Free Information Sheet in PDF - Kansas


File Size: 98.0 kB
Pages: 2
Date: June 20, 2006
File Format: PDF
State: Kansas
Category: Court Forms - State
Author: ptull
Word Count: 312 Words, 3,079 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.kscourts.org/pdf/childSupport/childsupportinfosheet.pdf

Download Information Sheet in PDF ( 98.0 kB)


Preview Information Sheet in PDF
KANSAS PAYMENT CENTER ­ CHILD SUPPORT ORDER INFORMATION SHEET

As per Supreme Court Administrative Order No. 168 (amended), all new or modified non-IVD support orders filed in the Kansas district courts must be accompanied by this child support order information sheet.
P.O. Box 758599 Topeka, KS 66675-8599

Purpose: Federal law requires Kansas to process child support through a single location in the state. To insure that processing of child support payments is not delayed, the Kansas Payment Center must have all information listed on the form below. Who submits this information sheet: The payee's attorney shall submit a child support order information sheet with any new or modified non-IVD support orders filed with the Clerk of the District Court. Case Number: You must give the full, accurate case number, or payments may be delayed. The case number may be copied from the child support order. Date: _________________________ Case Number: ___________________________________________ Payer's Name: __________________________________ Date of Birth: ____________ Gender: Male/Female SSN: __________________________________ *If SSN not known, give reason for unavailability of SSN: __________________________________________________________________________________________ Address, City, State, Zip: _____________________________________________________________________ Payee's Name: __________________________________ Date of Birth: ____________ Gender: Male/Female SSN: __________________________________ *If SSN not known, give reason for unavailability of SSN: __________________________________________________________________________________________ Address, City, State, Zip: _____________________________________________________________________ Debt Type: (Circle one) Obligation Frequency: Weekly (circle one) Bi-weekly Semi-Monthly Monthly Obligation Amount: $______________ Start Date: _______________ Child #1: Name: ________________________________ Date of Birth: ____________ Gender: Male/Female SSN: ____________________________ (If SSN known, please provide) Child #2: Name: ________________________________ Date of Birth: ____________ Gender: Male/Female SSN: ____________________________ (If SSN known, please provide) Child #3: Name: ________________________________ Date of Birth: ____________ Gender: Male/Female SSN: ____________________________ (If SSN known, please provide) Third Party Payee: ______________________________ Date of Birth: ____________ Gender: Male/Female SSN: __________________________________ (*If SSN not known, give reason for unavailability of SSN) __________________________________________________________________________________________ Address, City, State, Zip: _____________________________________________________________________ *Absent extenuating circumstances as determined by the Kansas Payment Center, Payers' and Payees' Social Security Numbers must be provided on this form.
Revised date: 6/20/06

CS MN OT

Form Completed By: ________________________________________________________

Revised date: 6/20/06