Free Use separate sheet for insurance, medical and other expenses ordered - Louisiana

The Family Court of East Baton Rouge Parish, State of Louisiana

Spousal Support/Child Support Arrearages
( Note: Use separate sheet for insurance, medical and other expenses ordered) Date of last hearing at which award was made: Effective date of award: Amount of award: Amount payable when: ___________________
Date

___________________
Date

$__________________
Amount

___________________
Time

Item Number
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30.

Due Date

Amount Due

Date Paid

Amount Paid

Check Number

Accrued Arrearage

Totals

Last arrearage judgment date: _____________
Date

Number of prior findings of contempt: _____________
Number

Balance due on prior arrearages as of date of filing this action: _____________
Amount

Form B, Spousal Support/Child Support Arrearages Adopted 1-1-91 Form revised: September, 1999