Fillable Record of Support Child Support Division

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Record of Support Child Support Division

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Record of Support
Order Information
County Name: TARRANT
Cause No.:
Income Withholding:
○ Yes ○ No
Family Violence:
○ Yes ○ No
OAG Case No.:
Date of Hearing:
Order Sign Date:
Order Type: ○ Divorce ○ Paternity ○ SAPCR ○ Enforcement ○ Modification Order Status: ○ Temporary ○ Final
Obligee/Custodial Parent Information
Name:
Date of Birth:
Social Security No.:
Address:
City:
State:
Zip:
Driver’s License No.:
Email:
Relationship to children:
Home Phone:
Employer Name:
Work Phone:
Employer Address:
City:
State:
Zip:
Obligor/Non-Custodial Parent Information
Name:
Date of Birth:
Social Security No.:
Address:
City:
State:
Zip:
Driver’s License No.:
Email:
Relationship to children:
Home Phone:
Employer Name:
Work Phone:
Employer Address:
City:
State:
Zip:
Dependent Information (Attach additional forms if there are more children in this cause.)
Name:
Date of Birth:
Social Security No.:
Name:
Date of Birth:
Social Security No.:
Name:
Date of Birth:
Social Security No.:
Name:
Date of Birth:
Social Security No.:
***FOR OFFICE USE ONLY*** Financial/Pay Plan Information ***FOR OFFICE USE ONLY***
Child Support: $ ( monthly / semi-monthly / bi-weekly / weekly ) beginning , 20_____
Decrease w/ emancipation? (1
st
child) $ ( monthly / semi-monthly / bi-weekly / weekly ) (2
nd
) $ (3
rd
) $
CS Arrears: $ As of: Arrears Payplan: $ ( m / s / b / w ) beginning , 20_____
Medical Support: $ ( monthly / semi-monthly / bi-weekly / weekly ) beginning , 20_____
MS Arrears: $ As of: Medical Arrears Payplan: $ ( m / s / b / w ) beginning , 20_____
Dental Support: $ ( monthly / semi-monthly / bi-weekly / weekly ) beginning , 20_____
DS Arrears: $ As of: Dental Arrears Payplan: $ ( m / s / b / w ) beginning , 20_____
Attorney Information
Obligee Attorney:
Phone:
Obligor Attorney:
Phone:
Address: PO Box 961014, Fort Worth, TX 76161 Phone: 817-884-1475 Email: dro-ros@tarrantcounty.com Website: tarrantcounty.com
Domestic Relations Office
Child Support Division
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Record of Support Child Support Division

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Completed 1 January 2021

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