 

 

SUPERIOR COURT OF WASHINGTON, COUNTY OF KING

 

In re:
Elora Ralidak, Aidan Ralidak, and Raina No. 20-3-03830-3 SEA
Ralidak,
Minor Children Child Support Order
Petitioner: Final (ORS)
VERONIKA GOODNIGHT, Clerk’s action required: WSSR, 1
And
Respondent:
MATHEW RALIDAK.

 

Child Support Order

1. Money Judgment Summary
[x] No money judgment is ordered.

» Findings and Orders

2. The court orders child support as part of this family law case. This is a
final order.

3. The Child Support Schedule Worksheets attached or filed separately are
approved by the court and made part of this Order.

4. Parents’ contact and employment information

RCW 11.130.255; RCW Child Support Order Lawgate
26.09.135, 320; RCW 26.26B.030

del BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 1 of 15 11300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125

206-365-5500 » www.lawgate.net

 

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Each parent must fill out and file with the court a Confidential Information form (FL All
Family 001) including personal identifying information, mailing address, home address,
and employer contact information.
Important! |f you move or get a new job any time while support is still owed, you
must:

* Notify the Support Registry, and

* Fill out and file an updated Confidential Information form with the court.
Warning! Any notice of a child support action delivered to the last address you
provided on the Confidential Information form will be considered adequate notice, if the
party trying to serve you has shown diligent efforts to locate you.

5. Parents’ Income
Parent (name): Mathew Parent (name): Veronika
i
| Net monthly income $ 7,320.93 . Net monthly income $4;855.577 2319.46
| (line 3 of the Worksheets) (line 3 of the Worksheets)
| This income is (check one): This income is (check one):
[x] this parent's actual income [x] imputed to this parent. (Skip to 6.) |
(after any exclusions approved below). [ ] this parent's actual income |
(after any exclusions approved below).
6. Imputed Income
To calculate child support, the court may impute income to a parent:
"whose income is unknown, or
* who the court finds is unemployed or under-employed by choice.
Imputed income is not actual income. It is an assigned amount the court finds a parent
could or should be earning. (RCW 26.19.071(6))
Parent (name): Mathew Ralidak Parent (name): Veronika Goodnight
[x] Does not apply. This parent's actual income [ ] Does not apply. This parent's actual income
is used. (Skip to 7.) is used. (Skip to 7.)
RCW 11,130,255; RCW Child Support Order Law gate

26.09.135, .320; RCW 26.26B.030
Mandatory Form (07/2021) p. 2 0f 15

BUGNI & ASSOC. FAMILY LAW
11300 Roosevelt Way NE, Suite 300

FL All Family 130 Seattle, WA 9B125

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Parent (name): Mathew Ralidak ' Parent (name): Veronika Goodnight

[ ]: This parent's monthly net income is imputed — [x] This parent's monthly net income is imputed
because (check one): because (check one):
[ ] this parent's income is unknown. [ ] this parent's income is unknown.
[ ] this parent is voluntarily unemployed. [ ] this parent is voluntarily unemployed.
[ ] this parent is voluntarily under-employed. [ ] this parent is voluntarily under-employed.
[ ] this parent works full-time but is purposely [ ] this parent works full-time but is purposely

under-employed to reduce child support.

under-employed to reduce child support.

[ ] this parent is currently enrolled in high [ ] this parent is currently enrolled in high

school full-time and is voluntarily
unemployed or under-employed.

school full-time and is voluntarily
unemployed or under-employed.

The imputed amount is based on the The imputed amount is based on the
information below: (Options are listed in information below: (Options are listed in
order of required priority. The Court used the order of required priority. The Court used the
first option possible based on the information first option possible based on the information
it had unless a presumed option was it had unless a presumed option was
rebutted.) rebutted.)

