Free Information Sheet in PDF - Kansas

Kansas Payment Center - Child Support Order Information Sheet
Purpose: Federal law requires Kansas to process child support through a single location in the state. To insure that processing of child support payments is not delayed, the Kansas Payment Center must have all information listed on the form below. Who submits the completed form: The payee's attorney shall file the completed form along with the Journal Entry with the Clerk of the District Court per Kansas Supreme Court Administrative Order No. 154. Case Number: You must give the full, accurate court order number, or payments may be delayed. The case number may be copied from the child support order. The case number format is as follows: County Year Case Type Case Number Example: LN00D 000123 (LN) (00) (D) (000123)

Please call your local Clerk of the District Court if you need additional information to complete this form. Additional copies may be made as necessary. PLEASE print or type all information. Case Number ____________________ Interstate: Circle One Y N Check if applicable: Court Trustee case Check one: New case/order Modified order File stamp date of order: _____________________
Start Date __________ __________ __________ __________ __________ __________ Payment Frequency Codes (W) (B) (M) (SM) (Q) (A) (SA) (L) Weekly Biweekly Monthly Semi-Monthly Quarterly Annually Semi-Annually Lump Sum

Obligation Information Current Child Support due: ____________________________ Current Maintenance (Alimony) due: ______________________________ Other Support due: _____________________________ ______________________________

Support Amount $________ $________ $________ $________ $________ $________

Frequency Code ________ ________ ________ ________ ________ ________

Information about the PAYING Parent NAME: (First, Middle Initial, Last): _________________________________________________________________

Address: ____________________________City: ____________________________State: __________ Zip: ______

Social Security Number: _______________

Date of Birth:____________

Phone Number: _________________

Information about the Parent or Person RECEIVING support NAME (First, Middle Initial, Last): _________________________________________________________________

Address: ____________________________City: ____________________________State: __________ Zip: ______

Social Security Number: _______________ Information about the Third Party Payee

Date of Birth:____________

Phone Number: _________________

NAME (First, Middle Initial, Last): _________________________________________________________________ Address: ____________________________City: ____________________________State: __________ Zip: ______

Social Security Number: _______________

Date of Birth:____________

Phone Number: _________________

Information about CHILD(REN) covered by this support order NAME (First and Last: 1. _________________________ 2. _________________________ 3. _________________________ 4. _________________________ 5. _________________________ 6. _________________________ 7. _________________________ 8. _________________________ Social Security Number ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ Date of Birth ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________

Form completed by: _______________________________________________ Date: ________________________ Print Name (and title): __________________________________________________________________________ The completed form must be attached to the journal entry and filed with the Clerk of the District Court.