| Support Enforcement Agency New Case Number Work Sheet Form. This is a Ohio form and can be used in Domestic Relations Montgomery County (Court Of Common Pleas) . |
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DR-16( rev.8/ 99)Montgomery County Support Enforcement AgencyNew Case Number Work SheetThisistheinformationnecessarytoenteracaseintotheSETSsystemuptothepointoftheSESO(SupportOrder)screen. Itisvitalthat wegetasmuchofthisinformationaspossiblesothatwecanproperlycleartheparticipantsandloadthecaseintotheSETSsystem.CourtOrder#:SETSCase#:SEACase#:JudgeCustodialParent/CaretakerInformation: (PL) (DF) (P1) (P2) AbsentParentInformation: (PL) (DF) (P1) (P2)NameNameAddress1Address1Address2Address2CityCityStateZipCodeStateZipCodeBirthdateSSNBirthdateSSNRaceSexPhone#RaceSexPhone#EmployerEmployerEmpAdd1EmpAdd1EmpAdd2EmpAdd2CityCityStateZipCodeStateZipCodeInsured?Insuranceavailable?Insured?Insuranceavailable?BeginDate:PlanTypeGroupIndivBeginDate:IndivGroupPlanTypeInsuranceCoInsuranceCoInsAddr1InsAdd1City/State/ZipCity/State/ZipPlanTypePlanNameGroup#Policy#Policy#Group#PlanNamePl nTypeMedicalMedicalDentalDentalDrugDrugEmp AssistanceEmpAssistanceUninsuredExpensesObligeePercentage:%ObligorPercentage:%ChildInformation:FirstNameMiddleNameDisabled? PatEst? BOW?SocialSecurityNumberBirthdateLastNameDateenteredintoSETS:DEOInitials:DateSkeletononCOS-E:Remember:YouonlyneedtobuildonecaseinSETSiftheorderisforbothChildandSpousalSupport. ThereforeonlyoneSEANumberis needed. MakesureyoucommenttheCOS-EIMScreenwiththeSETSCaseNumberandcloseitproperlyontheIGscreen.Rev. 8/30/992001 © American LegalNet, Inc.
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