[ ] Pay for 20 hours per week at minimum [ ] Pay for 20 hours per week at minimum

wage where this parent lives because
this parent is enrolled in high school full-
time and is voluntarily unemployed or
under-employed.
Full-time pay at current pay rate.
Full-time pay based on reliable
information about past earnings.
Full-time pay based on incomplete or X]
irregular information about past
earnings.
[ ] Pay for 32 hours per week at minimum []
wage where this parent lives because
this parent:
[ ] recently graduated from high school.
[ ]is on TANF now, or recently came off
TANF, public assistance, SSI, or
disability.
[ ] was recently incarcerated.
Full-time pay at minimum wage where [
the parent lives because this parent
(check all that apply):
[ ] recently worked at minimum wage
jobs.
{ ] has never been employed.
{_] does not have information about past

[

RCW 11.130.255; RCW Child Support Order

26.09.135, .320; RCW 26.26B.030
Mandatory Form (07/2021) p. 3 of 15

FL All Family 130

wage where this parent lives because

this parent is enrolled in high school full-

time and is voluntarily unemployed or

under-employed.

Full-time pay at current pay rate.

Full-time pay based on reliable

information about past earnings.

Full-time pay based on incomplete or

irregular information about past

earnings.

Pay for 32 hours per week at minimum

wage where this parent lives because

this parent:

[ ] recently graduated from high school.

[ ]is on TANF now, or recently came off
TANF, public assistance, SSI, or
disability.

[ ] was recently incarcerated.

Full-time pay at minimum wage where

the parent lives because this parent

(check all that apply):

[ ] recently worked at minimum wage
jobs.

[ ] has never been employed.

_[] does not have information about past_

Lawgate

BUGNI & ASSOC. FAMILY LAW
11300 Roosevelt Way NE, Suite 300
Seattle, WA 98125

206-365-5500 > www.lawgate.net

 

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Parent (name): Mathew Ralidak Parent (name): Veronika Goodnight
eamings. earings.
[] Table of Median Net Monthly Income. [ ] Table of Median Net Monthly Income.
[ ] Other (specify): [ ] Other (specify):

 

7. Limits affecting the monthly child support amount

[x] Does not apply. The monthly amount was not affected by the upper or lower limits
in RCW 26.19.065.

8. Standard Calculation

Parent Name Standard calculation

_ Worksheets line: 17
Mathew Steerer (quis
Veronika ‘$542.09 6 \T- 44

9. Deviation from standard calculation
Should the monthly child support amount be different from the standard calculation?
[x] No — The monthly child support amount ordered in section 10 is the same as the
standard calculation listed in section 8 because (check one):
[ ] No one asked for a deviation from the standard calculation. (Skip to 10.)

[x] There is not a good reason to approve the deviation requested by (name/s):
Mathew Ralidak. The facts supporting this decision are (check all that apply):
[ ] detailed in the Workshéets, Part VIII, lines 20 through 26.
[ ] the parent asking for a deviation:
[ ] has a new spouse or domestic partner with income of $.

RCW 11.130.255; RCW Child Support Order Law gate
26.09.135, .320; RCW 26.26B.030

ne BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 4 0f 15 12300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125

206-365-5500 » www.laweate.net.

 

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[ ] lives in a household where other adults have income of §. .
[ ] has income from overtime or a second job that was excluded in section
5 above.
[x] other (specify): Granting a deviation would create a hardship on the Mother.
But the future of a residential time deviation may be addressed in future

adjustments. The parties do not need to modify the order of support in
order for a Commissioner to address that issue on the statutory time frame.

10. Monthly child support amount (transfer payment)

After considering the standard calculation in section 8, and whether or not to apply a
deviation in section 9, the court orders the following monthly child support amount
(transfer payment).

[x] Mathew must pay child support to Veronika each month as follows for the children
listed below (add lines for additional children if needed):

Child’s Name Age Amount
1. Elora $647.00 GER 1k)
| 2. Aidan $-647-08 OY: 1K
| 3. Raina $647-00 64

| Total monthly child support amount: ; $1,944-001G od

11. Starting date and payment schedule

The monthly child support amount must be paid starting (month, year): February 2022
on the following payment schedule in two payments each month; the first half on the
1% day of the month and the second half on the 15" day of the month.

