Fillable 9 1. DIRECT PAYMENT: All child support, alimony, (The 15th Judicial Circuit of Florida)

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9 1. DIRECT PAYMENT: All child support, alimony, (The 15th Judicial Circuit of Florida)

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SUPPORT INFORMATION SHEET
PURSUANT TO S.61.13(10), F.S., THE SECOND PAGE OF THIS DOCUMENT, CONTAINING SOCIAL
SECURITY NUMBERS OF THE PARTIES, SHALL BE KEPT CONFIDENTIAL FROM PUBLIC
DISCLOSURE. THIS DOCUMENT IS NOT AN ORDER, AND IS FOR ADMINISTRATIVE USE BY THE
CLERK. THIS DOCUMENT DOES NOT ESTABLISH OR MODIFY THE RIGHTS OFANY PARTY. THE
FORMAT OF THIS DOCUMENT IS APPROVED BY ADMINISTRATIVE ORDER NUMBER 5.012/12-99,
AND SHALL NOT BE AMENDED WITHOUT A NEW ADMINISTRATIVE ORDER.
and CASE #
9 1. DIRECT PAYMENT: All child support, alimony, or other support, included in any order
requiring the payment of same shall be paid directly to:____________________________
address:___________________________________City/State/Zip:___________________
9 2. PAYMENTS THROUGH STATE DISBURSEMENT UNIT: All child support and/or alimony
and/or arrearage shall be made payable to and mailed to the State of Florida Disbursement Unit, Post
Office Box 8500, Tallahassee, FL 32314-8500.
9 3. CHILD SUPPORT: The following provisions for payment shall apply: $______Total
9 Temporary 9Permanent 9Modified (Child Support Payment)
Child support payments shall start on ________________ (Date) and shall stop:
9 upon the child reaching the age of 18.
9 upon the child’s graduation from high school or at age 19.
9 upon the child’s graduation from college or at age ________.
9 by further order of Court or in accordance with the law.
9 4. ALIMONY: The following provisions for payment shall apply: $______Total
(Alimony Payment)
9 TEMPORARY $_________________9 REHABILITATIVE $_______________
9 PERMANENT PERIODIC $_______9 LUMP SUM $____________________
Payments shall start on ________________ and shall stop on ________________
or upon full payment.
9 5. ARREARAGE $_______________DUE AS OF ___________________. $_________Total
(Arrearage Payment)
Arrearage payments shall start on _______________ in the amount of $__________
and shall stop upon full payment.
9 6. OTHER PAYMENTS: DUE FOR ___________________________________ $______Total
(equitable distribution, attorney’s fees, etc)
Payments shall start on _______________ in the amount of $__________
and shall stop upon full payment.
(Date)
9 7. SERVICE CHARGE: 4% of each payment, not to exceed $5.25: $_______Total
9 8. PAYMENT SCHEDULE : Payment shall be made: $_______
9 WEEKLY 9 MONTHLY GRAND TOTAL
9 EVERY OTHER WEEK 9 TWICE MONTHLY
9 (1ST & 15TH) 9 (15TH & 30TH) Arrearage or other payment)
______________________
The preparer of this form shall insert a specific commencement date which coincides with the first payroll cycle date of the Obligor following
entry of the implementing judgment (order), but no earlier than 30 days from entry of the judgment (order). This is because the Court
acknowledges that it will take some time to have the Clerk establish the C.S.E. Ledger and to effectuate income deduction order. Accordingly, in
the interim, for the next 30 days, those post-judgment support obligations shall be paid directly between the parties, with the Court reserving
jurisdiction to enforce non-payment upon the filing of the appropriate motion. The first post-judgment support payment made through F.L.S.D.U.
shall occur on the first payment date after expiration of the 30 days hereinabove referenced.
******CLERK: PLEASE KEEP THIS PAGE SEPARATE FROM FILE AND KEEP CONFIDENTIAL******
9. PERSONAL INFORMATION:
Person Paying Support (Obligor) Person Receiving Support (Obligee)
Name:___________________________________ Name:______________________________________
Address:_________________________________ Address:____________________________________
City/State/Zip:____________________________ City/State/Zip:_______________________________
Phone Number:(____)______________________ Phone Number:(_____)________________________
Driver's License No.:_____-_____-_____-______ Driver's License No.:_____-_____-_____-_________
Car Tag Number:__________________________ Car Tag Number:_____________________________
Date of Birth:__________/__________/________ Date of Birth:__________/__________/___________
Social Security Number:_______-______-______ Social Security Number:________-______-________
Employer:___________________________________ Employer:___________________________________
Employer Address:____________________________ Employer Address:____________________________
___________________________________________ ___________________________________________
Employer's Phone Number (____)______________ Employer's Phone Number (____)______________
Children:
Name:__________________________________DOB:__________/__________/__________SS No.:_____-______-__
Name:__________________________________DOB:__________/__________/__________SS No.:_____-______-___
Name:__________________________________DOB:__________/__________/__________SS No.:_____-______-___
Name:__________________________________DOB:__________/__________/__________SS No.:_____-______-___
PREPARED BY: ____________________________________ _____________________________
Name Date
REVIEWED BY: ____________________________________ _____________________________
Name Date
sis2/12-16-99/lrs
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9 1. DIRECT PAYMENT: All child support, alimony, (The 15th Judicial Circuit of Florida)

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Completed 13 June 2021

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