The Plaintiff must submit this document where the services of the Support Collection Unit are requested. The Support Collection Unit is a state agency that assists litigants in obtaining the child support that has been ordered by the court. You may utilize the service or decline the service. If you decline the service you may apply to the Support Collection Unit in the future to assist you in obtaining the child support that the court has ordered to be paid.

Field 1: Fill in the county in which the action is brought.

Field 2: Print the Plaintiff's name.

Field 3: Write in the index number assigned to this case.

Field 4: Print the Defendant's name.

Field 5: Fill in the Plaintiff's name, address, date of birth and social security number.

Field 6: Fill in the Defendant's name, address, date of birth and social security number.

Field 7: Fill in the date and the place of marriage.

Field 8: Check the appropriate box.

Field 9: Indicate the name(s) and date(s) of birth of the unemancipated child(ren). List the amount of support for each child and check the appropriate box for either per week or per month.

Field 10: Indicate who will be receiving the support payments by checking the appropriate box.

Field 11: Fill in the name and address of the third-party person if this person is receiving the support payments.

Field 12: Fill in the non-custodial parent's employer's name and address.

Field 13: Fill in the date the form is completed.