12. Step Increase (for modifications or adjustments only)

Does not apply.

13. Periodic Adjustment

Child support may be changed according to state law. The Court is not ordering a
specific periodic adjustment schedule below.

14. Payment Method (check either Registry or Direct Pay)

Registry — Send payment to the Washington State Support Registry. The Division of
Child Support (DCS) will forward the payments to the person owed support and keep
records of all payments.

Address for payment: Washington State Support Registry
PO Box 45868, Olympia, WA 98504

Phone number/s: 1 (800) 922-4306 or 1 (800) 442-5437
RCW 11.130.255; RCW Child Support Order Lawgate
26.09.135, .320; RCW 26.26B.030
. 7 BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 5 of 15 12300 Roosevelt Way NE, Suite 300

FL All Family 130 Seattle, WA 98125
206-365-5500 + www.laweate.net

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15.

Important! if you are ordered to send your support payments to the Washington State Support
| Registry, and you pay some other person or organization, you will not get credit for your payment.
DCS Enforcement (if Registry is checked above):

DCS will enforce this order because (check all that apply):
[ ] this is a public assistance case.
[x] one of the parties has already asked DCS for services.

[ ] one of the parties has asked for DCS services by signing the application
statement at the end of this order (above the Warnings).

[ ] DCS will not enforce this order unless one of the parties applies for DCS
services or the children go on public assistance.

[ ] Direct Pay —- Send payment to the other parent or non-parent custodian by:
[ ] mail to:

 

street address or PO box city state zip

or any new address the person owed support provides to the parent who owes
support. (This does not have to be a home address.)

{ ] other method:

 

 

Enforcement through income withholding (garnishment)

DCS or the person owed support can collect the support owed from the income,
earnings, assets, or benefits of the parent who owes support, and can enforce liens
against real or personal property as allowed by any state’s child support laws without
notice to the parent who owes the support.

If this order is not being enforced by DCS and the person owed support wants to have
support paid directly from the employer, the person owed support must ask the court to
sign a separate wage assignment withholding order requiring the employer to withhold
income and make payments. (Chapter 26.18 RCW.)

Income withholding may be delayed until a payment becomes past due if the court
finds good reason to delay.

[x] Does not apply. There is no good reason to delay income withholding.

[ ] Income withholding will be delayed until a payment becomes past due because
(check one):

[ ] the child support payments are enforced by DCS and there are good reasons
in the children’s best interest not to withhold income at this time. If this is a
case about changing child support, previously ordered child support has been
paid on time. ~

List the good reasons here:

 

 

RCW 11.130.255; RCW Child Support Order Lawgate

26.09.135, .320; RCW 26.26B.030
Mandatory Form (07/2021) p. 6 of 15

BUGNI & ASSOC. FAMILY LAW
11300 Roosevelt Way NE, Suite 300

FL All Family 130 Seattle, WA 98125

206-365-5500 + www.lawgate.net

 

[ ] the child support payments are not enforced by DCS and there are good
reasons not to withhold income at this time.

List the good reasons here:

 

 

[ ] the court has approved the parents’ written agreement for a different payment
arrangement.

16. Temporary reduction if incarcerated (abatement)

Important! Read Support Abatement Warnings at the end of this order.

If the person who owes support is incarcerated:

* The total monthly child support amount may be temporarily reduced to $10
while the person who owes support is in jail, prison, or a correctional facility for

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4 at least six months (or serving a sentence of more than six months), and has
no income or assets available to pay the support.

1 «If reduced, the support amount will be $10 a month.

12 = Beginning the fourth month after the person who owes support is released,

support will be 50% of the original amount, or $50 per child, whichever is
13 more.

= One year after release, support will return to the original amount in section 10.
= Reinstatement of the support amount at 50% does not automatically apply, if a
15 Petition to Modify Child Support Order is filed during the period of abatement.

