Washington > Statewide > Domestic Relations > Child Support
Child Support Order Summary Report - Washington
| Child Support Order Summary Report Form. This is a Washington form and can be used in Child Support Domestic Relations Statewide . |
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CHILD SUPPORT ORDER SUMMARY REPORT Fathers Name: _______________________________ Mothers Name: ______________________________ Cause Number: _______________________________ County: ____________________________________ Date of Order: _______________________________ Summary Report Filed by: Father Mother 1. Type of Order (check one): Superior Court Administrative Law Judge 2. Was the order for child support: Original Order for Support Order Modifying Support 3. Number of children of the parties: ______ 4. List each childs age below: Child 1 _____ Child 2 _____ Child 3 _____ Child 4 _____ Complete lines 5-13 using the amounts entered on the child support worksheets signed by the judge/reviewing officer. 5. Fathers monthly net income (Support Worksheet Page 1, Line 3) $______________ 6. Mothers monthly net income (Support Worksheet Page 1, Line 3) $______________ 7. List the basic child support obligation for each child (from Worksheet, Page 1, Line 5, individual amounts) Child 1 __________ Child 2 __________ Child 3 __________ Child 4 __________ 8. Health Care Expenses (Support Worksheet Page 1, Line 8f) $_____________ 9. Day Care and Special Expenses (Support Worksheet Page 2, Line 9) a. Day Care Expenses $_____________ b. Education Expenses $_____________ c. Long Distance Transportation Expenses $_____________ d. Other _______________________________ $_____________ e. Other _______________________________ $_____________ 10.a. Fathers standard calculation support obligation (Support Worksheet Page 3, Line 15) $_____________ b. Mothers standard calculation support obligation (Support Worksheet Page 3, Line 15) $_____________ Actual Transfer Payment Ordered and Deviation (if any) 11. Which Parent is Payor? Father Mother 12. Transfer Payment Amount Ordered by Court $_____________ 13. a. If the Court deviated (amount from Line 12 differs from amount on Line 10 for the Payor), was the deviation due to: Child Needs Parental Factors b. If the Court deviated, what were the reasons stated by the Court for the deviation? ___________________________________________________________________________________________ ___________________________________________________________________________________________ 14. a. Was post-secondary education provided for? Yes No b. If provided for, was a dollar amount ordered? Yes No c. If a dollar amount was ordered, enter Payors amount $______________ Answer remaining questions only if this was an order modifying support. 15. Total amount of the support transfer payment on the previous order: $______________ 16. Which parent paid the transfer payment in the previous order? Father Mother 17. Was the change in the support transfer payment, if any, phased in? Yes No 18. The change in the support order was due to: (check all applicable categories) Change in parent income Change in residential schedule Age of children Change in support schedule Other WSCSS/Summary Report 06-10-04
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