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