[ ] The person who owes support qualifies for abatement. Monthly child support is

16 temporarily reduced (abated) to $10 and will be reinstated as described above.

17

18|| 17. End date for support

19 ome must be paid for each child until the court signs a different order or (check
one):

20 [x] the child turns 18 or is no longer enrolled in high school, whichever happens last,

21 unless the court makes a different order in section 18.

[ ] the child turns 18 or is otherwise emancipated, unless the court makes a different
22 order in section 18.

 

23 [ ] after (child’s name): turns 18.
Based on information available to the court, it is expected that this child will be
24 unable to support them self and will remain dependent past the age of 18. Support

must be paid until (check one):

 

25 [ ] this child is able to support them self and is no longer dependent on the
parents.
[ ] other: .
RCW 11.130.255; RCW Child Support Order Law gate
26.09.135, .320; RCW 26.26B.030
oe BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) P. 7 of 15 11300 Roosevelt Way NE, Suite 300
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206-365-5500 » www.laweate.net

 

 

 

 

 

{ ] other (specify):

 

18. Post-secondary educational support (for college or vocational school)

[x] Reserved — A parent or non-parent custodian may ask the court for post-
secondary educational support at a later date without showing a substantial
change of circumstances by filing a Petition to Modify Child Support Order (form FL
Modify 501). The Petition must be filed before child support ends as listed in
section 17. There is an expectation that the child will also contribute towards post-
secondary support.

Granted — The parents must pay for the children’s post-secondary educational
support. Post-secondary educational support may include support for the period
after high school and before college or vocational school begins. The amount or
percentage each person must pay (check one):

[ ] will be decided later. The parties may make a written agreement or ask the
court to set the amount or percentage by filing a Petition to Modify Child
Support Order (form FL Modify 501).

[ ] is as follows (specify):

 

 

[ ] Denied — The request for post-secondary educational support is denied.
[ ] Other (specify):

 

19. Tax Issues

Important! Although the personal tax exemptions are currently suspended under federal law through
_ fax year 2025, other tax benefits may flow from claiming a child as dependent.

[x] The parties will follow the law and IRS rules about claiming children on tax
forms.

[] The parties have the right to claim the children as their dependents for
purposes of personal tax exemptions and associated tax credits on their tax
forms as follows ((check one):

[] Every year - ((name):
has the right to claim ((children’s names):

and ((name):

 

has the right to claim ((children’s names):

[] Alternating - ((name):
has the right to claim the children for ((check one): [ }even [ ] odd years

 

RCW 11.130.255; RCW Child Support Order Lawgate
26.09.135, .320; RCW 26.26B.030 BUGNI & ASSOC, FAMILY LAW
Mandatory Form (07/2021) p. 8 of 15 r

r 11300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125

206-365-5500 + www.lawgate.net

 

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and ((name): has the right to claim the children for
the opposite years.

[x] Other ((specify): Each year each parent shall claim one child per year. For
filing purposes each party may claim one child (Raina or Aidan). In odd tax
years Veronika shall claim Elora. In even tax years Mathew shall claim Elora.
When Elora reaches 18 each party shall claim one child each. When Aidan
reaches 18 in even years Veronika shall claim Raina and in odd years
Mathew shall claim Raina. Mathew shall only claim the children if he i

ae hen. tes

in hi ligations. iw toro
current. In Weta a Pav coves delay Buys,

For tax years when a non-custodial patent has the right to claim the children, the
parents must cooperate to fill out and submit IRS Form 8332 in a timely manner.

20. Medical Support

Important! Read the Medical Support Warnings at the end of this order. Medical
Support includes health insurance (both public and private) and cash payments
towards premiums and uninsured medical expenses.

