or to purchase such a policy(ies), or its equivalent as long as the defendant has an obligation, of support, for each child; 3. Requiring the defendant to pay the cost of medical and/or dental care for the above-named dependents not covered by insurance; 4. Other 5. For such other and further relief as may be reasonable, just and proper. ; and

WHEREFORE the plaintiff prays for an order: (Please check)

Plaintiff DIRECTIONS TO PLAINTIFF: Defendant should be served with a copy of Complaint, Summons, and Notice of Hearing. DIRECTIONS TO PLAINTIFF AND DEFENDANT: A current Financial Declaration, on a form prescribed by the Supreme Court, must be filed with the clerk of court and served on the opposing party before or at the first hearing, or no later than 45 days after the Complaint is served, whichever occurs first. SCCA 431 (04/02)