Form WC-103 "Order for Distribution for Child Support" - New Jersey

What Is Form WC-103?

This is a legal form that was released by the New Jersey Department of Labor & Workforce Development - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 18, 2015;
  • The latest edition provided by the New Jersey Department of Labor & Workforce Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form WC-103 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Labor & Workforce Development.

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Download Form WC-103 "Order for Distribution for Child Support" - New Jersey

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State of New Jersey
Case No.:
ORDER FOR DISTRIBUTION
Department of Labor and Workforce Development
FOR CHILD SUPPORT
Division of Workers' Compensation
Vicinage
:
WC-103 (R. 9/18/15)
Petitioner:
Respondent:
Probation Case #:
Probation Division (County):
1.
The Division of Worker’ Compensation has matched data received from the New Jersey Administrative Office of the
Courts on child support judgment debtors against the information the Division maintains for individuals who have filed
workers’ compensation claims, and the match has identified the petitioner as a child support judgment debtor;
2.
Total support arears owed by the petitioner on all cases enforceable through the state Probation Division are
$_____________ as of __________________, as indicated in the records of _____________________ Probation
Division;
3.
The net proceed of the within award are more than $2,000.00, after payment of attorney fees, witness fees, costs, fees
payable to health care providers, reimbursement to the employer, employer’s insurance carrier, Second Injury Fund of
the State of New Jersey, State Division of Temporary Disability Insurance and an approved Private Plan covered
under the Temporary Disability Benefits Law or other reimbursement to an employer or employer’s workers’
compensation carrier as provided in R.S. 34:15-40.
IT IS ON THIS _______ DAY OF _______________, _______, HEREBY ORDERED THAT
1.
The petitioner shall pay $_______________ for Child Support arrearage(s), through the ______________________
Probation Division. The employer or employer’s insurance carrier shall deduct said payment from the petitioner’s net
proceeds.
2.
This order adjudicates the disbursement of net proceeds of the within award as it pertains to satisfaction of the above
referenced child support obligation. All other provisions previously entered in this or related matters shall remain in full
force and effect until further order of the court.
3.
A copy of this order shall be served upon the ___________________________ Probation Division by the respondent’s
attorney within 10 days from the execution of this order.
Attorney for Petitioner
JUDGE OF COMPENSATION
DATE
PETITIONER
THE ORIGINAL OF THIS DOCUMENT, SIGNED BY THE JUDGE OF
COMPENSATION WILL BE MAINTAINED ON FILE IN THE DIVISION OF
WORKERS' COMPENSATION, PURSUANT TO N.J.S.A. 34:15-121 et.seq.
General/Misc. Order
State of New Jersey
Case No.:
ORDER FOR DISTRIBUTION
Department of Labor and Workforce Development
FOR CHILD SUPPORT
Division of Workers' Compensation
Vicinage
:
WC-103 (R. 9/18/15)
Petitioner:
Respondent:
Probation Case #:
Probation Division (County):
1.
The Division of Worker’ Compensation has matched data received from the New Jersey Administrative Office of the
Courts on child support judgment debtors against the information the Division maintains for individuals who have filed
workers’ compensation claims, and the match has identified the petitioner as a child support judgment debtor;
2.
Total support arears owed by the petitioner on all cases enforceable through the state Probation Division are
$_____________ as of __________________, as indicated in the records of _____________________ Probation
Division;
3.
The net proceed of the within award are more than $2,000.00, after payment of attorney fees, witness fees, costs, fees
payable to health care providers, reimbursement to the employer, employer’s insurance carrier, Second Injury Fund of
the State of New Jersey, State Division of Temporary Disability Insurance and an approved Private Plan covered
under the Temporary Disability Benefits Law or other reimbursement to an employer or employer’s workers’
compensation carrier as provided in R.S. 34:15-40.
IT IS ON THIS _______ DAY OF _______________, _______, HEREBY ORDERED THAT
1.
The petitioner shall pay $_______________ for Child Support arrearage(s), through the ______________________
Probation Division. The employer or employer’s insurance carrier shall deduct said payment from the petitioner’s net
proceeds.
2.
This order adjudicates the disbursement of net proceeds of the within award as it pertains to satisfaction of the above
referenced child support obligation. All other provisions previously entered in this or related matters shall remain in full
force and effect until further order of the court.
3.
A copy of this order shall be served upon the ___________________________ Probation Division by the respondent’s
attorney within 10 days from the execution of this order.
Attorney for Petitioner
JUDGE OF COMPENSATION
DATE
PETITIONER
THE ORIGINAL OF THIS DOCUMENT, SIGNED BY THE JUDGE OF
COMPENSATION WILL BE MAINTAINED ON FILE IN THE DIVISION OF
WORKERS' COMPENSATION, PURSUANT TO N.J.S.A. 34:15-121 et.seq.
General/Misc. Order