[ ] The court is not ordering how health care coverage must be provided for the
children because the court does not have enough information to determine the
availability of accessible health care coverage for the children (coverage that could
be used for the children’s primary care). The law requires every parent to provide
or pay for medical support. DCS or any parent can enforce this requirement. (Skip
to 27)

Private health insurance ordered. (Name): Mathew must pay the premium to
provide health insurance coverage for the children. The court has considered the
needs of the children, the cost and extent of coverage, and the accessibility of
coverage.

[ ] The other parent must pay their proportional share* of the premium paid.
Health insurance premiums (check one):

[x] are included on the Worksheets (line 14). No separate payment is needed.

[ ] are not included on the Worksheets. Separate payment is needed. A
parent or non-parent custodian may ask DCS or the court to enforce
payment for the proportional share.

Proportional share is each parent’s percentage share of the combined net
income from line 6 of the Child Support Schedule Worksheets.

[x] The other parent is not ordered to pay for any part of the children’s insurance
because (explain): Mathew has access to private insurance; Veronika does not,
nor does she have the resources to contribute to the children’s medical issues.

Ix

*

 

‘A parent cannot be excused from providing health insurance coverage through an employer
or union solely because the child receives public health care coverage.

 

RCW 11,130,255; RCW Child Support Order Law gate
26.09.135, .320; RCW 26,26B.030

oo BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 9 of 15 11300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WAQB125

206-365-5500 + www.laweate.net

 

 

 

[ ] A parent has been ordered to pay an amount that is more than 25% of his/her
basic support obligation (Worksheets, line 19). The court finds this is in the
children’s best interest because:

 

iA parent cannot be ordered to pay an amount towards health care coverage premiums that is :
more than 25% of his/her basic support obligation (Worksheets, line 19) unless the court finds it is
in the best interest of the children.

[ ] Public health care coverage. (Name): has enrolled the child in public health care

coverage, and does not have available at no cost accessible health insurance
coverage through an employer or union.

[ ] The other parent must enroll the child in accessible health insurance coverage

through their employer or union up to 25% of their basic support obligation.

[ ] The other parent must pay their proportional share* of the premium for public
health care coverage for the child. Public health care premiums (check one):

[ ] are included on the Worksheets (line 14). No separate payment is needed.

[ ] are not included on the Worksheets. Separate payment is needed. A
parent or non-parent custodian may ask DCS or the court to enforce
payment for the proportional share.

* Proportional share is each parent’s percentage share of the combined net
income from line 6 of the Child Support Schedule Worksheets.

[ ] The other parent is not ordered to pay for any part of the children’s health care

coverage because (explain):

 

| A parent cannot be excused from providing health insurance coverage through an employer or
| union solely because the child receives public health care coverage.

[ ] A parent has been ordered to pay an amount that is more than 25% of their basic
support obligation (Worksheets, line 19). The court finds this is in the children’s
best interest because:

 

{ ] Other (specify):

 

 

 

21. Health care coverage if circumstances change or court has not ordered

If the parties’ circumstances change, or if the court is not ordering how health care
coverage must be provided for the children in section 20:

= A parent, non-parent custodian, or DCS can enforce the medical support
requirement.

« If a parent does not provide proof of accessible health care coverage (coverage
that can be used for the children’s primary care), that parent must:

RCW 11,130,255; RCW Child Support Order Lawgate
26.09.135, .320; RCW 26.26B.030
7 ‘ BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 10 of 15 12300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125
206-365-5500  www.lawgate net

 

 

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¢ Get (or keep) insurance through their work or union, unless the insurance costs
more than 25% of their basic support obligation (line 19 of the Worksheets),

¢ Pay their share of the other parent's monthly premium up to 25% of his/her
basic support obligation (line 19 of the Worksheets), or

¢ Pay their share of the monthly cost of any public health care coverage, such as
Apple Health or Medicaid, which is assigned to the state.
22. Children’s expenses not included in the monthly child support amount

Uninsured medical expenses — Each parent is responsible for a share of uninsured
medical expenses as ordered below. Uninsured medical expenses include premiums,
co-pays, deductibles, and other healthcare costs not paid by healthcare coverage.

