Form AOC-CV-615 "Consent Agreement and Order to Modify Child Support Order" - North Carolina

What Is Form AOC-CV-615?

This is a legal form that was released by the North Carolina District Court - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2009;
  • The latest edition provided by the North Carolina District Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form AOC-CV-615 by clicking the link below or browse more documents and templates provided by the North Carolina District Court.

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Download Form AOC-CV-615 "Consent Agreement and Order to Modify Child Support Order" - North Carolina

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IV-D Case No.
Court File No.
STATE OF NORTH CAROLINA
Film No.
County
In The General Court Of Justice
District Court Division
Name Of Plaintiff
CONSENT AGREEMENT AND ORDER
VERSUS
TO MODIFY CHILD SUPPORT ORDER
Name Of Defendant
G.S. 50-13.4
Name And Address Of Obligor
Name And Address Of Custodial Parent/Caretaker
Date Of Current Support Order
Current Amount Of Child Support
Bi-weekly
Monthly
Weekly
Wage Withholding
Non IV-D
In Effect
$
Other (specify)
IV-D
We, the undersigned, have agreed and consented to modify the current child support order in this case as follows:
Increase Or Decrease In Current Child Support. The amount of child support payable by the obligor will be
increased
decreased to $
per month beginning on the first day of
. The information shown on the attached child support worksheet is correct. The amount of child support
(month/year)
agreed to above
was
was not determined in accordance with the presumptive child support guidelines
based on the attached child support worksheets.
(Complete and attach a child support worksheet.)
Payment Of Child Support Arrearages. The parties acknowledge and agree that the obligor owes $
in past due child support as of
under the terms of the current support order. The
(date)
obligor will continue to make current child support payments of $
per month beginning on the first
day of
under the current support order, plus an additional payment of
(month/year)
$
per month beginning on the first day of
toward the accrued
(month/year)
arrearage and continuing until arrearage is paid in full. The parties further understand and agree that the obligor's
payment of arrearages under this Consent Order does not prevent the custodial parent/caretaker or the IV-D agency
from taking other action, including request for income withholding and/or set-off of the obligor's federal or state income
tax refunds, to collect the past due child support owed by the obligor.
Health Insurance Coverage. The obligor agrees to provide health insurance coverage for the minor child(ren) under
an employment related or group health insurance policy as shown below, and to provide written notice of any change
in such health insurance coverage to the
IV-D agency
custodial parent/caretaker. If the obligor fails to
obtain or maintain such health insurance coverage when it is available, the obligor will be liable for any medical
expenses incurred from the date of this Consent Order that would have been covered by insurance if it had been in
force.
Name And Address Of Insurance Carrier
Employer/Group Name
Policy No.
Medical Support. The obligor agrees to reimburse the Division of Medical Assistance or the custodial parent/
caretaker for medical and/or dental expenses of the minor child(ren) as follows:
Temporary Suspension Of Support. The obligor may temporarily suspend making child support payments under the
current support order
beginning
and continuing until
(date)
(date)
or
until further order of the court.
(State reason for suspending child support payments.)
AOC-CV-615, Rev. 3/09
(Over)
© 2009 Administrative Office of the Courts
IV-D Case No.
Court File No.
STATE OF NORTH CAROLINA
Film No.
County
In The General Court Of Justice
District Court Division
Name Of Plaintiff
CONSENT AGREEMENT AND ORDER
VERSUS
TO MODIFY CHILD SUPPORT ORDER
Name Of Defendant
G.S. 50-13.4
Name And Address Of Obligor
Name And Address Of Custodial Parent/Caretaker
Date Of Current Support Order
Current Amount Of Child Support
Bi-weekly
Monthly
Weekly
Wage Withholding
Non IV-D
In Effect
$
Other (specify)
IV-D
We, the undersigned, have agreed and consented to modify the current child support order in this case as follows:
Increase Or Decrease In Current Child Support. The amount of child support payable by the obligor will be
increased
decreased to $
per month beginning on the first day of
. The information shown on the attached child support worksheet is correct. The amount of child support
(month/year)
agreed to above
was
was not determined in accordance with the presumptive child support guidelines
