Vacation Credit For Child Support

VACATION CREDIT DATE: _________________________________ CASE NUMBER: ________________________ IN THE CASE OF: ________________________________________ PLAINTIFF S.S.# ______________________ FOR FOC USE ONLY: SUPPORT ABATEMENT CLAUSE IN ORDER? ____ YES ____ NO CASEWORKER: ______________ APPROVED BY: ______________ DRIVER LICENSE NO. AND STATE: _____________________________________ GENDER: _______________ BIRTH DATE: _______________ RACE: ________________ ________________________________________ DEFENDANT S.S.# ______________________ DRIVER LICENSE NO. AND STATE: _____________________________________ GENDER: _______________ BIRTH DATE: _______________ RACE: ________________ I, _______________________________, hereby request credit allowance in the amount of $_______________ (total amount) for a period of _________________ to _________________ for having ____________________________________________ in my care. Child(ren) Name(s) SIGNED: _____________________________________ (Payer) APPROVED: _________________________________ (Payee) Check this box if you want part or all of the money withheld from your source of income for the above period of time returned to you. Your request may be denied, or modified, depending on the amount of credit to which you are entitled and the amount of your arrearage. Requested amount to be returned to payer $________ per ________, for a total of $__________. PAYER'S CURRENT ADDRESS: ________________________________________________________________________ PAYER'S CURRENT EMPLOYMENT: ____________________________________________________________________ PAYER'S CURRENT TELEPHONE NUMBER(S): ___________________________________________________________ PLEASE INCLUDE CHILDREN'S: NAME ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ GENDER ________ ________ ________ ________ ________ RACE ___________ ___________ ___________ ___________ ___________ SOCIAL SECURITY NO. ______________________ ______________________ ______________________ ______________________ ______________________ BIRTH DATE ____________ ____________ ____________ ____________ ____________ CHECK THIS BOX IF OTHER PARTY HAS REFUSED TO SIGN THIS FORM. VacationCredit American LegalNet, Inc. www.FormsWorkflow.com