Make payments to:

Parent (name): Parent (name).
. Person who , ;
Children’s Mathew «Veronika | pays the Service
Expenses for: pays monthly paysmonthly expense Provider
Uninsured {x] Proportional Share* wl Proportional
; Share’ i] i
medical expenses | j %

if] _

* Proportional Share is each parent's percentage share of the combined net income from line 6 of
the Child Support Schedule Worksheets.

Other shared expenses (check one):

{ ] Does not apply. The monthly amount covers all expenses, except health care
expenses.

[x] The parents will share the cost for the expenses listed below (check all that apply):
Make payments to:

| Parent (name): Parent (name):

. Person who Service
| Children’s Mathew Veronika paysthe der
“Expenses for: | pays monthly pays monthly expense

[x] Proportional
Share; Veronika's
Day care: [x] Proportional Share* proportional share
[]$ shall not exceed ir (]
(] ogee $500.00*
(1s
[] ____%*
RCW 11.130.255; RCW Child Support Order Lawgate
26.09.135, .320; RCW 26.26B.030 BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 11 of 15 1300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125,

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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

 

 

Children’s

Expenses for:

Education:

Extracurricular
activities:

[ ] Other (specify):

Parent (name):

Mathew
pays monthly

[x] Proportional Share*

‘1s

(] CS

[x] Proportional Share*
[1s

{} __

Ge

[ ] Proportional Share*
[1§

——

me

Parent (name):

Veronika
pays monthly

| [x] Proportional

: Share; Veronika's
proportional share
shall not exceed
$500.00*

(]$__
{] ___%&*
[x] Proportional
Share; Veronika's
proportional share
shall not exceed
$500.00*

fs

oe

{}] __

[ ] Proportional
Share*

(18,

{] ____%*"

Make payments to:
Person who .
Service
pays the ,
expense Provider

Kl (]

x] {]

[1] a

* Proportional Share is each parent's percentage share of the combined net income from line 6 of
the Child Support Schedule Worksheets,

** If any percentages ordered are different from the Proportional Share, explain why:

 

[ ] Other (give more detail about covered expenses here, if needed):

 

 

A person receiving support can ask DCS to collect:

" expenses owed directly to them.

. reimbursement for expenses the person providing support was ordered to

pay.

. an order for a money judgment from the court.

23. Past due child support, medical support and other expenses
[x] This order does not address any past due amounts or interest owed.

RCW 11.130.255; RCW

Child Support Order

26.09.135, .320; RCW 26.26B.030

Mandatory Form (07/2021)
FL All Family 130

p. 12 of 15

Lawgate

BUGNI & ASSOC. FAMILY LAW
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22
23
24
25

 

 

24. Overpayment caused by change
Does not apply.

25. Other Orders

All of the Warnings below are required by law and are incorporated and made part of
this order.

{ ] Other (specify):

 

Ordered.
Mau 3%, Wee Neher ruol

 

 

Dale ‘i 6! iSsioner r- Leonid Ponomarchuk
Petitioner and Respondent or theif lawyers fill out below:

This document (check any that apply): This document (check any that apply):
[ ] is an agreement of the parties [ ] is an agreement of the parties

[ ]is presented by me [ ]is presented by me

[ ] may be signed by the court without notice to me [ ] may be signed by the court without notice to
me

Date: Date:
BUGNI & ASSOC, FAMILY LAW

 

Greta M. Jibbensmith, WSBA #41737 Margaret Bender, WSBA#
Attorney for Petitioner Attorney for Respondent
Petitioner/Respondent Petitioner/Respondent

[ ] If any parent or child received public assistance:

The state Department of Social and Health Services (DSHS) was notified about this order through the
Prosecuting Attorney's office, and has reviewed and approved the following:

 

[ ] child support [ ] medical support
[ ] past due child support [ ] other (specify):
Deputy Prosecutor signs here Print name and WSBA # Date

[ ] Parent or Non-Parent Custodian applies for Division of child Support
enforcement services:

RCW 11.130.255; RCW Child Support Order Lawgate
26.09.135, .320; RCW 26.26B.030

heoeee BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 13 of 15 11300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125

206-365-5500 » www.lawgate.net

 

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| ask the DCS to enforce this order. | understand that DCS will keep $35 each year as a fee if DCS.
collects more than $550, unless | ask to be excused from paying this fee in advance. (You may call DCS
at 1-800-442-5437. DCS will not charge a fee if you have ever received TANF, tribal TANF, or AFDC.)