based on the attached child support worksheets.
(Complete and attach a child support worksheet.)
Payment Of Child Support Arrearages. The parties acknowledge and agree that the obligor owes $
in past due child support as of
under the terms of the current support order. The
(date)
obligor will continue to make current child support payments of $
per month beginning on the first
day of
under the current support order, plus an additional payment of
(month/year)
$
per month beginning on the first day of
toward the accrued
(month/year)
arrearage and continuing until arrearage is paid in full. The parties further understand and agree that the obligor's
payment of arrearages under this Consent Order does not prevent the custodial parent/caretaker or the IV-D agency
from taking other action, including request for income withholding and/or set-off of the obligor's federal or state income
tax refunds, to collect the past due child support owed by the obligor.
Health Insurance Coverage. The obligor agrees to provide health insurance coverage for the minor child(ren) under
an employment related or group health insurance policy as shown below, and to provide written notice of any change
in such health insurance coverage to the
IV-D agency
custodial parent/caretaker. If the obligor fails to
obtain or maintain such health insurance coverage when it is available, the obligor will be liable for any medical
expenses incurred from the date of this Consent Order that would have been covered by insurance if it had been in
force.
Name And Address Of Insurance Carrier
Employer/Group Name
Policy No.
Medical Support. The obligor agrees to reimburse the Division of Medical Assistance or the custodial parent/
caretaker for medical and/or dental expenses of the minor child(ren) as follows:
Temporary Suspension Of Support. The obligor may temporarily suspend making child support payments under the
current support order
beginning
and continuing until
(date)
(date)
or
until further order of the court.
(State reason for suspending child support payments.)
AOC-CV-615, Rev. 3/09
(Over)
© 2009 Administrative Office of the Courts
Temporary Change Of Physical Custody and Child Support Payments. The obligor will have physical custody of
the following minor child(ren):
Name(s)
Beginning Date
Ending Date
The obligor's child support obligation under the current support order is
suspended
decreased to
$
per month beginning on the first day of
. Regular child
(month/year)
support payments under the current child support order are to resume on
(first day of
.
month)
Credit For Direct Payments. The obligor will be given credit for $
which was paid directly to the
custodial parent/caretaker or expended by the obligor on behalf of the minor children.
Date
Name Of IV-D Agent Or Attorney (Type Or Print)
Signature Of IV-D Agent Or Attorney
NOTE:
If parties appear in open court, notarization is not necessary.
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date
Date
Signature Of Obligor
Signature Of Custodial Parent/Caretaker
Name Of Obligor (Type Or Print)
Name Of Custodial Parent/Caretaker (Type Or Print)
Date
Signature
Date
Signature
Title Of Person Authorized To Administer Oaths
Title Of Person Authorized To Administer Oaths
Deputy CSC
Assistant CSC
Clerk Of Superior Court
Deputy CSC
Assistant CSC
Clerk Of Superior Court
Date My Commission Expires
Date My Commission Expires
Notary
Notary
County Where Notarized
County Where Notarized
SEAL
SEAL
ORDER
The above Agreement, the terms of which are incorporated by reference herein, is hereby approved by the Court, and shall have the
same force and effect as an order for child support entered by this Court, and shall be enforceable and subject to modification in the
same manner as is provided by law for orders of this Court entered in child support cases.
If income withholding is in effect, the Clerk shall issue an Order/Notice To Withhold Income For Child Support (OMB-0970- 0154),
reflecting the changes in this Order.
The Court finds that the amount of child support under this Agreement is:
the amount due under the presumptive child support guidelines based upon the incomes of the parents shown on the attached
child support worksheets which are incorporated herein by reference
OR
reasonably based upon the needs of the child(ren) and the ability of the parent(s) to support the child(ren) and that deviation from
the amount of child support calculated under the presumptive child support guidelines is appropriate because:
(State reasons for
deviation.)
Date
Name Of Judge (Type Or Print)
Signature Of Judge
AOC-CV-615, Side Two, Rev. 3/09
© 2009 Administrative Office of the Courts
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