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Uniform Child Support Order 152 - Kentucky
| Uniform Child Support Order Form. This is a Kentucky form and can be used in Civil Statewide . |
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AOC-152 Rev. 6-12 Page 1 of 2 Doc Code: OSUP OSUPW COM M O NW E A LT H O F K E lex et justitia U RT Commonwealth of Kentucky Court of Justice www.courts.ky.gov * See Footnotes & Additional Information OF JUS TI UNIFORM CHILD SUPPORT ORDER AND/OR WAGE/INCOME WITHHOLDING ORDER [ ] NEW ORDER [ ] AMENDED ORDER [ ] ORDER FOR WAGE/INCOME WITHHOLDING Case No.____________________ Court [ ] District [ ] Circuit [ ] Family County ______________________ IV-D Case No. ________________ NT U CK Y NOTICE: The Federal Income Withholding For Support Form OMB 0970-0154 must be used by private parties or their attorneys in non-IV-D eligible cases to notify an employer/income withholder of any wage/income withholding ordered herein. _______________________________________________________________________________________________ Plaintiff/Petitioner Name Birthdate SSN _______________________________________________________________________________________________ Defendant/Respondent Name Birthdate SSN In Re: Child's Name _____________________________________________________________________________ Social Security No. _____________________ Social Security No. _____________________ attachment is incorporated into this Order by reference. IT IS HEREBY ORDERED AND ADJUDGED THAT: The [ ] Mother [ ] Father [ ] Other _________________ ___________________________________________ shall pay child support as follows: 1) 2) 3) $__________ per month as current child support effective ____________________, ______: [ ] As determined by KY Child Support Guidelines; [ ] By written agreement of parties with knowledge of the Guidelines; []UponafindingthatapplicationoftheGuidelineswouldbeunjustorinappropriatebecause:__________________ ___________________________________________________________________________________________. $__________ per month toward arrearage judgment totaling $______________, calculated for period beginning _________________________, ______ and ending ___________________________, ______. [ ] Health insurance is currently accessible and reasonable in cost. The [ ] Mother [ ] Mother [ ] Father is ordered to provide and maintain health insurance coverage for the minor child(ren). [ accessible and reasonable in cost but shall be provided by the [ 4) 5) 6) ] Health insurance is not currently ] Father when it becomes Birthdate __________________________ Birthdate __________________________ Child's Name _____________________________________________________________________________ If there are more than two (2) children, attach separate sheet with identifying information and check here [ ]. Said accessible and reasonable in cost. Extraordinary medical expenses shall be paid as follows: _________________. $__________ per month for other expenses: _______________________________________________________ ___________________________________________________________________________________________. $__________ TOTAL MONTHLY AMOUNT to be paid at: 1 $ _________ per [ ] week [ ] bi-weekly [ ] semi-monthly [ ] month Other conditions: _____________________________________________________________________________ _______________________________________________________________________________________________. DOMESTIC VIOLENCE PROTECTIVE ORDER ISSUED [ ] YES [ ] NO PROTECTED PARTY: [ ] PETITIONER [ ] RESPONDENT 1 2 Child Support Recipient's Name & Address 2 - _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ CHILD SUPPORT SHALL CONTINUE IN FULL FORCE AND EFFECT UNLESS MODIFIED by THE COURT, OR ENDED by OPERATION OF LAW. If child support is paid by wage withholding, a job change may affect the frequency and amount of wages to be withheld in order to meet the monthly obligation amount. Child support recipient may elect not to provide address information in this section but in order to be properly disbursed his/her mailing address must be provided to the child support agency. American LegalNet, Inc. www.FormsWorkFlow.com C CO E AOC-152 Rev. 6-12 Page 2 of 2 7) Check only box A, B, or C as appropriate and any applicable options therein. A. [] Child supportorderedhereinshallbesubjecttowage/incomewithholdingontheeffectivedateofthisOrder,to begin immediately. 3 The employee is responsible for making payments to recipient: (check one) [ ] directly, OR [ ] through _______________________________________________________ until such timeaschildsupportiswithheldfromtheemployee'spaycheck.ThisOrdershallapplytoany subsequent employer. The Federal Income Withholding Support Form OMB 0970-0154 must be utilized by private parties and attorneys in non-IV-D eligible cases, and must direct the employer to remit payment to the State Disbursement Unit. 4 Attach a copy of this Order, AOC-152, to Form OMB 0970-0154 when serving the employer. 5 OR B. [] OnepartyhasdemonstratedandtheCourtherebyfindsthatthereisgoodcausenottorequireimmediate wage/income withholding. Child support shall be paid as follows: (check one) [] Mailed directly to: OR [] Other: ________________________________________________________________________ Kentucky Child Support Enforcement at Centralized Collection Unit P.O.Box14059,Lexington,KY40512-4059 Wage/Income withholding shall take effect when an arrearage accrues that is equal to the amount of support payable for one month without the need for a judicial or administrative hearing. If wage/income withholding becomes applicable, see footnotes 3, 4, and 5 below relating to the mandatory federal income withholding form. OR C. [ ] TheCourthasmadeafindingthatbothpartieshavereachedawrittenagreementwhichprovidesforan alternative arrangementtowage/incomewithholdingasfollows:_________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 3 Effective June 1, 2012, the Federal Income Withholding For Support Form OMB 0970-0154 must be used by private parties or their attorneys in non-IV-D eligible cases to notify an employer/income withholder of any wage/income withholding ordered herein. All child support payments made pursuant to a wage/income withholding order shall be directed to the State Disbursement Unit at: Kentucky Child Support Enforcement at Centralized Collection Unit, P.O. Box 14059, Lexing
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