Provide Mother's information

Name:
Address:
City:    County:
State: Zip:

Provide Father's Information

Name:
Address:
City:    County:
State: Zip:


Indicate whether you are the mother or father:
Your phone number:
Your email:


Provide Minor Children's Information

List the name and birthdate of each child included in the child support order (Indicate M for male and F for female):



Provide Case Information

Indicate Case Number:

Indicate County where case originated:

Indicate assigned Judge:

Indicate which parent has physical custody of the child(ren):Select OneMotherFatherJoint

Indicate which parent has legal custody of the child(ren):Select OneMotherFatherJoint

Indicate the date of the divorce judgment or child support order:

Indicate whether this is the most recent order:Select OneYesNo

If no, indicate the date of the most recent order:

Indicate whether child support credit request is based upon direct payment(s) to custodial parent:Select OneYesNo

If yes, provide detailed information regarding the payment(s), (i.e., date, amount, type, proof of payment):

Indicate whether child support credit request is based upon parenting time periods over 6 days:Select OneYesNo

If yes, provide detailed information regarding the parenting time periods (i.e, dates, number of days, reason, proof) :


 ACKNOWLEDGMENT: Speedy Legal Docs did not provide me with any advice, explanation or representation about any legal rights, remedies, defenses or options