Free Uniform Child Support Order - Kentucky

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AOC-152 Doc. Code: OSUP Rev. 3-03 OSUPW Page 1 of 2 01/8/2007 03:19 pm Commonwealth of Kentucky Court of Justice Ver. 1.01 www.kycourts.net * See Footnotes & Additional Information

Case No. Court UNIFORM CHILD SUPPORT ORDER [ ] NEW ORDER [ ] AMENDED ORDER [ ] ORDER FOR WAGE/BENEFIT WITHHOLDING County IV-D Case No. ________________ [ [ [ ] District ] Circuit ] Family

_______________________________________________________________________________________________ Plaintiff/Petitioner Name Birthdate SSN _______________________________________________________________________________________________ Defendant/Respondent Name Birthdate SSN IN Re: Child's Name _____________________________________________________________________________ Social Security No. _____________________ Birthdate __________________________ Child's Name _____________________________________________________________________________ Social Security No. _____________________ Birthdate __________________________ If there are more than two (2) children, attach separate sheet with identifying information and check here [ ]. IT IS HEREBY ORDERED AND ADJUDGED THAT: The [ ] Mother [ ] Father [ ] Other __________________ _________________________________________________________________ shall pay child support as follows: 1) $__________ per month as current child support effective ___________________, 2______: [ ] As determined by KY Child Support Guidelines; [ ] By written agreement of parties with knowledge of Guidelines; [ ] Upon a finding that application of Guidelines would be unjust or inappropriate because: ________________________________________________________________________________ ________________________________________________________________________________ 2) 3) 4) 5) $__________ per month toward arrearage totaling $______________, calculated for period beginning _________________, ______ and ending _________________, 2______. $__________ per month for medical support, effective _________________, 2______; if not included in child support amount on line (1). $__________ Other expenses: __________________________________________________________________ $__________ TOTAL MONTHLY AMOUNT to be paid at: [ ] semi-monthly [ ] month [ ] Wage withholding is NOT implemented immediately for good cause shown and child support shall be paid as follows: ____________________________________________________________________________________ Date: _____________________, 2______. ______________________________________ Judge
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$ _________ per [ ] week [ ] bi-weekly

DOMESTIC VIOLENCE PROTECTIVE ORDER ISSUED [ ] YES [ ] NO PROTECTED PARTY: [ ] PETITIONER [ ] RESPONDENT

MUST BE COMPLETED2 - Child Support Recipient's Name & Address _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

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If child support paid by wage withholding, job change may affect frequency and amount of wages to be withheld in order to meet monthly obligation amount. If domestic violence order in effect, child support recipient may elect not to complete this section BUT MUST immediately provide his/her mailing address to Cabinet for Families & Children local child support office.

NOTICE: FOR WAGE/BENEFIT WITHHOLDING, REQUESTING PARTY MUST MAIL COPY BY CERTIFIED MAIL TO EMPLOYER WITHIN 2 WORKING DAYS.

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AOC-152 Rev. 3-03 Page 2 of 2 WAGE/BENEFIT WITHHOLDING ORDER FOR EMPLOYER OF ______________________________________ This order of wage withholding shall be effective __________________, 2______ . Within 7 working days, employer shall pay withheld amount to: Division of Child Support, P.O. Box 14059, Lexington, KY 40512-4059 (include SSN on payment). Amount withheld shall not exceed _________ % of employee's disposable earnings. This sum shall be withheld in the following increments: $ ___________ per week if employee is paid weekly; $ ___________ bi-weekly if employee is paid every two weeks; $ ___________ semi-monthly if employee is paid twice per month; or $ ___________ per month if employee is paid monthly. EMPLOYEE IS RESPONSIBLE FOR MAKING CHILD SUPPORT PAYMENTS TO RECIPIENT [ ] DIRECTLY OR [ ] THROUGH ___________ ____________________________________________ UNTIL SUCH TIME AS CHILD SUPPORT IS WITHHELD FROM EMPLOYEE'S PAYCHECK. THIS ORDER SHALL APPLY TO ANY SUBSEQUENT EMPLOYER. EMPLOYER NAME: _________________________________________________________________________ ADDRESS: ________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

DOCUMENT PREPARER: _____________________________________________________________________ Address:____________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Phone No. __________________________

INSTRUCTIONS TO PERSON ORDERED TO PAY CHILD SUPPORT ("OBLIGOR") & EMPLOYER A. Per KRS 405.465 & 205.710, this Withholding Order is binding on any benefits provider. The sum ordered withheld shall be withheld from commissions, earnings, salaries, & any other income, including but not limited to, benefits for social security; unemployment; workers' compensation; disability insurance; supplemental employment; severance; retirement and pension. The maximum part of an individual's disposable earnings which is subject to wage withholding for child support is stated in 15 USC Sec 1673 as follows: 50% if obligor is supporting a second family; 60% if obligor is NOT supporting a second family; 55% if obligor is supporting a second family and owes an arrearage that is 12 weeks or more past due; OR 65% if obligor is NOT supporting a second family and owes an arrearage that is 12 weeks or more past due. "Disposable Earnings" is that part of a person's earnings remaining after deduction from those earnings of amounts required by law to be withheld. Amounts required by law to be withheld include income taxes, occupational license taxes, social security, railroad retirement and retirement for teachers and state & county employees. This Withholding Order shall be binding on the employer until further order of this Court. This Withholding Order shall have priority over any attachment, execution or other withholding, unless otherwise ordered by this Court. This Withholding Order shall not constitute grounds for dismissal of the employee/obligor, refusal to employ the employee, or any disciplinary action against the employee. Any violation of this Withholding Order by the employer may be grounds for contempt and/or may subject employer to civil liability. Employer may deduct and retain the additional sum of $1.00 for administrative expenses for each payment made pursuant to this Withholding Order. KRS 405.465. Employee/Obligor shall be responsible for making child support payments until such time as child support is withheld from the employee's/obligor's paycheck. Obligor: interest may be charged on any delinquent child support payments. KRS 360.040 and 405.467(2). This order reflects statutory provisions of KRS 403.211-.212, 405.467, 360.040, 405.465, 205.710, 205.712, 403.215, 403.750, and 610.170. Court File - Original CFC (place in Contracting Official's basket) Petitioner Respondent

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C. D. E. F. G. H.

Distribution:

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