 

Parent or Non-Parent Custodian signs here Print name Date
(lawyer cannot sign for party)

All the warnings below are required by law and are part of the
order. Do not remove.

Warnings!

If you don’t follow this child support order...
= DOL or other licensing agencies may deny, suspend, or refuse to renew your licenses, including your driver's
license and business or professional licenses, and

" Dept. of Fish and Wildlife may suspend or refuse to issue your fishing and hunting licenses and you may not be
able to get permits. (RCW 74.20A.320)

If you receive child support...

You may have to:

* Document how that support and any cash received for the children's health care was spent.
= Repay the other parent for any day care or special expenses included in the support if you didn't actually have
those expenses. (RCW 26.19.080)

 

Support Abatement Warnings!

The Division of Child Support (DCS), the person required to pay support, the payee under this order, or the person
entitled to receive support may ask the court or DCS to temporarily reduce child support to $10 per month when
the person required to pay support is in jail, prison, or a correctional facility for at least six months, or serving a
sentence of more than six months.

There is a rebuttable presumption that an incarcerated person cannot pay child support. DCS, the payee under this
order, or the person receiving the support may overcome the presumption by showing that the person required to pay
support has income or other assets available to pay support.

When a request for abatement is made, DCS will review its records and other available information, and decide if
abatement is appropriate. DCS will send notice of the decision to the person required to pay support, and to the
payee under this order or the person entitled to receive support. Any of those persons may object to DCS's decision.

If at any point during the period of incarceration, a person or DCS later learns of income or other assets available to
pay support, a request to terminate or reverse the abatement may be made through DCS or the Office of
Administrative Hearings.

 

 

 

Medical Support Warnings!

The parents must keep the Support Registry informed about whether they have access to health care coverage for the
children at a reasonable cost and to provide the policy information for any such coverage.

If you are ordered to provide children’s healthcare coverage...

RCW 11.130.255; RCW Child Support Order Lawgate
26.09.135, .320; RCW 26.26B.030

" 7 BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 14 of 15 11300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125

206-365-5500 » www.lawgate net

 

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You have 20 days from the date of this order to send:

* proof that the children are covered , or

* proof that health care coverage is not available as ordered.
Send your proof to the other parent or to the Support Registry (if your payments go there).
If you do not provide proof of health care coverage:

* The other parent or the support agency may contact your employer or union, without notifying you, to ask for
direct enforcement of this order (RCW 26. 18.170), and

* The other parent may:
Ask the DCS for help,
Ask the court for a contempt order, or
© File a Petition in court.
Don’t cancel your employer or union health insurance for your children unless the court approves or your job ends,
and you no longer qualify for insurance as ordered in section 20.
If an insurer sends you payment for a medical provider's service:

= you must send it to the medical provider if the provider has not been paid; or
* you must send the payment to whoever paid the provider if someone else paid the provider; or
* you may keep the payment if you paid the provider.

If the children have public health care coverage, the state can make you pay for the cost of the monthly premium.
Always inform the Support Registry and any parent if your access to health care coverage changes or ends.

RCW 11.130.255; RCW Child Support Order Lawgate

26.09.135, .320; RCW 26.26B.030 BUGNI & ASSOC. FAMILY LAW
Mandatory Form (07/2021) p. 15 of 15 11300 Roosevelt Way NE, Suite 300
FL All Family 130 Seattle, WA 98125

206-365-5500  www.lawegate,net

 

